12080101 CITY OF CUPERTINO BUILDING PERMIT
BUILDINC ADDRESS: 21086 RED FIR Cf CONTRACTOR:FOUR SEASONS ROOFING PERMITNO: 12080101
O\\;NIiR'S NANIE: MOINZADEH NASSER AND MARYAM PO BOX 1668 DATE ISSIJEW OV132012
OWNER'S I'IIONIi: 4082552343 SANJOSE,CA 95109 NIONF.NO:(408)278-0330
J' LICENSED CON"FRAC'FOR'S DECLARATION
ry BUILDING PERMIT INFO: 13LDC r ELECT r PLUMB
License Class C3q— / Lic.4 4 1 2- to
R,
��99 EC11 r RESIDENTIAL r— COMMERCIAL
ContractorFSF-f 1 rJ C • Date
I hereby affirm that 1:un licensed under the provisions of Chapter 9 JOB DESCRIPTION:TEAR OFT EXISTING WOOD SHAKE ROOF.INSTAI.1.13
(Commencing with Section?()Ill))of Uivisinn 3 of the Business S Professions I2
Code and that Illy license is in full force and effect. INS PLL CE T INTETHEN 30#FELT PRESIDENTIAL
CO
MENT.FINALI-Y,
' INSTALL CERTAINTEED PRESIDENTIAL COh1P
I herebp:dfirm under penalty of perjury one of the following nen 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 perinil 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. Ft Floor Area: Valuation:54500
API'LICANI'CFItT'IPIC.\'I'II IN
I cenify that I have read this application and state that the above infomtation is APN Number:35905051.00 Occupancy Type:
correct.I agree to comply with all city and county ordinances and state laws relating
to building construction,and hereby authorize representatives ofthis city to enter
upon the above mentioned property for inspection purposes. (We)agreeto save
indennif'y 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 Elie
granting ofthis permit. Additionally,the applicam unders(mWs 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.
.Signature Date -1 3"I't- Issued by: -���9N /—/�1Tli� Date: e!5�-13 %a
❑ O\ /' IIILDI9t DECLARATION
hereb%y affirm that 1 am exempt from the Contractor's License Law fur one of RE-ROOFS:
the following two reasons: All roofs shall be inspected prior to any roofing material beiig installed.If a roof is
I,as owner of the propeny,or my employees with wages as(heir sole compensation, installed without firs,obtaining on inspection,I agree to remove all new materials for
will do the work,and the structure is not intended or of Icred for sale(Sce.7044, inspection.
Business&Professions Code)
1,as owner of the property,am exclusively contracting With licensed contractors to Signature of Applinnu Date:
construct the project(Sec.7044,Business S Professions Code).
1 hereby affirm under penalty of perjury one of the following three AL1-ROOF COVERINGS TO BE CLASS"A"OR BETTER
declarations:
I have and Will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS 1)ISCLOSI lRE,
Compensation,as provided for by Section 3700 of(he 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 I Icalth S Safety Code,Sections 25505,25533,and 25534. 1 will maintain
erfortnance of the work for which this compliance with the Cupertino Municipal Code.Chapter 9.1'_and the Ilealth S
Section 3700 of the Labor Code,for the
p Safety Code.Section 25532(x)should 1 store or handle hazanrdous material.
permit is issued. Additionally should 1 use equipment or devices which emit hazardous air
I certify that in the performance of the work for which this permit is issued,1 shall conmminanis as defined by the Buy Area Air Qualiq.Management District 1 will
not employ any person in any manner so as 10 become subject to the Worker's maintain compliance With the Cupertino Municipal Code,Chapter 9.12 and the
Compensation Imus of California. If,after making this certificate of exemption,I Health S Safely Code,Sections 25505,25533,and 25534.
become subject to the Worker's Compensation provisions of the labor Code.I must
fonhWi(h comply with such provisions or this pemnit shall be deemed revoked Owner ) ed uL�nt: n
Date:
APPLICANT CIERTIFICTIONCONS'1'RI1CI'ION I.F:- 'C.\CIiNCI'
I certify that I have read this application mid state that the above information is
correct. I agree to comply with all city and county ordinances and state laws relating I hereby affirm that there is a construction lending agency I'or the performance of ssork's
to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Cir 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(he Lender's Address
granting ofthis permit.Additionally,,he applicant understands and Will comply
With all non-point source regulations per the Cupertino Municipal Code,Section
9.18. ,\12CI I I•I•p1-1••S DECLARATION
I understand my plans shall beused as public records.
Signature Dae
Licensed Professional
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 21086 Red Fir Ct. DATE: 0 810 812 01 2 REVIEWED BY: Sean
\ APN: BP#: 'VALUATION: $4,500
*PER\IITTI'PE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PUS:: I' >3 St Stories
is PENTANIATION
USE: Multi-Family Dwelling Bu Stories (� Yes Q No PERMITTITE: 1R2RO0F dl
WORK
SCOPE
FEE ID ROOFAREA
(s.f.)
1REROOFMRES 1,300
Meth. Plan Check Plumb. Plein Check Flee.Plan Check
hlech.Permit Fee: Plumh. Permit Fee: Elec.Permit Fee:
Other dlech.Insp. Other Plumb Insp. Ll I Other Elec.Insp.
Hach.Insp. Fee: Plumb. bnsp.Fee: Oce.Insp.Few:
N07'E: This evtinate does not ine•Iudejeec due to other Departments(i.e. Planting, Public Works, Fire,Sanitary Sewer District,School
District, etc.). These feev are haver on the prelindnan in onnation available and ore onh•an estimate. Contact the Det or addn'I in n.
FEE ITEMS'(Fee Resohuion 11-053 En: 71/71/) FEE QTY/FEE MISC ITEMS
Plan Check I'ee:
SuppL PC Fee
Plumb./:1•lech./Elec
Permit Fee: $195.00
.Supp!. Insp Fee
Phtmh.hllech./Elcc.
Plumb./Adech./Elec Permit Fee:
Construction Tar:
Administrative Fee:
Work Without Permit? O Yes Q No $0.00
Advanced Planning Fces:
Travel Documentation Fees:
Strom Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item
Blde Sids Commission Fee: 18CBSC $1.00
SUBTOTALS: $196.50 $0.001 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•building(d)-cuoertino.org
PROJECTADDRESS Z to?(. eco ,.r APN#
OWNER NAME A ,GSSL� - `' PHONE 410.0-Z
Z 3 4 E-MAIL
¢ O
STREET ADDRESS .Swm L2 CIT'.STATE Z C,A FAX
-O /T
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC.a
C-39
COMPANY NAME 4r E-MAIL FAX
eG.l0 i1J IM
STREETADDRESS CITY.STATE PONE
S-oz or i f e- s 2 -0330
1 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/" 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$126.00. The re-inspection fee shall be paid before another inspection
can be scheduled.
By my signing below, I certify each of the following is true: I am the property owner or authorized agent to act on the
property owner's behalf. 1 understand and agree to comply with the re-roof policy stated above. I also understand that
smoke detectors and carbon monoxide detectors are required to be installed in accordance with Sections R314 and R315 of
the 2010 Califomia Residential Code.
Signature of ApplicanUAgent: Date:
ReroofPo1icv_201 Leloc reviser/02116/11
T
l Zoe cel v
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO,CA'95014-3255
CUPERTINO (408)777-3228• FAX(408)777-3333•buildinO(ftupertino.oro
PROJECT ADDRESSZ/O Q ,{pNv ' `l/—� 05
OWNER NAME A�a�e PHONE E-NAIVE `,/
/V O 0 _O SS—
STREET ADDRESS 2/ CITY. STAT
P I FAX
a '
CONTACT .NAME PHONE 'O I E-?TAIL
STREET'ADDRESS5,o 2- CITY.STATE. ZIP FAX
❑OwNFR ❑ OwSER-RUILDER ❑ OWNER AGENTCONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER '❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME LICENSE NUMBERLICENSE 'PE I BUS.tic.-
41T1 08
COMPANY SAME E-a1.41L FAX
SAME
STREET ADDRESS CITY.$TATE.ZIP PHONE
Sot w oS¢ C 8-0
ARCHIrFCDENGINEER NAME LICENSE NUMBER BUS.LIC.
COMPANY NAME E-MAIL FAX'
STREET ADDRESS I CITY.STATE,LIP PHONE
uE OF ❑ SFD or Duplex r Muld-Family ROOF AREA: 119 VALCATION: p
STRUCTURE: ❑ Commercial /3 S 5-00
EXISTING ROOF TYPE: ❑BUILT-CP ROOF ❑ASPHALT SHINGLES PCOODSHAKPS E_) ❑01 HER(SPECIFY)
RE.NOYF.:REPLACE VYES IFNO. PLY11'OOD ❑ PLYWD ❑OSB PITCH: ROOF
❑
No • AYER � ,�/ I 'NECS' ❑ s: 1'1'P � D% ')2 CLASS' A
PROPOSED ROOF TYPE: ❑BUILT-UPROOF XASPHALTSHINGLES ❑WOODSHAKES ❑\\'OODSHINGLES CI OTHER ICC-ES REPORT.
DESCRIPTION OF\\,ORI;:
l/Z1t
se President•;>1 come siniew es _ 001017 : Co-ACY Bled- .
Rv my signature below.I certify touch of the following: 1 am the propem owner or authorized agent to act on the property owner's behalf. 1 have read this
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building const•' tion. 1 a' OnU reprcse tiv c of Cupertino to enter the above.identified property for inspection purpose.
Signature of ApplicandAgenC Date: 6612
SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY
_ If building is associated with a Home Ovrner'S Association.provide letter PLAN CHECK TYPE ROUTING SLIP
of approval from HOA. ❑ OYER-THF-COUNTER ❑ BUILDING PLAN REVIEW
_ Provide Planning approval to verify if there any restrictions. ❑ EXPRESS ❑ PLANNINGPLAN REVIEW
_ Provide copy of Manufacturer's Installation Specifications. ❑ STANDARD ❑ FIRE DEPT
Provide signed copy ofCupertino's Tear-Of Policy. ❑ OTHER:
ReroofApp_201 Ldoc revised 03/16/11