12080299 CITY OF CUPERTINO BUILDING PERMIT
.BUILDING ADDRESS: 21091 WHITE FIR CT CONTRACTOR:FOUR SEASONS ROOFING PERMITNO: 12080299
OWNER'S NAME: CI IAN IAN I AND KOO SIN YI3E CATIIY PO BOX 1668 DA'Z'E ISSUED:082912012
OWNER'S PHONE: 4082526915 SAN.IOSF,CA 95109 PHONE NO:(408)278-0330
LICENSED CONTRACT'OR'S DECLARA'T'ION BUILDING PERMIT INFO: BLDG C ELECT r PLUMB IJ
License Class C _—V Lie.N W 2 i 6 8 r� r r
�r c MECII RESIDENTIAL CCOMMERCIALContractor rs5 Qt I rJ c- • Date O p—�I - ;S
hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION:TEAR OFF WOOD SHAKE AND INSTALL 13 SOFT CLASS A
(commencing with Section 7000)of Division 3 of the Business& Professions COMP SHINGLES
Code and that my license is in full force and effect.
hereby affirm under penalty of perjury one of the following I"a 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 Sq.Ft Floor Area: Valuation:54500
Section 3700 of the Labor Code,for the performance of die work for which this
permit is issued.
APN Number:35905075.00 Occupancy Type:
APPLICANT CERTIFICATION
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,mid herebyauthorize representatives ofthis city to enter PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We)agree to save
indemnify andkeep harmless the City ofCupertino against liabilities,judgments, WITHIN Igo DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may accrue against said City inconsequence of the 180 DAYS FROM LAST CALLED INSPECTION.
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section q
9.18. Issued by: �GA/1� ��ri Dale: OG
Signature Date 8-29-i2
❑ O\1'NE -IIl1ILUF-R DECLARATION R&ROOFS:
All roofs shall be inspected prior to an)-roofing material being installed.If a roof is
I hereby affirm that I am exempt front the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for
the following two reasons: inspection.
I,as owner of the property,or my employees with wages as their sole compensation. C
will do the.work,and the structure is not intended or offered for sale(Sec.7044, Signature of Applicator Date:
Business&Professions Code)
1,as owner of the property,ran exclusively contracting with licensed contractors to
construct the project(Se0044,Business&Professions Code). ALL ROOF COVERINGS•1'O BE CLASS"A"OR BETTER
1 hereby affirm under penalty of perjury one of the following three
declarations: IlAZARDOUS NIATEIRIAI S DISCLOSURE
I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the
Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code.Sections 25505,25533,and 25534. 1 will maintain
performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code.Chapter 9.12 and the Ilealth&
I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Sectiod25532(a)should 1 store or handle hazardous material.
Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should 1 use equipment or devices witch emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District 1 will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
I certify that in the performance of the work forwhich this pennit is issued,I shall Health&Safety Code,Sections 25505.2.5533,and 25534.
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California. If,after making this certificate of exemption,I Owner m nr` d agent: 812 91��
become subject to the Worker's Compensation provisions of the Labor Code,I must �'-"�� Dote'
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRIICI'ION LENDING,\GFNC1'
APPLICANT CERTI FICAT'ION I hereby ammo that there is a construction lending agency for the performance of work's
1 certify that I have read this application mid state that the above information is for which this permit is issued(Sec.3097,Civ C.)
correct.1 agree to complywith all city and county ordinances and state laws relating Lender's Name
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply ARCI I1"1'ECf'S DECLARATION
with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records.
9.18.
Licensed Professional
Signature Date
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: j White fir ct. DATE: 08127/2012 REVIENVED BY: bobs,
APN: BP#: 'VALUATION: 1$4,500
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex PENTAMATION 1SFDWLROOF
USE: PERMITTYPE: A
WORK tear off wood shake and install comp shingles.
SCOPE
blech. Plan Check Plumb.Plan Cherk Elec.Plan Check
ILlech. Permit Feta: Plural,.Permit Fee: Flee. Permit Fee:
Other Hoch.Insp. Other Plumb Insp. Ll I Oiher Flee.Insp.
,Ilcch. bap. Fee: Plumb, hasp.Fra: Elec.Insp. Fee:
NOTE: This estimate does not includejees due to other Departments(i.e. Planning, Public Works, Fire,Sanitary Sewer District,School
District,etc). Thtese ea are based on the preIhninan information mailable and are onb,an estimate Contact lite De t or addn 7 info.
FEE ITEMS (Fee Resolution 11-053 F_JL Ublll FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 1,300 s.f. Re-roof
Suppl. PC Fee: (F) Reg. 0 OT0.0 hrs $0.00 $195.00 IREROOFRES
PME Plan Check: $0.00
Permit Fee: $0.00
Supp]. Insp. Fee-.0 Reg. 0 OT O.p hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
CO)IMP'liction Tae:
Administrative Fee: 0
Work Without Permit? 0 Yes (F) No $0.00 (2)
Advanced Planning Fee: $0.00 Select a Non-Residential 0
Building or Structure 0
Travel Documentation Fees: A
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg Sids Commission Fee: IBCBSC $1.00
SUBTOT.CLS:; $1.501 $195.00 . TQT L FFE: $196.50
Revised: 07/01/2012
i Zo, C-)zq q
REROOF PERMIT APPLICATION
COMMUNITY,DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
` CUPERTINO (408)777-3228• FAX(408)777-3333•buildinct(dcuoertino.oro
PROJECT ADDRESS ^ 1 01 1 ^ e FI-r C4 APNv /O O
OWNERNAME (/ PHONE E-MAIL _•/
A A F,.A CL.ApQ
STREEr ADDRESS1091
O^ I CI STATE.ZIP I FAX
C M i
CONTACT NAME PHONE E-N1.11L
.Q
STRELT ADDRESS 5Z C CITY.STATF ZIP FAC .
❑OWNER ❑ OWNER-BUILDER ❑ OWN'ERAGENT J( CONTRACTOR ❑CONTRACTORAGEPT ❑ ARCHITECT ❑FAGINF.F.R ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME LICENSE N'L'SISER LICENSE 'PE BUS.LIC
COMPANY NAMC E-MAIL FAX
SAME
STREET ADDRESS S'07- CITY.STATE.ZIP Q cKe f••'^ PHONE 8_0
ARCHITECTiENGINEER NANIE LICENSE NUMBER BUS,LIC.
COMPANY NAME E-MAIL FAX -
STREET ADDRESS CRY'.STATE,%IP PHONE
USE OF ❑ SFD or Duplex JLf Multi-Family ROOF AREA: VALUATION:
STRUCTURE: O Commercial p�ry $ SQ
y
EXISTING ROOF TYPE: ❑BUILT-UPROOF ❑ASPILALTSHINGLES oW'OODSHAKES ❑W'OODSHINGLES 00111ERISPECIFYI
RENIO\'F.:REPL.ACE VES IF NO. PLYWOOD 4, ❑ PLYN'D ❑ OSB PITCH: ROOF
❑ N . AVER dd 'N ❑ 5"r A
PROPOSED ROOF TYPE: ❑BUILT-UPROOF OCASPHALTSHINGLES ❑tiOODSILAEES ❑WOODSHISGLES ❑OTHER ICC-ES REPORT.
DFSCRIPTION OF WORK:
30!�\
ff d6
Ry my signature below'.I certify to each of the following: I am the property oW,ner or authorized agent to act on the property owner's behalf. I 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 slate laws relating to building cons lion. I e orize rcprqSWdvQ of Cupertino to enter the above.identified property for inspection purposes.
Sigroture of ApplicxnJAgenC Date: a612
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. OVER --TH OUNTER BLS UILDTIG PLAN REVIEW
Provide Planning approval to veri fY if there any restrictions. ❑ EXPRESS ❑ PLANNING PLAN REVIEW
_ Provide copy of Manufacturer's Installation Specifications. ❑ STANDARD ❑ nRE DEPT
rovide signed copy ofCupertino's Tear-Off Policy. ❑ OTHER:
ReroojApp_101 Ldoc revised 03116111
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE •CUPERTINO, CA 95014-3255
CUPERTINO
(408)/77'7/-3228• FAX(408)777-3333•building okupertino.oro
PROJECT ADDRESS 7_10T1 W H; G F/;- C APN a
OWNER NAMEPHONE E-MAIL
� C 110k_ 9/r
STREET ADDRESS CITY, STATE Zee. FAX
Z/O *r CA qmlm
CONTRACTOR NAME LIC ENSENUMBE.R LICENSE TY BUS.LIC.k
tt7 O C
COMPANY NAME (' EMAIL FAX
r 56...rOAr oo r,
STREETADDRESS CITY,STATE.ZIP PHONE
S'D2 .� $4. -r,Sc 08- 2 - o
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 1/<" 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 California Residential Code.
Signature of Applicant/Agent: Date: Q'27 -/-L
Reroo/Policv_201 l.doc revised 02116/11