12090036 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21101 WIIITE FIR CT CONTRACTOR:FOUR SEASONS PFRMIT NO: 12090036
ROOFING
OWNER'S NADIFI: DESARAJU GEETA AND GIRIDIIAR PO BOX 1668 DATE ISSUED:09/10012
OWNER'S P116NF: 4082591623 SAN JOSE,CA 95109 PRONE NO:(408)278-0330
L� LICENSED CONTRACT'OR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL[]
License Clercs C-99 Lie.4 )ot�m� RE-ROOF 13 SQ TEAR OFF WOOD SHAKE AND INSTALL
f� CLASS A COMP SHINGLES
CoContractor [ 3 � I f C. Date ''7i�O–� �.
hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000)of Division 3 of the Business& Professions
Code and that my license is in full force and effect.
1 hereby affirm tinder 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. Sq. Ft Floor Area: Valuation:&4500
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 APN Number:35905080.00 Occupancy Type:
permit is issued
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.1 agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the 4 I O— I Z
granting of this permit. Additionally,the applicant understands and will comply Issued by: Dale:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signaturei Date —10 :�:Z All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
❑ OWNER-BUILDER DECLARATION
Signature of Applicane ate:
hereby affirm that 1 am exempt from the Contractor's License Law for one of
the following two reasons. ALL ROOF COVER GS TO BE CLASS"A"OR BETTER
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,
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to IIA%ARDOUS\IATFRIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. 1 will
1 hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Ptunicipal Code,Chapter 9.12 and the
declarations: Health&Safety Code,Section 25532(x)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of die Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 255V.25533,and 25534.
Section 3700 of the Labor Code,for the perfommnce of the work for which thisq a
Owner or authorized age
permit is issued.
I certify that in the performance of work for which this permit is issued,I shall
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 CONSIRIICI'ION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby atfrn that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked, w'ork's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICA\1'CERTIFICATION Lender's Address
I certify that I have read this application and state that the above information is
correct. I agree to comply with all city and comity ordinances and state 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
indemnify and keep ham less the City of Cupertino against liahilities.judgments, ARCI IITEC`I"S DECLARATION
costs,and expenses which may acerae against said City in consequence of the I understand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Dale
REROOF PERMIT APPLICATION
COMMUNITY)DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO,CA 95014-3255
CUPERTINO (408)777-3228• FAX(408)777-3333• building(Mcupertino.oTo
PROJECT:WDRESS ^ I O G APYe 2 / �`� / O yt\
OWNERNANE PHONE J E-MAIL
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DeSickmu b ZS - 6
STREET ADDRESSI I 0 G CI STATE.ZIP I FAS
CON-TACT NAME PHONE E-NIAIL
STREET ADDRESSFAX
�b� CITY.STATE. I.IP
❑OWNER ❑ OWNERRUILDER ❑ ORNER AGENT CONTRACTOR ❑CONTRACTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER 13 TENANT
CONTRACTOR NAME LICENSE NL'NIBER LICENSE 'PE BUS,LIC--
COMPANY NAMEE-PIAIL FAX
STREET ADDRESS CIT\',STATE.ZIP PHONE
SoZ a ose C 8-0
.ARCHITECT,ENGINEER NAME LICENSE NUMBER BUS.LIC..
COMPANY NAME E-MAIL FAX
STREET ADDRESS CIT'.STATEZIP PHONE
CSE OF ❑ SFD or Duplex jyd Multi-Family ROOF AREA: VALUATION:
STRUCTURE: [3 ^,Commercial �/ SQ
EXISTING ROOF TYPE: ❑BUILT-CP ROOF ❑ASPIIALTSHINGLES r`VOODSHAKES ❑N'OODSHINGLES ❑DINER(SPECIFY)
RLMOVE:REPLACEYES IF NO. PLYWOOD :i' ❑ PLYWD ❑OSB PITCH; ROOF
❑ .V . A\'F.R THICKNESS C35'- TY' . C '1 2 CLASS' A
PROPOSED ROOF TYPE: ❑BUILT-UPROOF 241SPHALT SHINGLES ❑wOOUSIIARES ❑UOODSHINGLES 13 OTHER ICC-ES REPORT.
DFSCRIPTION OF U'ORR: `/Z 1
Cox
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6
By my signature below.I cenifY to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information 1 have provided is correct. I have read the Description of Pork and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relative To building cons tion. I a orize represe In, of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date: S ao
SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY
_If building is associated with a Home Owner's Association.provide letter PLAN CHECK TYPE ROUTIN'C SLIP
of approval from HOA. ❑ OVER-THELOUNTER ❑ BUILDINC PLAN REVIEW
Provide Planning approval to verify if there any restrictions. ❑ EXPRESS ❑ PLAN;NINC PLANREVIEW
Provide copy of Manufacturer's Installation Specifications. ❑ STANDARD ❑ FIRE DEPT
Provide signed copy of Cupertino's fear-Off Policy. ❑ OTHER:
ReroojApp_201 l.doc 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)777-3228• FAX(408)777-3333•buildinaCa)cuoertino.org
PROJECT ADDRESS e DAPN N
I' L
OWNER NAME 1I10NE EMAIL
STREET ADDRESS CITY.S E.ZIP FAX
V U G CA
CONTRACTORNAME LIC E,NSENUMBER1 LICENSE TYPE BUS.LIC.N
7 0$
COMPANY NAME /1 EMAIL FAX
✓f S'eG1'o A t
STREET ADDRESSr CITY.STATE.L e . PRONE
M7— f S . 6 95 6
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.
In. 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. 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 It314 and R315 of
the 2010 California Residential Code.
Signature of Applicant/Agent Date: 9/r�/R
ReroofPolici,2011.dacrePiser1027I6111
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 21101 WHITE FIR CT DATE: 0 910 512 0 1 2
REVIEWED BY: MENDEZ
APN: BPtl: 'VALUATION: $4,500
*PERMITTYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Duplex PENTAMATION 1SFDWLROOF
USE: PF,RMIT TYPE:
WORK RE-ROOF 13 SQ TEAR OFF WOOD SHAKE AND INSTALL CLASS A COMP SHINGLES
SCOPE
FEE ID ROOFAREA
s.f.
iREROOFFRES 1,300
blech. Plan Check Plumb.Plan Check Flee.Plan Check
Mech. Permit Fee: Plumb.Permit Fee: F,Ice.Permit Fee:
Other Meeh. Insp. Other Plumb Insp. Other Elcc.Insp. Ll I
.Rech. Insp. Fee,: Plumb. Insp. Fee: Elcc.hcsp.Fec:
NOTE: This estimate does not inclurlejees due to other Departments(i.e. Planning, Public Works, Fire,Sanitary Sewer District,School
District, etc.). These fees are baser/on the prelimrinar3 information available and are only an estimate. Contact the De t or atldn'I info.
FEE ITEMS (Fee Resolution 11-053 Elf 7/1/1 U FEE QTY/FEE MISC ITEMS
Plan Check Fee:
suppl. PC Fee
Phanh.Ablech./Flee
Permit Fee: $195.00
SuppL Insp Fee
Plant b.A%,1ech./Flee
P/urnh.Ablech./Flee. Permit Fee:
Consnvction Tar:
Administrative Fee:
Work Without Permit? O Yes No $0.00
Advanced Planning Fees:
Travel Documentation Fees:
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
131dg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $196.50 $0.00 TOTAL FEE: 1 $196.50
Revised: 07/01/2012