12080160 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21076 RED FIR CI' CONTRACFOR:FOUR SEASONS ROOFING PERMITNO: 12080160
OWNER'S NAME: CUOCI-IUN ZIIAO.0 WEIWEN LU PO BOX 1668 DA'Z'E ISSUED:08/152012
OWNER'S PIIONEI: 40851705511 SAN.IOSE.CA 95109 PI ZONE NO:(+08)278-0330
Ja- IAC,ENSED CONTRACfOR'S DECLARATION BUILDING PERMIT INFO: BLDG I- ELECT r PLUMB I-
License Class C-39 hic.N 472 10% — -
NIECII r RESIDENTIAL r COMMERCIAL r
Contractor FS1zt I IJ C• Dale
1 hereby affirm that I am licensed under the provisions of Chapter 9 •JOB DESCRIPTION:TEAR OFF EXISTING WOOD SHAKE ROOF.INSTALL 13
(commencing with Section 7000)of Division 3 of the Business S Professions SQRS
Code and that nn'license is in full force and elTecL 112"CDS PLYWOOD THEN 30N PELT UNDERLAYMF.NT.
INSTALL CERTAINT'EED PRESIDENTIAL COMPOSITION
1 hereby affirm under penalty of perjury one of the following oro 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
perfommnce of the work for which this permit is issued.
1 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
pemtit is issued. Sq.Ft Floor Area: Valuation:54500
AI'I'LIC.\\"1'CIiR'I'I FIC.\TION
I certify that I have read this application mid slate that the above information is APN Number:35905056.00 occupancyType:
correct.I agree to comply with all city and county ordinancesand state laws relating
to building construction,mid hereby authorize representatives of this city to enter
upon the above mentioned property t'or inspection purposes. (We)agree to sane
indemnify laid keep harmless(lie City o(Cnpertinoagainst liabilities,judgments. PERMIT EXPIRES IF WORK IS NOT STARTED
costs,and expenses which may accrue against said City in consequence of the
gmmingofthis permit. Additionally,the applicant understands and will comply WITHIN 180 DAPS OF PERMIT ISSUANCE OR
with all non-point source regulations perthe Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION.
9.18.
Signature Date 8'/.f'/2 Issued by: �E/g/✓ /TA]—l/a^/ Date: 4!p
•/•s•/2
❑ ON'NE - 1 ODER DECLARATION v
I hereby affirm that 1 ani exempt from the Contractor's License Law for one of RE ROOFS:
the following two reasons: All rools shall be inspected prior to may roofing material beiig installed If roof is
I,as owner of the property,or illy employees with wages as their sole compensation, installed withow first obtaining an inspection,I agree to remove all new materials for
will do the work,and the structure is not intended or of fered for sale(Sec.7044, inspection.
Business B.Professions Code) -- -
I,as owner of the property,am exclusively contracting with licensed commclors to Signmureof Applicant: Date:, �/r•/'L
construct the project(Sec.7044,Business S Professions Code).
I hereby affirm under penalty of perjury tine of the following three ALL ROOK COVEI .S'I'0 IIF CLASS"A"OR BE'1-ITR
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's 14\%,\KUf11IS M,\"I'I'RIAIS DISCLOSURE
Compensation,as provided for by Section 3700 of the Labor Code,for the -
performance of the work for which this pemtit 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`Safety Code.Sections 25505,25533,and 2553.1. 1 will maintain
Section 3700 of the Labor Code,for theeribrinance of lite work for which this Compliance with the Cupertino Municipal Code.Chapter 9.12 and the Ilfnith
F Safety Code,Section 25532(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 the work for which this permit is issued I shall contaminants as defined by the Bay Area Air Quality\lanagement District I 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 ranking this certificate of Exemption,I I Ifalth S Safety Code.Sections 25505,25533,and 2553.1.
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 Owner or rAlhor. :rSem:
DllIC:
.Usappli,\\I' mid state
that
thcN .EONS"l'RHCI'ION LENDING,\G6:NCY
I certify that 1 have read this application mod state that lhE above information is
correct. I agree to comply with all city and county ordinances and stale laws relating I hereby affirm that there is a construction lending scene}'for the performance of work's
to building construction,mid hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.)
upon the above mentioned property fix inspection purposes.(We)agree to save Lender's Name
indcnmrifyand keep harmless the City of Cupertino against liabilities•judgments,
costs,and expenses which may aceme 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 regulaticns per the Cupertino Municipal Code,Sectiai ARCII IT'F.Cf'S DECLARATION
9.18.
I understand my plans shall be used as public records.
Signature Dale
Licensed Professional
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
:941 ADDRESS: 21076 Red Fir Ct DATE: 08115/2012 REVIEWED BY: Sean
ANN: BP#: �j Q/ 6 'VALUATION: $4,500
*PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY Multi-Family Dwelling Buildina is PENTADIATION 1R2R00F
USE: >3 Stories Q Yes 0 No PERMITTYPE:
1VORK Tear off existingwood shake roof. Install 1/2" CDX plywood then 30#felt underla ment. Install
SCOPE Certainteed Presidential composition shingles. Color: Country Gray
FEE ID ROOFAREA
(s.f.)
1REROOFMRES 1,300
'tech.Plan Check Pluutb.Phut Check Elec.Plan Chrs:k
Rech. Permit Fee: Plumb.Permit Fee: Elec Permit Fee:
(Wher Much.last). Other Plumb losp. Other Elec.leap.
Har.h. Inst). Fre: Plumb.htsp.Fee.. Mee.hop.Fee:
NOTE: This estimate does not include fees due to other Departments(i.e. Planning, Public Works. Fire,Sanitary Sewer District,School
District, etc.). These fees are hosed oil the prelintinarl information available and are on1v as ectintate. Contact the De t for adds 7 in a.
FEE ITED'IS (Fee Resolution 11-053 E(f 71111/) FEE QTl'/FEE MISC ITED'IS
Plan Check Fee:
Supp/. PC Fee
Pl um h.,'He ch.%El ec
Pennit Fee: $195.00
Supp/. hop Fee
Plumh_.;14ech.lElec
Plumb.Afech.!Elee Permit Fee:
Consrruction Tax:
Administrative Fee.:
Work Without Pennit? O Yes E) No $0.00
Advanced Planning Fees:
Travel Documentation Pees:
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $196.50 $0.00 TOTAL FEE-.T $196.50
Revised: 07/01/2012
REROOF PERMIT APPLICATION
COMMUNIT)'DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE -'CUPERTINO,CA•95014-3255
GUPERTINO (408)777-3228• FAX(408)777-3333•building0cuoertirl
• /�DSD//�
PROIECT ADDRESS Z 0-7 I Pil rj 1 App• 0 ✓ � /
OWNER NAME b PHONE .`/l1 l'/lE-?fAIL S/U_
� ' o - - rr
STREEF ADDRESS � C4. CIT'. STAP I FAX
T
CONTACT NAM. Camaci 53%01
PHONE EdIA1L
STREET ADDRESS CIT'.STATE.ZIP
Sot S I FAA
ClTO.Cal CA .
OWNER ❑ OWNER-BUILDER ❑ ON"NER AGENT /f CONTRACrOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ Tl
CONTRATOR NAME&urLICF.NSENL'.MBER ZORT'LICENSEPE iCIC.•
COMPANY SAME SAME
E-MAIL FAX
STREET ADD0.F.S5 CIT',STATE.ZIP PHONE
SOZ A ii C 8-0
ARCHTFECT ENGINEER SAME LICENSE NUMBER IF BUS.LIC.
COMPANY BAMS E-MAIL
FAS
STREET ADDRESS CIT'.STATE ZIP PHONE
USE OF ❑ SFD or Duplex /R�1 Multi-FamilyROOF AREA: ./ VALL'ATIO>:
STRUCTURE: ❑ Commercial /3 I�S 5-00
EXISTING ROOF TYPE: ❑BUILLL'P ROOF ❑ASPHALTSHINGLES rt\'OODSHAKES ❑WOOD SHINGLES ❑OITIER(SPECIFY)
REMO\'E:REPLACE YE5 IF NO. PL1'\GOOD ❑ PU'1\'D ❑ OSBPIIC H ROOF
❑ N • Al'FRTiXESS' 13T\'P p. LA A
PROPOSED ROOF TYPE: ❑BUILT-UPROOF XASPHALTSHINGLES ❑\COODSHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT.
DESCRIPTION OF WORK:
I4
ae 'v
0
BY my signature below.I cert to each of the follo\Ying: I am the property msner or authorized all to act on the property owner's behalf. I have read this
application and the infomution I have provided is correct. I have read the Description of work and verify itis accurate. I agree to corl with all applicable local
ordinances and sate laws relative to building cons tion. I Vol represe Uv of Cupertino to enter the above-identifiedcrq
prop" for inspection purposes.
Signature Di npplicanJAgent[ Date: 3 O
SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLS'
_ If building is associated\with a Home 0\vner's Association.provide lever PLAN CHECK TYPE ROUTING SLIP
ofapproval from HOA. ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW
_ Provide Planning approval to verify'if there any restrictions.
❑ EXPRESS ❑ P".NNI.NC PLA.\RE\•IF.N'
_ Provide copy of.Manufacturer's Installation Specifications. ❑ STANDARD ❑ FIREDEPr
_Provide signed copy Of Cupenino s Tear-Off Policy. ❑ OTHER:
ReroojApp 201 Lai revised 03116111