12080242 CiTY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRI?SS: 20673 GARDENSIDE CIR CON'I'RACI'OR:BRADS[IAW ROOFING INC PERpIPf NO: 12080242
OWNER'S NAME: TIANIZON RIOLITO E.M ANDZENAID 1821 S BASCOM AVE PNIB 160 DATE, ISSUED:08232012
OWNER'S PHONE:.4083091256 CAAIPBELL,CA 95008 PHONE NO:(408)246-9930
LICENSED CONTRACI'OR'S�DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
License Class _ Lic.9 JIB b
Mr r COMMERCIALr
EGH RESIDENTIAL COMMERCIAL
Contractor_ Date S b 31 a
hereby affirm that Iain licensed under the provisions of Chapter 9 JOB DESCRIPTION: REMOVE EXISTING WOOD SHAKE ROOF.INSTALL 12SQ
(con incncing frith Section 7000)of Division 3 of the Business S Professions NEW
Cute and that niv license is in full force and effect. CLASS A ASPHALT SHINGLES:AGED BARK
hereby affirm under penalty of perjury one of the follue'ing two declarations:
I have and will maintain a certificate co'consent to self insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
perfomtance 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 forwhich this Sq.Ft Floor Area: Valuation:$6000
permit is issued.
\I'PLIC.\N'I'f.I?R'I'IFICA'1'I(1N APN Number:36232020.00 Occupancy Type:
I certify that I have read this application mid state that the above inlomiation is
correct. ['agree to comply with all city and county ordinances and stale laws relating
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save PERMIT EXPIRES iF WORK iS NOT STARTED
indemnity and keep harmless the City of Cupertino against liabilities,judgments, WITHIN i80 DAYS OF PERMIT ISSUANCE OR
costs,and cxpenses.which may accrue against said City in consequence of the
granting of this perinit. Additionally,the applicant understands mid will comply 180 DAY FROM LAST CALLED INSPECTION.
with all non-point source regulations per the Cupertino Municipal Code,Section,
gigs. �qt2%�"
Issued by: L" Date:
Signature i Daic
❑ OWNER-BUILDER DECLARATION
Rt:ROOFS:
I hereby affirm that 1:un exempt from the Cmuractor's License Lai$fur one 0f All roofs shall be inspected prior to any rooting material beiig installed.If a roof is
the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
1,as owner of the property,or my employees with wages as their sole compensation, inspection.
will do the work,and the structure is not intended or ollered for sale(Sec.7044,
Business 3 Professions Code) Signature of Applicata Date: S/a3/yL
I,as owner of the property,am exclusively contracting.with licensed contractors to I '
construct(lie project(Sec.7044,Business S Professions Code), ALL ROOF COVERINGS TO BE CLASS^A^OR BETITR
hereby affirm under pen:dty.of perjury one of the following three
declarations: HAZARDOUS MATERIALS DISCLOSURE
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 I have read file hazardous materials requirements under Chapter 6.95 of the
performance of the work forwhich this permit is issued. California Ilealth S Safety Code.Sections 25505,25533.and 25.534. 1 will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance,,ith the Cupertino Municipal Code,Chapter 9.12 and the Ilealth S
Section 3700 of the Labor Code,.for the performance of the work for which this Safety Code,Section 25532(•)should I store or handle hazardous material.
Additionally,should I use equipment or devices which emit Imuzardous air
permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will
1 certify than in the performance of die work fareliich this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
not employ airy person in any manner sons to become subject to the Worker's Health S Safety Code.Sections 25505.25533,and 25534.
Compensation laws of Calitbmia. 11,after making this cenihcate of exemption,I
become Subject to the WorkerN Compensation provisions ohne Labor Code,I Elitist (>,y�Ecr or lyrtl rizeJ
I'miliw�idi comply with such provisions or this permit shall be deenned revoked. wlai tr hate'
APPLICANTCERI'IFICATION CONSTRUCTION LENDING AGENCY
I certify that F.have read this application and state that the above information is I hereby affirm that there is a construction lending agency.fordue performance of work's
correct I agree to comply with all city and county ordinances mid state laws relating for which this permit is issued(Sec.3097,Civ C.)
to building construction,.mid hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned property for inspection purposes.(We)agree to save
indennnit'y and keep harmless the City of Cupcninoigainst liabilities,judgments, Lender'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 ARCIHTrC`I"S DECLARATION
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: 20673 Gardenside Cir. DATE: 08/2212012 REVIEWED BY: Sean
APN: BP#: 'VALUATION: $6,000
*PERMITTYPE: ,Minor Building Permit PLAN CIIECK Tl'PE: Re-roof
PRIMARY Multi-Family Dwelling Buildina is PEN'I'AIIIATION 1R2ROOF
USE: >3 Stories O Yes (D No I PER,MITTI'PE:
WORK Remove existing wood shake roof. Install new Class A asphalt shingles: Aged Bark.
SCOPE
FEE ID ROOFAREA
(s.f.)
1REROOFMRES 1,200
,Neth.Plan Check Pbunb.Plan Check Elec.P/an Check
dlech. Permit Fee Plumb.Permit Fee: Elec.Permit Fee:
Other Afec•h. Insp. Other Plumb Insp. El Other Elce. Insp.
,Wech.lmp.Fee: Phanb. losp.Fee: flee.Insp.Few:
NOTE: This estimate Aries trot include jeer due to other Departments(i.e. Planning, Public Works, Fire,Sanitary Server District,School
District. etc.). These fees are based on the prelitninan•in orntntion available and ore onli,cut estinrate. Contact the Dept for addn'I infer.
FEE ITEMS (Fee Resolution 11-053 E)T 7/1111) FEE QTY/FEE MISC ITEMS
Plan Check Fee..•
• Suppl. PC Fee
P1amh./Adech./Elec
Permit Fee: $180.00
Supp/. lisp Fee
Pho»l./Ade ch./Elec
Plunib.hl•lech./Elec Permit Fee:
Construction Toa:
Administrative Fee:
Work Without Permit? C) Yes (j) No $0.00
Advancect Planning Fees:
Travel Documentation Fees:
Strone Motion Fee: IBSEISMICR $0.60 Select an Administrative Item
131d,, Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: 1 $181.60 $0.00 TOTAL FEE: $181.60
Revised: 07/01/2012
REROOF PERMIT APPLICATION!
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO,CA 95014-3255
CUPERTlNO (408)777-3228•FAX(408)777-3333•buildinafG)cuoertinD.oro
PROTECT ADDRESS O C` Sk \ APN z r
OWNE NAMEP E "�T�- E-MAIL
tIl Jr/ C/
S71� CEADDRESS , STATE,ZIP FAX
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CONTACT NANIE PHONE E-MAIL
STREET ADDRESS CITY,STATE, ZIP FAX
❑OWNER ❑ Otwm.BUILDER ❑ 211cONMICTOR ❑CONTRACIVRAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVMOPER ❑TENANT
CAN"ntACT RNwh� LICENSE NUNOER LICENSETYPE BUS.LIC.s
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COMPANY NAME E-NW �C n� FA.X
STREET.ADDRESSCITy',STATE rP PHONE
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ARCHITECT/ENGINEER NAME LICENSE NUN®ER BUS.UC,d
COh4PA4Y NAME - -E.Un. FAX
STREET ADDRESS CRY,STATE,ZIP. PHONE
USE OF ❑ SFD or Duplex Multi-Family, ROOF AREA: - VALUATION:
c,e
IlR . ❑ ConClld � (o STRUC
_
ms rwO ROOF TYPE,:..,/❑BmlT-UPROOF ❑ASPHALT SHINGLES STWOOD SHARES ❑WOODSHINGIES ❑OTHER(SPECIFY)
REMOVE/REPLACE 94R-
0 1 IF NO, //' - PLriVOOD :5- ❑ PLriVD 11 OSB PITCH: .(� ROOF a
❑ O RS- ,j, I c. ❑ 5
3- ❑ DXCLASS
PROPOSED RMF TYPE: ❑BUILT-UP ROOF 2 ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT 4
DESCRIPTION OF WORK: `
117, 1
By my signawre below,I certify to each of the following: I am the property owner or authorized agent to act on the proper'owner's behalf. t 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 ail applicable local
ordinances and slate laws relating to buil/Qm const 'on. I au oriz epresenm[ives of Cupertino to enter the-�lbo/ve-identif/¢d property for inspection purposes.
Sigrlamre of Applicant!AgenG AI�/.(/Lim��� Date-
SUPPLEMENTAL INFOR-MATION,
ate:SUPPLEMENTALINFOR-MATION, REQUIRED OFFICE USE ONLY
_If[wilding is associated with a Honte Owners Association,provide letter �,[ PLAN CHECKT'PE a,I ROVTINGSLIP
of approval from HOA. IRA OVER.THE.& MI1 BUILDING P"N REVIEW
_Provide Planning approval to verity if there any restrictions. El EXPRESS PLANNING PLAN REVIEW
_Provide copy of Manufacturers Installation Specifications. ❑ STANDARD ❑ FIRE DEPT
Provide signed copy efCupertin0's Tear-Off Policy. ❑ OTHER:
Rerooldpp_20!1.doc revised 03:1 611
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)cuoertino.org
PROJECT ADDRESS1 APN M
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Ow ERNAME PHO'E E-MAIL
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STREET ADDRESS I STATEZtP
C c-d-en C.� Ct, P_rt o CAqsplq FAX
C CTO NA. E, t LICENSE�MBE LICENSE TYP BUS.LIC.M
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COMPANYNAME E-MAI ` tY F [r��((''�
7 - - '1k7
STREET ADDRESS ` , ` ' ` S C� CITY.STATE,ZIP . I ONE
eC_
V 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. Proeress 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:
Rerot?PDlicv_2011.doc revised 02/16111