12070208 CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS: 20670 GARDENSIDIi CIR CONTRACI'OR:BRADSIIAW ROOFING PFRMITNO: 12070208
O\w'NE.R'S NAME: YU-WEN KAO 1821 S BASCOM AVE 1'\IR 160 DATE ISSUED:07/272012
O\w'NER'S PHONE: 4082469930 CAMPBELL.CA 95008 PHONE NO:(408)2169930
❑ LICENSED CO\I"RACI'OR'S DECLARATION
�:�-Sf(��—f' BUILDING PERPIIT INFO: BLDG ELECT PLUMB "
License Class J l Lie.N :s,9
�� l_ — I 1 NIECf1 r RESIDENTIAL r' COMMERCIAL r.
Contractor�Z'f,L�1�j`I�.J Dalc
hereby affirm that I am licensed under the provisions of Chapter') JOB DESCRIPTION: RE-ROOF- 12 SQ-REMOVE EXISTING WOOD SHAKE
(coil]mencing with Section 7000)of Division 3 of the Rusiness R Professions ROOFING
Code and that nnlicense is in full force and effect. AND INSTALL NEW CLASS A ASPHALT SHINGLES
(CERTAINTEED-AGED DARK)
herehy nffinn under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the labor Code,for the
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of One work for which this
permit is issued Sq.Ft Fluor Area: Valuation:$6000
APPLICAN f CERTIFICATION
I certify that I have read this application and state that the above informtion is AI;N Number:36232029.00 Occupancy Type:
correct.I agree to comply with all city and county ordinances and state laws relating
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save
indemnify and keep harmless the City of Cupeninoagainslliabilities,judgments, PERMIT EXPIRES IF WORK IS NOT STARTED
costs,and expenseswhich may accme against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR
with allnon-point source regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION.
9.18.
t
Signatures/(/ /1 ate /��2 Issued by: : Date: / '97/�L—
❑ OWNER-BUILDER DECLARATION
1 herehy affirm that I:un exempt from the Contractor's License Law fur one of RF.-ROOFS:
the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
I,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for
will do the work,and the structure is not intended or o0cred for sale(Sec.7044, inspection.
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: Date:
construct the project(Sce.7044,Business&Professions Cade).
hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO RE CLASS"A"OR BE'FI ER
declarations:
I have and will maintain a Certificate of Consent to self insure for Worker's IL\%ARDOUS\LVITRIALS DISCLOSURE'
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued I have read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain Worker's Compensation Insurance,as provided for by California Ilealth S Safety'Code.Sections 25505,25533,and 25534. 1 will maintain
Section 3700 of the Labor Code,for the performance of the work for which this compliance with the Cupertino Municipal Cade,Chapter 9.12 and the Health S
Safety Code.Section_553_(a)should I store or handle hazardous material.
permit is issued Additionally,should I use equipment or devices which emit hazardous air
I cenify that in lire performance of the work for which this permit is issued,I shut] contaminants us defined by the Bay Arca Air Quality Nlanagemen(District 1 will
not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Compensation laws of California. If,after making this certificate of exemption,I Beallb&Safety Code,Sections 25505,25533,and 25534.
become subject to the Worker's Compensation provisions of the Labor Code,I must / `
forthwith comply with such provisions or this permit shall be deemed revoked. O ner m lhorq agaaC But7//
e
APPLICANT CER'T'IFICATION CONS'1-RUCTION LENDING AGENCY
I cenify that I have read this application and state that the above information is
correct.I agree to comply with all city and county ordinances aid state laws relating I hereby affirm that there is a construction lending agency for the performance of work's
to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.)
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence ofthe Lender's Address
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Sectio,
9.18. ,\RQI VISCI"S DECLARATION
I understand my plans shall be used as public records.
Signature Dale
Licensed Professional
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
C U P E RT I N O Fax: 408-777-3333
CONTRACTOR / SUBCONTRACTOR LIST
JOB ADDRESS: C2,0,670 1 PERMIT# e?, a7D dG�'
OWNER'S NAME: S Cir - PHONE# aL{ 0
GENERAL CONTRACTOR: BUSINL'SS LICENSE #
ADDRESS: f A3XpV CITY/ZIPCODE: n p -25
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO 13UILDING FINAL OR FINAL OCCUPANCY INSPECTIONS) WILL 13E SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
13USINESS LICENSE.
1 am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAVE BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring/ Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
p
Owner/ Contractor Signature Date
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 20670 Gardenside Cir DATE: 07/26/2012 REVIE'*VED BY: Sean
APN: BP#: 'VALUATION: IS6,000
*PER,MIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY PENTAMATI ON
USE: SFD or Duplex PERMIT TYPE: 1SFDWLROOF
woRK Remove existing wood shake roofing and install new class A asphalt shingles.
SCOPE
FEE ID ROOF AREA
s.f.
1REROOFFRES 1,200
Alech. Plan Check Plumb.Plan Check Elec.Plan Check
Mech.Penna Fee: Plumb. Permit Fee: Elec.Permit Fee:
Other A4cch.Lisp. Other Phtntb 1, Other Elec..Lisp.
:tech.Insp.Fee: Plumb.Insp.Fee: Elea Lisp.Fee:
NOTE: This estimate does not include fees due to other Departments(i.e.Planning, Public N'orks, Fire,Sanitaq•Sewer District,School
District,eta). These ees are based on the prelintinarl•information available and are only an estimate Contact the De t or addn't info.
FEE ITEMS (Fee Resolution 11-053 Elf 7/1/11) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Suppl. PC Fee
Plumb./Mech./Elec
Permit Fee: $180.00
Suppl. Insp Fee
Plumb.Afech./Elec
PlumbJMech./Elec Pernnii Fee:
Construction Tax:
Administrative Fee:
Work without Permit? O Yes (F) No S0.00
Advanced Planning Fees:
Travel Documentation Fees:
Strong Motion Fee: IBSEISMICR S0.60 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC S1.00
1 I
SUBTOTALS: 1 $181.60 $0.00 TOTAL FEE: F$181.60
Revised: 07/01/2012
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O.. BUILDING OFFICIAL
10300 TORRE AVENUE •CUPERTINO,CA 95014-3255
CUPERTINO (408)777-3228• FAX(408)777-3333•buildingecupertino.orD
PROJECT ADDRESS O APN N
!o?o r. - -t
OWNER NAME w 1,C PHONE E-MAIL
u — \ 111
STRE ADD `
CITY STATE 21PQ A FA%
C CIO NA, E T LICENSE NUcMBE LICENSE TYP BUS.LIC.
(. ' i
COMPANY NAME E-MAI FAX -7-2 - _
STREETADORFSS ` , ; CG CITY,STATE LP2141
1 ONE
993 0
I UNDERSTAND AND AGREE TO THE FOLLOWING:
I. The re-roof project shall comply with all applicable provisions of the 2010 California Codes.
2. An inspection request can be scheduled up to the day before the inspection date. Please call (408)777-
3228 from 7:30 - 3:30pm (Mon-Thurs) or 7:30 - 2:30pm (Friday) to schedule the next day inspection.
For Tear-Off and Nailing Inspections, you must also call on the day of the inspection only after that
phase of the work is completed. The building inspector will be available within one hour. Progress
and Final Inspections will be given a two hour window.
3. Tear-Off Inspection is required. Any and all dry-rotted wood shall be replaced prior to this inspection.
Unless new plywood roof sheathing is proposed throughout, all the nails/fasteners shall be either
completely knocked-down or removed.prior to this inspection.
4. If plywood is installed, a plywood Nailing Inspection is required.
5. Roofing shall not be applied without first obtaining all prior inspection and written approvals from the
building inspector. Any roofing which is applied without first obtaining an approved inspection will
require the removal of all new material down to the sheathing so a proper inspection can be performed.
6. Progress Inspection is required when approximately 50%of roof covering is installed.
7. A Final Inspection and approval shall be obtained from the building inspector when the re-roofing is
completed. To receive a final sign-off, the following items will be verified:
a. Flat roofs shall have a minimum of I/<" per foot of slope and demonstrate there is no ponding.
b. Listings from approved testing agencies for all pre-manufactured products used shall be
available on-site to review at the time of the inspection.
c. Proper spark arrestor installation, vents painted, gutter/downspouts installed, debris removed.
8. NOTE: .If you call for a tear-off or plywood nailing inspection and the work is not complete, you will be
charged a re-inspection fee of$126.00. The re-inspection fee shall be paid before another inspection
can be scheduled.
By my signing below, I certify each of the following is true: I am the property owner or authorized agent to act on the
property owner's behalf. 1 understand and agree to comply with the re-roof policy stated above. I also understand that
smoke detectors and carbon monoxide detectors are required to be installed in accordance with Sections R314 and 8315 of
the 2010 California Residential Code
Signature of Applicant/Agent: Date. -7
ReroofPo1icv_201/.dot revised 02/16111
_Yrovide Copy or manufacturer instaltatlon Speciricactons. ❑ STANDARD ❑ FIRE DEPT
—Provide signed copy of Cupertino's Tey--Off Policy. ❑ OTTER: