12070210 CITY OF CUPERTINO BUILDING PERMIT
BIIILDINGADDRESS: 20674 GARDENSIDE CIR CONI'RACI'OR:BRADSHAW ROOFING PERMITNO: 12070210
OWNER'S NAME: KELLY ROBERTSON 1821 S BASCOM AVE PMR 160 DATE ISSUED:07272012
OWNER'S PHONE: 4082469930 CAMPBELL.CA 95008 PHONE NO:(408)24&9930
❑ LICENSED CON'IRACI'OR'S DECLARATION BUILDING PER\IIT INFO: BLDG r ELECT r PLUDIB r
License Class�/-C-3c , Liie.# -7Q37C, RIECHr RESIDENTIAL COi51MERCIALr
Contractor &-Q,Q,. <; IQ✓ rCCJ Dwca&7 l f
hereby affirm(hat I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:RE-ROOF- 12 SQ.REMOVE:EXISTING WOOD SIIAKE
(commencing,,ith Section 7000)of Division 3 of lite Business S Professions ROOFING
Code cold chat my license is in full force and effeel. AND INSTALL NEW CLASS A ASPHALT SHINGLES
(CERTAINTEED-AGED HARK)
I hereby affirm under penally 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 Ibr by Section 3700 ollhe 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 the Work for which this
permit is issued. Sq. FI Flour Area: Valuation:$6000
APPLICANT CERTIFICATION
I certify that I have read this application laid state that the above information is AI'N Number:36232028.00 Occupancy Type:
correct.1 agree to comply with all city and county ordinances laid 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
indemnity and keep hammlessthe City ofCupertino against liabilities,judgments, PERMIT EXPIRES IF WORK IS NOT STARTED
costs,and expenses which may accrue against said City in consequence of the
granting ofthispermii. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Willi all non-point sourI fl ertheCiperime Municipal Code.Section 180 DAYS FROM LAST CALLED INSPECTION.
9.18.
Signator rte--7 i 2 Issued by:�7 /✓ //22f Date: 7'47 la—
❑ OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of RE-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 otlered for sale(Sec.7044, inspection.
Business&Professions Code)
I,as owner of the property,am exclusively contracting With licensed contractors to Signature of Applicant: Dale:
construct the project(Sec.7044,13usiness K Professions Code).
1 hereby affirm under penally of perjury one of the following three ALL ROOF COVERINGS 9'O BE CLASS"A"OR BETTER
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE
Compensation,as provided for by Section 3700 of the labor Code,for the
performance of cite 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 Health A`Safely Code,Sections 25505,25533,and 25534. I will maintain
Section 3700 of the Labor Code,far the performance of the Work for which this compliance With the Cupertino Municipal Cade.Chapter 9.12 and the Ilcalth S
Safely Code.Section_553_(x)should I store or handle hvardous material.
permit is issued. Additionally.should I use equipment or devices which emit hazardous air
I certify that in the performance of the work for which this permit is issued,I shall contaminams s defined by the Bay Area Air QualityDtanagemenc District I will
not employ any person in any manner so as to become subject to the Worker's maintain compliance wish the Cupertino Municipal Code,Chapter 9.12 and the
Compensation Imus of Cali fomia. If,after making this certificate of exemption.I Ilealth S Safely 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 UI mer ar_ 1 ri
Ui,["/L )ate: /li
/
APPLICANT CIi12'I'I FICATION CONSTRUC11O,N LENDING AGENCY
I certify that I hive read this application and state that the above information is
correct. I agree to comply With all city and county ordinances mid 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 of the Lender's Address
granting of thispermit.Additionally,the applicant understands and will comply
with all non-point source regulatims per the Cupertino Municipal Code,Sectiam ARCA I"fFCI"S DECLARATION9.18.
I understand my plans shall be used as public records.
Signature Date
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: 403-777-3333
CONTRACTOR / SUBCONTRACTOR LIST
JOB ADDRESS: 62plp 7 PFRMIT# �a0 O ID
OWNER'S ts C,<- S� 4.n.A- PRONE # a 0
GENERAL CONTRACTOR: ( BUSINESS LICENSE #
ADDRESS: f V CITY/ZIPCODE: n -25
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE. OB'T'AINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR 13USINESS NAME 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
I &1�1- / /r`4:�
Owner/Contractor Signature Date
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 20674 Gardenside Cir DATE: 07/26/2012 REVIEWED BY: Sean
MAPN: BP#: 'VALUATION: $6,000
*PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Duplex PENTAAIATION 1SFDWLROOF
USE: PERD1IT TYPE:
WORK Remove existing wood shake roofing and install new class A asphalt shingles.
SCOPE
FEE ID ROOF AREA
s.f.
1REROOFFRES 1,200
Mech. Plan Check Plumb.Plan Check Elec.Plan Check
Mech.Permit Fee. Plumb. Permit Fee: Elec. Permit Fee:
Other Alech.Insp. Other Plumb Insp. Other Elec.Insp. Ll
Alech.Insp.Fee: Plumb.Insp.Fee: Elec. hrsp.Fee:
!VOTE: This estimate does not include fees due to other Departments(i.e. Planning, Public Works, Fire,Sanitary Sewer District,School
District, etc.). Thesefees are based on the preliminan information available and are onb,an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eft 7/1/11) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Suppl. PC Fee
Phonb. Afech./Elec
Permit Fee: $180.00
SuppL Insp Fee
Plumb./Afech./Elec
Plnmb./Alech./Elec Permit Fee:
Construction Tax:
Administrative Fee:
Work Without Permit? O Yes Q No $0.00
-4dvanced Planning Fees:
Travel Documenlatian Fees:
Strong Motion Fee: IBSEISMICR $0.60 Select an Administrative Item
Blde Stds Commission fee: IBCBSc $1.00
SUBTOTALS: 1 $181.601 $0.001 TOTALFEE: $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•building(gDcuoertino.org
PROTECT ADDRESS APN M
OWNER NAME PHONE ? E-MAIL
STREET ADDRESS CITY,STATE,2 P FAX
n ' C.c i
C CTOR,N&NIE LICENSENU?IBE LICENSE TYP BUS.LIC_P
1 t fic flic 7 11 IR 6 t C-
COMPANYNAME E-MAI lY FAx `_2
STREa ADDRESS ; ��CG CITY.STATE LP 1 J NONE/
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 - 3:30prn (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 V4" 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 S 126.00. The re-inspection fee shall be paid before another inspection
can be scheduled.
By my signing below, 1 certify each of the following is true: 1 am the property owner or authorized agent to act on the
property owner's behalf. I 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 R315 of
the 2010 California Residential Code
Signature of Applicant/Agent: Date:
ReroofPo1icv_201 Ldoc reviser!02116111
Reroofdpp_?011.doc revised 03/1671