12070230 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21107 RED 17IR CT CONI'RACI'OR:FOUR SEASONS ROOFING PERM IT NO: 12070230
O\);NEhi-S NAME: 110 GILBERT D AND JEAN C ET Al. PO BOX 1668 DATE ISSIIF.D:08/0 120 1 2
OW'NIsR'S PHONE: 4089676434 3ANJOSE.CA 95109 PI ZONE NO:(408)278-0331)
4r LICENSED CON'IRACI''OR'S DECLARATION BUILDING PERMIT INFO: BLDG 1- ELECT r PLUMB r7
LicenseClass C-3q Lie "L k q-?'Z 101 r r r
,// � l AIECII RESIDENTIAL C0ILMIERCLU.
Contractor Ps I L, /f)L Date 5 — I " I Z i
r_ JOB DESCRIPTION:TEAR OFF EXISTING WOOD SHAKE ROOF. 13 SQS-
hereby affirm that I am licensed mater the provisions of Chapter') INSTALL
(commencing with Section 7000)of Division 3 of the Business S Professions INS CDX PLYWOOD.30'A FELT UNDERLAYMENT.INSTALL
Gude and that my license is in full force and effect. C17RTAINTECD PRESIDENTIAL COMP SHINGLES,COLOR
I hereby affirm under penalty of perjury one of the following Iwo declarations:
I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided far 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 die work for which this
permit is issued Sq.Ft Floor Area: Valuation:54500
AI'I'LIGWI'CFR'I'1 FIG\'1'ION
I certify that I have read this application and stale that the above infomtation is APN Number:35905040.00 Occupancy Type:
correct.1 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 10 save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, PERMIT EXPIRES IF WORK IS NOT STARTED
costs,and expenses which may accrue 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 all non-point source regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION.
9.18. 77 C
Signature Date �L Issued Date: O � J I
❑ OWNER-BUILDER DECLARATION
hereby affirm that 1 am exempt from the Contractor's License Law for line of RF:ROOFS:
the following two reasons: All roofs shall be inspected prior to any roofing material being installed.Ifa roof is
I,as owner of the property.or my employees with wages as their sole comp_nsmion, 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 offered for sale(Sec.7044, inspection.
Business&Professions Code)
I,.as owner of the property,am exclusively contracting with licensed contractors to Signature of Applic nc Dale: e-1 -le-
construct
l -construct the project(Sec.7044,13usiness.Professions Code).
hereby affirm under penally of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETI'ER
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's IIAZARDOIIS,MATERIA S 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.IIealth S Safely Code.Sections 25505.25533,and 25534. 1 will maintain
Section 3700 ofthe Labor Code,for the erformance of the work for Which this compliance with(lie Cupertino Municipal Code,Chapter 9.1_yand the Ileallh S
p Safety Code.Section'_5532(a)should I store or handle hazardous material.
permit is issued Additionally,should I use equipment or devices which emit hazardous air
I certify that in the performance of due work for which this permit is issued,I shall contaminants as defined hr the Day Area Air Quality Management District I will
not employ any person m mry manner so as to become subject to the Worker's maintain compliance with the Cupertino Mlunicipal Code,Chapter 9.12 and the
Compensation laws of Cali forma. If,after making this cenificate of exemption,1 11ealth S Safely Code.Sections 25505,25533,and 25534.
become subject to the Worker's Compensation provisions of the Labor Code,I must
O"mer or a
forthith comply with such provisions or this permit shall be deemed revoked. '
whdrj�• rot: �,,/ _/2
Date.
,U'I'LICAN"f CIiR'1'I FIC,\'IIO,N CO,NS'1RUC1'ION LENDING AGENCY
I certify that I have read this application and state that the above information is
correct.I agree to comply with all city and county ordinances mud state laws relating I hereby aBir a that there is a construction lending agency for the performance of work's
to building construction,and hereby authorize representatives of this ciy to enter for which this permit is issued(Sec.3097,Civ CJ
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name
indemnify and keep harmless rhe City of Cupertino against I iabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the 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,Section ARCHI'1'F.CI"S DECLARATION
9.18.
I understand my plans shall be used as public records.
Signature Date
Licensed Professional
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
ADDIi ESS;.a liel) 61— (UC. DATE: 07/30/2012 RF%'IE\1'ED 13\': bobs.
2--m APN: 13139: 'VALUATION: $4,500
`'PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex PENTAN1ATlON 1SFDWLROOF
USE:
\VO it sfd tear off wood shake install new comp shingles.
SCOPE
NOTE: This estimate does not includejees due m other Departments(i.e. Plannin.-, Public Works, Fire.Saniarn'Sewer District,Sch(.ml
District,etc.). These fees are based mn the lreliminaninformation arnilable and are onIr an estimrne. Contact the Dem firr r ddn'l infix.
FEE ITEMS /Fee Hesolnrion 1I-053 Efl: 711/1 h FEE QT)'/FEN: NIISC ITE'NMS
Plan Check Fee: S0:00 1,300 s.f. Re-roof
Suppl. PC Fee: (D Reg. 0 Ol" 0.0 hrs SO.00 S195.00 IREROOPRES
PN/1E Plan Check: $0.00
Permit Fec: $0.00
Suppl. Insp. Fcc Q Reg, Q OTp.p [its SO.00
PME Unit Fee: 50.00
PME Permit Fee: 50.00
i rnr•:rs:n:r:r,
VC r Q
Work Without Permit? O Yes Q No $0.00 G
Advanced 1'lannine FCC: SO.00 Select it Non-Residential 0
a.;r•.;,r rduth'rr i-., , Building or Structure 0
Strong N'lotion Fce: IUSFISMICR 50.50 Select an Administrative Item
131de Sids Commission 17ce IBCBSC $1.00
SUBTOTALS: $1.50 $195.00 TOTAL-FEE:' $196.50
Revised: 07/01/2012
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
CUPERTINO 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255
(408)777-3228• FAX(408)777-3333• building(DDcupertino.org
PROJECT ADDRESS O G Cf'. APNk S S �D CJ
OWNER NAME PiloE E-MAIL .1S/E O a8'- - 6
STREET ADDRESS 2 GY- LICFI-
CITY,STATE FAX -
CONTRACTOR NAME SEh MBER LICE7jSE^ BUS.LIC.p' 3�
0 (�
COMPANY NAME E-MAIL FAX
0 �Qas
STREET ADDRESS Fer-2- (� CITY.STAT Exi „,, -T.M P E
(D maCA/� �^(rt 1?- ON4R—Z. 8—O O
I UNDERSTAND AND AGREE TO THE FOLLOWING:
1. 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/” 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 R315 of
the 2010 California Residential Code.
Signature of Applicant/Agent: Date:_7—?0—/Z
RerooJPo1icv_201 Ldoc revised 02/16/11
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA'95014-3255
(408)777-3228• FAX(408)777-3333•building6cuperiino.org
CUPERTINO
PROIECTAUDRESS 2//O el rlr /•/ I APS 31 O l\
OU'NER NAME PHONE �[+_-� v/� E MAIL (�
STREET-.{DURESS UI Q CITY.STCUP,
LIP v ]S5 GS \
2 O r C��.E�U
CONTACT NAME PHONE E-NIAIL
z og-Z28-o 30
STREET ADDRESS CITY.STATE.ZIP FAS
S02 S _ anTOSe CA- 4$1
❑ OWNER ❑ OWNER-RUILDER ❑ OWNER AGENT IVICOITRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENOISF.ER ❑ DFA ELOPER ❑ TENANT
CONTRACTOR NAME I LICENSE. UNISER I LICENSE T'PE I BUS.LIC.
a 2 0
COMPANY NAME 7C E-MAIL I FAX
STREET ADDRESS CITY.STATE.ZIP I PHONE �_O
$02 w o5¢ C
ARCHIrECLEN0INEERNANIE LICEMENUNISER I BUS.LIC.•
COMPANY NAME I E-MAIL FAX
STREET ADDRESS ,/ CIT\'.STATE.ZIP PHONE
USE OF ❑ SFD or Duplex F Multi-Family ROOF AREA: VALUATION- A0
STRUCTURE ❑ Commercial 3 S S_00j
ESISTINGROOr T'PE: ❑BUILT-CP ROOF ❑ASPHALTSHISGLES ;e' 13
❑WOODSHINGLES ❑OIHERISPECIFY)
REb10CF.:REPLACEYES IFNO. PLl'R'OOD {n tf ❑ PLY' D 11 OSB PITCH' ROOF
❑ N I v AVFRS' THICKXE ❑ ":S" TIP DS ')2 A A
PROPOSED ROOF TYPE: ❑BL'ILT-L'PROOY ASPHALT SHINGLES ❑\5'OCH)511 ARES ❑\cOOD SHINGLES ❑OTHER ICC-ES REPORT
DESCRIPTION OF\CORA:
t 5 t/?-" CDk
�yy_i,�9 Qd +�e n 3 0# '�1 Ern d e.cl.wI�ts
Ole w' seA PreslAen+,"t come CauAcy Gre6y
By my signature below'-I certify to each of the`olloWing: I am the property owner or authorized agent to act on the propemowner's behalf. I have read this
application and the information 1 have provided is correct. I have read the Description of Work and verity it is accurate. I agree to comp),with all applicable local
ordinances and state laws relating to building cons'' tion. I a orize represe - civ s of Cupertino to enter the above-identified property for inspection purposes.
Signature of ApplicanUAgenE Date: a30ao
SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY
_ Ifhuilding isassociated with a Home Nner's.Association.provide letter PLAN CHECK TPE ROUTING SLIP
ofapproval front HOA. L 'ER-THE-COUNTER 6T--MITIMDING PLAN REVIEW
Provide Planning approval to verify if there any.restrictions. ❑ EXPRESS ❑ PLANNING PLAN REVIEW
_ Prod 'copy of A1anufacturer's Installation Specifications. 13 STANDARD ❑ FIRE DEPT
Provide signed copy of Cupertino's Tear-Off Polies. ❑ OTHER:
ReroofApp_1011.doc revised 03/l6/ll