12080036 CiTY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20622 GARDENSIDE CIR CO\fRACI'OR:BRADSHAW ROOFING INC PFRAIII'NO: 12080036
OWNER'S NAME: NTNG I ISU 1821 S BASCOM AVE PAIII 160 DA'Z'E ISSUED:08!072012
OWNER'S Pl IONE: 4082469930 C\MPRELI-.CA 95008 PHONE NO:(408)246-9930
❑ LICEN
SED CON-fRAC'fOR'S DECLARATION 13UILDING PERMIT INFO: BLDG r ELECT r PLUMB r
License Class Lie.
9-2 7 fW
Contractor(2
AIECII r RESIDENTIAL r COMMERCIAL�c�SV,c.c; 3fccate—s/,7
r
/ Z
hereby afRrm that I am licensed wider(lie provisions of Chapter 9 JOB DESCRIPTION: REMOVE EXISTING ROOF SYSTEM AND INSI'ALL NEW
(commencing e'ith Section 7000)of[)IN ision 3 of the Business S Professions CLASS
Cade and(hat me license is in full force and effect. A ASPHALT SHINGLES,12 SQUARES
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 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 Codc,for the performance of die work for which this Sq. Ft Floor Area: Valuation:$6000
permit is issued.
.U'I'1.ICA\I'C:ICR'I'I PIC,\TION APN Number:36232044.00 Occupancy Type:
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 and state laws relating
to building construction,and hereby authorize representatives of this city to enter
upon lheabovementioned property forinspection purposes. (We)agree to Save PERMIT EXPIRES IF WORK iS NOT STARTED
indemniN and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this pernit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. /
/. , Q �.7 Issued by: � AN TIiH Date: e-7- -
Signature W Date a (_ II Z
❑ OWN11-14-BII1LDEl2 DECLARATION
RF.-ROOFS:
hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior many roofing material being installed.If a roof is
the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
I,as owner of the property,or my employees With wages as their sole compensation, inspection.
will do the stork,and the structure is not intended or offered for sale(Sec.7044,
Business K Professions Code) Signature of Applicant: Date:
I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code).
,U-I.ROOF COVFRINCS'1'O 1311 CLASS",\"OR I4F:1"1'IiR
hereby affirm under penalty of perjury one of the following three
declarations:
I have and will maintain a Certificate of Consent m self-insure for Worker's I I,\--/.,U2DOl1S AL\'I'FRhU.S DISCLOSURE
Compensation,as provided for by Section 3700 of the Labor Code,for the 1 have read(he hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California Ilcalth S Safety Code,Sections 25505,25533,and 25534. 1 will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the I lcalth S
Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(x)should 1 store or handle hazardous material.
Additionally,should 1 use equipment or devices which emit hazardous air
permit is issued. contaminants as defined by the Bay Area Air Quality Ala nagemen(District I will
I certify that in the perl'ormance of die work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code.Chapter 9.12 and the
not employ any person in any mariner so as to become subject to the Worker's I leal(h S Safe ode.Sections 25505.25533,and 25534.
Compensation Imus ofCalifomia. If,after making this certificate of exemption,I
become subject to the Worker's Compensation provisions of the Labor Code,I inust 4...x
forthwith comply with such provisions or this permit shall be deemed revoked Date /L
CONSTRUCfIONLENDING AGENCY
It IT LICANI'CERTIFICATION
I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's
correct.I agree to comply with all city mid county ordinates and stile laws relating for which this permit is issued(Sec.3097,Civ C.)
to building construction,mid hereby authorize representatives of this city to enter Leader's Name
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless.the City of Cupertino against liabilities,judgments, Leader's Address
costs,and expenses which may accrue against said City in consequence Of the
granting of this permit.Additionally,the applicant understands and will comply ARCA ITECI"S DFCLARAT'ION
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. 1 understand my plans shall be used as public records.
Signature Date Licensed Professional
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: aD��e? Q/ 6` DATE: 08/06/2012 REVIEWED BY: Beth
APN: BP#: /'j 0('003{0 'VALUATION: 1$6,000
•PER,IMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Duplex PENI'ANIATION 1SFDWLR00F
USE: I I PERMITTYPE:
WORK remove existing roofs stem and replace with Class A asphalt shingles
SCOPE
FEE ID ROOF AREA
(s.f.)
1REROOFFRES 1,200
Dlrch. Plan Chuck plunk. Plan Check Elee. Plan Check
,Meeh. Permit Fee: Plumb.Permit Fee: Elec. Permit Fee:
Other Mesh.In y. Ocher Phunb lisp. Ocher Eley. hap.
dfech, bap. Fee: Plumb.Insp. Fee: Flcr.hap.Fee:
NOTE: This estimate does not include fees rete to other Departments(i.e. Planning, Public Works. Fire,Sanitary Server District,School
District, etc.). These fees are baser/on the preliminarl information available and are onh'an estimate. Contact the Dept for addn'I info.
FEE ITEMS (Fee Resolution 11-053 F_ . 711/11) FEE QTY/FEE N'IISC ITEMS
Plan Check Fee:
Supp/. PC Fee
PLtmb.Alech./Elec
Permit Fee: $180.00
S!lppL 1my Fee
Phmth.1 1ech./Elec
Phunb.hb1ech.1Elec Permit Fee:
Construction Tax:
Administrative Fee:
Work Without Permit? O Yes (j) No $0.00
AtAwneecl Planning Fees:
Trcmel Documentation Fees:
Strong Motion Fee: 111SEISMICR $0.60 Scicct an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $181.60 $0.001 TOTAL FEE: $181.60
Revised: 07/01/2012
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
C U P E RTI N O Telephone: 408-777-3228
Fax: 408-777-3333
CONTRACTOR / SUBCONTRACTOR LIST
JOB ADDRESS: PERMIT# Q� CrJ
OWNER'S NAME: / PHONE #
GENERAL CONTRACTOR: BUSINESS LICENSE#
ADDRESS: ;Z �44 e_ V CITY/ZIPCODE: S pSeCA
S
*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 OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors: Signature Date
Date
Please check applicable subcontractors and complete the following information:
✓ SUBCONTRACTOR BUSINESS 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
Owner/Contractor Signature Date
2 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(a)cuperlino.oM
PROLE D S \ APN N rl 04
1
OWNERV ME PHOI!?L, E-MAIL
^.n .] (� E-MA•..
STREET A[)D S I �C �G \� CITY.STATE (,`�l'l Jc_ gSO1'4 FAX
Up
C TRACTO NA.tE d ..J LICENSE NUMBE LICENSETYP BUS.UC.N
C 11
COMPANY NAME E-MAI IrL F •� ��Z
gn
STREEr ADDRESS _ CITY.STATE ZIP HONE
J 1 S
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:
Reroo/Polirv_2011.doc revised 07/16111
REROOP PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION R 10300 TORRE AVENUE•CUPERTINO.CA 95014-3255
CU PERTlNO (408)777-3228• FAX(408)777-3333•buildinct0cuoertino.oro
(` O0
ti
6000
PROJECT ADDRESS OL-
OWNER NAME PHONE 1
STREET S C C /. STQ ZIP 1 l� I FAX
qc-n L4
CONTACT NAME PHONE t E-MAIL
STREET ADDRESS CITY,STATE.ZIP FAX
❑OWNER ❑ OSVNEit-0UILDER ❑ 0%VVER.AGEtrr clo TMICTOR Cl CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENA.`rr
CONTRAC RNAatE LICENSENUNar LICENSET\PE BUS.LIC.
COMPANYNAME E-MA FAX
STREET ADDRESS _ CITY.STATE ZIP PHONE
kj
CSan -1 qnso
ARCHITECIENG WEER NAME LICENSE NUMBER BUS.LIC.0
COMPANY NAME E-MAIL FAX
5TREST ADDRESS CT'•STATE ZIP PHONE
USE OF ❑ SFD or Duplex ❑ Multi-Family. ROOF AREA: VALUATION:
STRUCTURE. ❑ Commercial � C O
MSTINGROOP TYPE: ❑BUILT-UPROOF ❑ASPHALT SHINGLES 121R•OOD SHAKES l❑WOOD SIDNGLES ❑OTHER(SPECIFY,
REMObE,REPLACE 9�FS IF 140. �j PLrit'OOD :5' ❑ PLriVD ❑OSB PITCH: ROOF
G s "1� e . ❑ e, ^ P Cl D. I(2 C
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ASPHALT SK74GLFS ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER [CUES REPORT Y
DESCRIPTION
lq
• By any signature below,I certiiv to each of the folio%ine: I am the property owner or authorized agent to act on[tie property owner's behalf. 1 have read tha
application and the information I have provided is correct. [have read the Description of IVork and verify it is actuate. 1 agree to comply with all applicable local
ordinances and snae laws relating m buil/qui oast/ry-r��ian. I au nz presenatives of Cupertino to ener the•-olbo/ve-iden[if prapeny far inspection purposes.
Signature ofAppliconr/Agent:��/.(/Is�lytny-� Due: / �(712
SUPPLEMENTAL INFORMATION REQUIRED OMCE USE ONLY
_If building is associated with a Home Oumers Association,provide letter PLAN CHECK TIRE ROUTING SLIP
of approval from HOA. ❑ OVER.THE{OUNTER ❑ BUILDING PLAN REVIEW
Provide Planning approval to Verify'if there any restrictions. ❑ EXPRESS ❑ PLANNING PLAN REVIEW
_Provide copy of Mmwfacturer's Installation Specifications. ❑ brA.VD_A" ❑ FRE DEPT
Provide signed cc p-v of Cupenino's Teat-O@-Policy. OTHER:
Reroof.[pp 20/Ldoc revised 03:'16•!1