12080293 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21083 WHITE FIR Cf CONTRACTOR:FOUR SEASONS ROOFING PERMIT NO: 12080293
OWNER'S NAME: CHEN GANG ZHU PO BOX 1668 DATE ISSUED:082912012
OWNER'S PHONE: 4082176934 SAN.IOSE.CA 95109 PHONE NO:(408)27841330
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG [ ELECT ri PLUMB rt
License Class C- 31 Lic.q -7a 10
MECH (_ RESIDENTIAL(_t COMMERCIAL r
Contractor Fs4l, INc• Date
1 hereby affirm that I am licensed under the provisions of Chapter 9 ,JOB DESCRIPTION:TEAR OFF WOOD SHAKE AND INSTALL 13 SQFT CLASS A
(commencing with Section 7000)of Division 3 of the Business& Professions COMP SHINGLES
Code and that any license is in full force and effect.
hereby affirm under penalty 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 Sq.Ft Floor Area: Valuation:54500
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
Ali\Number.35905071.00 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,and hereby authorize representatives of this city to enter PERMIT EXPIRES IF WORK IS NOT STARTED
upon die above mentioned property for inspection purposes. (We)agree to save
indemnify and keep harmless the City ofCupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may accrue against said City in consequence ofthe 180 DAYS FROM LAST CALLED INSPECTION.
granting of this permit. Additionally,the applicant underst:mds mid will comply
with all non-point source regulations per the Cupertino Municipal Code,Section pp '7
9.18. �e p Issued by: ��+��✓ f�TGf� Date: Z -P7p
-/a
Signature Date
❑ ON'NF,R-BUILDER DECLARATION RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed.If a roof is
1 hereby affirm that 1 am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,1 agree to remove all new materials for
the following two reasons: inspection.
1,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044, Signature of Applicant: Date: •-t.9-�'L
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVIiRINGS TO BE CLASS"A"OR BETTER
1 hereby affirm under penalty of perjury one of the following three
declarations: HAZARDOUS MATERIALS DISCLOSURE
I have and will maintain a Cenificme of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the
Compensation,a 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 Health&
1 have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material.
Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air
contaminants as defined by the Ray Area Air Quality Management District I 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 for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534.
not employ any person in my manner so as to become subject to the Worker's
Compensation laws of California. If,alter making this certificate of exemption,I Owner r an nriz agent:
become subject to the Worker's Compensation provisions of the Labor Code,I must Date:
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRIJCFION LENDING AGENCY
APPLICANT CERTIFICATION 1 hereby affirm that there is a construction lending agency for the perfom mance of work's
I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.)
correct.1 agree to comply with all city and county ordinances and state laws relating Lender's Name
to building co istmetion,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 acerae against said City in consequence of the ARCHITECT"S DECLARATION
granting of this permit.Additionally,the applicant understands and will comply
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
PEE ESTIMATOR - BUILDING DIVISION
:MjADDRESS:q1' _ Whitefirct. DATE: 0812712012 REVIEWED BI': bobs,
PN: BP#: `VALUATION: $4,500
*PERMIT TI'PE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex PENTAMATION 1SFDWLROOF
USE: PERAIITTI'PE:
IVORK tear off wood shake and install comp shingles.
SCOPE
A/ech. Plan Check Plumb. Plan CherA Flec. Plan Check
Mech. Permit Fre: Plumb. Peonit Fee: Glee. Permit Fee:
Other Afech. lay. Other Plumb Insp. Other Elec.Insp.
Mech. hup. Fee: Plumb. Lisp. Fee: Elec.bup.Fee:
NOTE: This estimate does trot include fees due to otter Departments(i.e. Planning, Public Works, Fire,Sanitary Sewer District,School
District, etc). These fees are based on the prelindnan information available and are onh,rot estimate, Contact the Det for addn'1 info.
FEE ITEMS free Resolution 11-053 EA 71111 1) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 1,300 s.f. Re-roof
Suppl. PC Fee: Q Reg. 0 OT 0.0 1 hrs $0.00 $195.00 IREROOFRES
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee:Q Reg. 0 OT p.p hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Constntction Tax
Administrative Fee:
Work Without Permit? 0 Yes Q No $0.00
Advanced Planning Fee: $0.00 Select Non-Residential 0
Travel Documentation roes: Building or Structure 0
i
Strong Motion Fee: IBSEISA17CR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
:cSUBTOTA L$i;. $1.50 $195.00 Ls, a� _ TOTAL FEE_:`' $196.50
Revised: 07/01/2012
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO,CA 95014-3255
CUPERTINO (408)777-3228• FAX(408)777-3333•buildina(D)cupertino.oro
PROJECT ADDRESS Z/083 e
OWNER NAME ^ B I PROSE E-MAIL
STREETADDRESS�u�O w C CI ST.>TE,LIP l FAX
CONTACT NAME PHONE EMAIL
AVrego CA -0 30
STREET ADDRESS5'07— S CIT1'.STATE.ZIP FAX
❑OWNFR ❑ Ow NER-BUILDER ❑ OWNER.AGENT A CONTRACFOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONT0.,\CTOR\'AME LICENSE NUMBER LICENSE 'PE_Aq BUS:LIC.
COMPANYSAME EMAIL FAX
SAME
STREET ADDRESS CITY.STATE.LIP PHONE
Sot a oSe C 8-0
ARCH[TECT ENGINEER SAME LICENSE NUMBER BUS.LIC.
COMPANY NAME EMAIL FAX
MEET ADDRESS CITY.STATE LIP PHONE
GSE OF ❑ SFD or Duplex X, Multi-Family ROOF AREA: VAL0.>TION: p
STRUCTURE- ❑ CommercialS SO
EXISTING ROOF TYPE: ❑BUILT-CP ROOF 11 ��e//ASPIIALT SHINGLES r\VOODSHAKES ❑WOODSHINGLES ❑OTHER ISPECIFYJ
0.G10{'F.:0.EPL.{CE YES I IF NO. PLYss'OpD ❑ PLY
❑OSB PITCH: ROOF
❑ N LAYERS dd HI RN S ❑ T'P , X :)2 CLASS
A
PROPOSED ROOF TYPE! El BUILT-UP ROOF /.ASPHALT SHINGLES ❑WOODSHARES ❑wGOD SHINGLES ❑OTHER ICC-ES REPORT•
DESCRIPTIONOF\VORl::
I/Z 1 1 cbx
e
ae a
By my signature below.I cenifv to each of the following: I am the property owner or authorized agent to act on the propem 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 state laws relating to building cons tion, a orize represe ui of Cupenino to enter the above-identified property for inspection purposes.
Signature of Applicanl/AgenO Date: rO
SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY
_If building is associated With a Home 0"ner's Association.provide letter PLAIN CHECK TYPE ROUTING SLIP
of approval from HOA. oQ�'vTI E-C-COUNTERBu1Cfi LOJNC PIAN REVIEW
Provide Planning approval to verify if there any restrictions. ❑ EXPRESS ❑ PLANNING PLAN REVIEW
_ Prov' cop)'of Manufacturer's Installation Specifications. ❑ STANDARD ❑ FIREDEPT
Pro�Rned copy of Cupertino's Tear-0T Policy. ❑ CTHER:
Rerwf,4pp_201 Ldoc revised 03/16/11
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
10,300 TORRE AVENUE •CUPERTINO,CA 95014-3255
CUPERTINO
(408)777-3228• FAX(408)777-3333•building akupertino.ora
PROJECT ADDRESS 2-(093 wI 1LIt G APN a
Z
OWNERNAME //''�� /'1 PHONE E-MAIL
l-lp. u 1. O �t 7 —
STREETADDRESS CITY, STATE FAX
CA 'IM4
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC.a
1013 1 C—
COMPANY NAME E-MAIL FAX
STREET ADDRESS Sb?— CITY.STATE PHONE
ore C 9 -1M 08-2-18-0330
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 I/<" 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. I understand and agree to comply with the re-roof policy stated above. 1 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: 9— 27—/Z
RerooJPolicv_201 Lrloc revixed 02/16/11