12070234 CITY OF CUPERTINO BUILDING PERMIT
BUILDING AIIDRIiSS: 21099 RED FIR Cf CO\fRACI'OR:FOUR SEASONS ROOFING PERMIT NO: 12070234
ONVNER'S NAME: UMAI'ATIiY RAN DASWANIY AND VA I DYANATIIA PO BOX 1668 DATE ISSUED:08/0 1 20 1 2
ON1NER'SPIIONE: 4085580102 SAN3OSE.CA 95109 PI ZONE NO:(408)27M330
1a- LICENSED CON'FRACfOR'S UP.CLCA,.RATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
License Class C_3K Lie.q Lj-7�100 r r r
i\11ECH RESIDENTIAL CO\1hIERCLU.
Contractor �I 1JC' Date
hereby affirm that I am licensed under the provisions of Chapler 9 JOB DESCRIPTION:TEAR OFF WOOD SHARE&INSTALL I2'CDS
(commencing with Section 7000)of Division 3 of the Business.f Professions PLYWOOD,30N
Code and that my license is in full force and eDec(. PELT UNDERLAYNIENT.INSTALL CLASS A CERTAIN'TBED
PRESIDENTIAL COMP SI'IINGLES(COUNTRY GRAY)13SQFT
1 hereby affirm 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 die work for which this
pemnit is issued. Sq.FI Floor Area: Valualion:$4500
AI'I'LIC,W"I'CElffI FIG\'PION
I certify that I have read this application and state that the above infnmunion is APN Number:35905036.00 Occupancy Type:
correct.I agree to comply with all city and county ordinances mid state laws relating
to building construction,mid 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 Cit•of Cupertino against liabilities,judgments, PERMIT EXPIRES IF WORK IS NOT STARTED
costs,and expenses which may accrue against said City in consequence of due
grantingof(hispcnnil. Additionally,the applicant understands mid ivillcomply WITHIN 180 DAYS OF PERMIT ISSUANCE OR
with all non-point source reguluticns per the Cupertino Municipal Code.Section 180 DAYS FROM LAST CALLED INSPECTION.
9.18. /� t
Signature <:�4 C Date "� �� Issued te:�� /� Z
e_1 42
❑ OWNER-R(IILDER DECLARATION
herebyaffirm(hit( I am exempt from file Contractor's License Low for one of RE-ROOFS:
the following Iwo reasons: All roofs shall be inspected prior to any roofing material beig installed.If a roof is
1,as owner of the property,or my employees with Wages as their sole comp:nsation, installed Without first obtaining an inspection,I agree to remove all new materials for
will do the Work,laid the structure is not intended or offered for sale(Sec.7044, inspection.
13usiness C Prolessions Code)
I,as owner of the property,am exclusively contracting With licensed comme(ors to Signature of Applicant: Dale:
construct the project(Sec-7044,Business S Prolessions Code).
hereby affirm miler penalty of perjury one of the follmcing three ALL ROOF CO\'li i GS TO BE CLASS"A"OR BMTER
declarations:
I have and will maintain a Cenilicate of Consent to self-insure for Worker's IIAZARDOUS NIATERIALS 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 Cu lifornia Ilea lth S Safely Code,Sections 25505,25533,and 25534. I v ill maintain
Section 3700 of the Labor Code,for the perfomtance of the work for Which this compliance W Ill the Cu perlinu Municipal Code,Chapter 9.12 mad the I lealth K
Safe t'Code.Section 25532(a)should I store or handle haznrdou.s material.
permit is issued. Additionally,should I use equipment or devices which emit hazardous air
I certify that in the perfounmme of die work for which this permit is issued,I shall contain inn tits as defined by the Bay Aren Air Qualily Nlanagement District I will
not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Nlunicipal Code.Chapter 9.12 and the
Compensation laws ofCalifamia. If,after making this cenilicale of exemption,I Ileallh S Safety Code.Sections 25505.25533,and 25534.
become subject to the Worker's Compensation provisions of the Labor Code,I nuns(
forthwith comply with such provisions or this permit shall be deemed revoked.
Owner ori tho'' tgenC
Ie:
A PPLICAN-f CF.RTI FI CATI ON NSTRUC1'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 ordinutees and state Imus relaling I hereby afflmt that(here is a construction lending agency for the perfommnce 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 Iiabilities,judgmenis,
costs,and expenses which may accrue against said City in consequence of the Lender's Address
granting of this permit.Additionally,the applicanl understands and will comply
With all non-point source regulations per the Cupertino Municipal Code,Section ARCI I ITEC`I"S DECLARATION
9.18.
I understand my plans shall be used as public records.
Signature Dale r i ;a
Licensed Professional
/� 1 CITY OF CUPERTINO
�v'FEE ESTIMATOR - BUILDING DIVISION
ADDRESS• ,Q U 7ejr L DATE: 07I30I2012 I2EVIE\VED BY: bobs.
\ APN: lit'#: 'VALUATION: 54,500
'PERnIIT TYPE: Building Permit PLAN CHECK T)TE: Alteration / Repair
PRINIARY SFD or Du lex ill "I MATION
USE: p PERNIITII'PF: 1SFDWLR00 F
WORK sfd tear off wood shake install new comp shingles.
SCOM
..11 ;All-
NOTE: This estimate does not inchole fees due to other Departments(i.e. Planning, Public II'ork.v, Aire,Sanimrr Sewer District,School
District, etc.). These fees are hu.serl on the treliminan•information available and are onh'un Lwinune. Contact the Dem far adela'I infi).
FEF ITEMS (/'ce Res,dwi(m 11-0:3IW illi//) FEF QTY/FEF, I NIISC ITFN'IS
Plan Check Fee: S0.00 = s.f. Re-roof
SUppl. PC Fee: Q Reg. O O'I' 0.0 hrs $0.00 $195.00 /NERoorHES
PME Plan Check: 50.00
Permit Fee: 50.00
Suppl. Insp. Fec Q Reg. Q O'I' 0.0 1 [us 50.00
PME Unit Fee: $0.00
PM ' Permit Fee: 50.00
t rlt,l ,, It'd; 1,1.1.
Work Without PCI-mit? O Yes Q No $0.00 (D
Advanced Plannine Fee: $0.00 Select a Non-Residential G)
; ! r 1, r. .. r,;✓al•m i . . BUilding or Structure
01
Strove 1%40tion Fee: Ia.SE1SMICk $0.50 Select an Administrative Item
l3ldc Stds Commission Fec: IBCBSC $1.00
SUBTOTALS: $1.50 5195.00 TOTAL FEE: $196.50
Revised: 07/01/2012
REROOF TEAR-OFF POLICY
0 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•buildine(5cuoertino.oM
PROJECT ADDRESS IO APN n
C
OM'NER NAME PHONE E-MAIL
L sa,a -.STB- o/o
STREET ADDRESS CITY.STATE.ZI FAX
CCA Un 'tir
CONTRACTOR NAME LICFNSENUMBER LICENTYPE BUS.LIC.a
L1,7ZOR
COMPANYNAME E-MAIL FAX
S¢w.fu it
STREET ADDRESS CITY.STAT P 4SI1�2 PHONE - OO
xv 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 S 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:7-3 0 -J 2
Re)-ooJPoliev_20/Lr1oc revised 02/16/1/
� av� i� 23 `7
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO,CA-95014-3255
(408)777-3228• FAX(408)777-3333•buildin(i(dcupertino.ore
CUPERTINO
PROJECT ADDRESS '2/e C74,
I APN'• 1 J I 0,5 /
OWNER NAME PHONE E-MAIL
STREETADDRESS 1
CI' ' 21P FAN
2-1699 ge
lr (i N /1 O CA
CONTACT NAME. PHONE E.IAII
A � yo8=2,Z.8-o 30
sTREEI'ADDRESSI CITY.STA I'F..ZIP
zpn-- J� I FA..
k
Cl OUNF.R ❑ OWNER-RUILDER ❑ OµNERAGENT CONTRACTOR ❑CONTRACTORAGEST ❑ ARCHITECT ❑ENGINEER ❑ OF.\'ELOPER ❑ TEN.N?
CONTRACTOR NAME v I LICF.NSENUMBER I LICESSE TYPE BUS.LIC-
4-77.108
COMPANY SAME SAkE E-MAIL I FAX
STREET ADDRESS CITY.STATE.21P PHONE
$02 A ea5¢ C
ARCHI rECTENGINEER NAME LICENSENUSIBER I BUS,LIC.<
COMPANY NAME I E-MAU I FAX
STREET ADDRESS I CITY.STATE.ZIP PHONE
USE OF ❑ SFD or DupleN JC Multi-Family ROOF AREA: VALUATION 00
STRUCTURE: O Commercial r 3 .SQ & O
EXISTING ROOF TYPE: ❑BUILTUP ROOF ❑:SPIIALTSHI\GLES ��$vOODSHAKES ❑`A'OODSHISGLES ❑OIHERISPECIFY')
RGMO\'FAEPLACE YES IF NO. PLYWOOD {r!i ❑ PU'\\'D ❑OSB PITCH, ROOF
❑ N .LAYER ' THICKNESS ❑ -:. Tl'P - - CDX '12 CLASS A
PROPOSED ROOF TYPE: ❑BUILT-GP ROOF X>SPHAL7 SHINGLES ❑\\'OOU SIIARES ❑\cppD SHI\GLEN ❑OTHER IMES REPORT
DFSCRIPTIONOF\\"ORR7 +\ wc 1/Z It It
IuWOOct +6 e A 30# �e.�+ LndeAwjliei&-_F:l_&o I
O-eco.' a'aad Presider+,"l_ Cone din b
By my signature below.I certify to each of the following: I amthe property owner or authorized agent to act on the propem owner's behalf. I have read This
application and the information 1 have provided is correct. 1 have read the Description of work and yeritj'it is accurate, I agree to comply with all applicable local
ordinances and stale laws relating to building cons lion. 1 alWortze represe Uv,of Cupertino to enter the above-identiliedproperty for inspection.purposes.
Signature of ApplieandAgenl: _�,�� Date: -7 1301 6i0
SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY
_ If building is associated with a Home Owner's Association.provide letter PLAN CHECK TYPE ROUTING SLIP
of approval from HOA. �O\'ER-THE-COUNTER ILDIN'G PLAN REVIEW
Provide Planning approval to verify'if there any restrictions. ❑ EXPRESS ❑ PW\'\'ISG PWA RE\'IEw
Z'de copy ol'Manufacturer's Installation Specifications. El STANDARD 11FIRE DEPT'
Provide signed copy of Cupenino's Tear-Off Policy. ❑ OTHER:
RerwfApp_2011.doc revised 03/16/11