12090037 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21099 WHITE FIR CT CON'1•RAC'FOR:FOUR SEASONS PERMIT NO: 12090037
ROOFING
O\\'NF,R'S NApIF-: BOEHNER AMY L PO BOX 1668 DATE ISSUED:09/102012
OWNER'S PHONE: 4084472976 SAN JOSE,CA 95109 PHONE NO:(408)278-0330
k— LICENSED CONTRACTOR'S DECLARATION JOB DF,SCRIPT•ION: RF,SIDE:NTIAI, COMMERCIAL
License Class e _3q LOdic.q W7,rl,I RE-ROOF 13 SQ TEAR OFF WOOD SHAKE AND INSTALL
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Contractor �2f IIJC• Date 9-10-1CLASSA COMP SHINGLES eri
1 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.
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. Sq.Ft Floor Area: Valuation:$4500
I 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:35905079.00 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, ?-/1)-costs,and expenses which may accrue against said City in consequence of the ( Z
granting of this permit. Additionally,the applicant understands and will comply Issued by: � Date:
with all non-point source regulationsper the Cupertino Municipal Code,Section
9.18.
�7 Rb:ROOFS:
Signature _ Date i—/O—(� NI roofs shall be inspected prior to my roofing material being installed. If a roof is
installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
❑ O\\'NBRBI)ILDER DECLARATION
Signature of Apphcane i Date: IF—/a—/ 2
hereby arm that I am exempt from the Contraclnr's License Lai, for one of
the following two reasons: ALL ROOF CON, IN 'S TO RF,CLASS"A"OR BETTER
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,
Business&Professions Code)
I,as owner of the property,am exclusively contracting wide licensed contractors to IL\'/,ARDOUS INL\T•F,RLUS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). 1 have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. I will
1 hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal 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 Ilealth&Safety Code.Sections 25505.2553J.and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Owner or authorized agent: Date:
I certify that in the performance of the work for which this permit is issued,I shall
not employ any person in any manner so as to become subject to the Worker'sCompensation laws of California. If,after making this certificate of exemption,1 CONSI'RU 40N LF\DING AG F,NCY
become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby alum 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
APPLICANT 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 county 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 harmless the City of Cupertino against liabilities,judgments, ARCIIITECT'S DECLARATION
costs,and expenses which may accrue 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 Date
r I .
REROOF PERMIT APPLICATION
COMMUNITY,DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO,CA 95014.3255
COPE RTINO (408)777-3228-FAX(408)777-3333•building(dicupertino.orG
PROJECT ADDRESS ^ IL�Pis //�1
G e � O `✓ I V l
OU'NE0.NAME • rHONE E-?TAIL
eAAIS LQe. _ �-hnP.� YoP 4�- 2
STREET ADDRESS Z I OR, CI STATE.LIP I TAS
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CONTACT NAME PHONE 'O O I E\HIL
STREEr ADDRESS Sot CITY.STATE.ZIP FAS
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❑O%NFR 13OU'SER BUILDER ❑ OUNER.AGENT J( CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER 1 ❑ DEVELOPER ❑ TENANT
CONTRACTOR SAME LICENSE NLSIBER LICENSE "PE BNS.LIC.•
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COMPANY NAME 'jI C-MAIL FA;
STREET ADDRESS CITY.STATE.ZIP PHONE
SoZ a ose C i 8-0
ARCHI TEMENGINCER NAME LICENSE NUMBER BUS.LIC.
COMPANY NAME E-NIA1L FAX
STREET ADDRESS CIT\'.STATE.ZIP PHONE
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USE OF E] SFD or Duplex jid Multi-Family ROOF AREA: VALUATION:
_99—
STRUCTURE ❑ Commercial 5a, SSS
EXISTING ROOF TYPE: ❑BUILT-GP ROOF ❑ASPHALT SHINGLES PeU'OOD SNAKE$ ❑U'ppD SHINGLES ❑OTHER 1SPECIFYI
REMOVE:REPLACE IV,F.SI IF NO. PLYWOOD t ' ❑ PL
Y\CD ❑OSB PITCH: ROOF
❑ R -LAYERS� ICKNE � ❑ 5!- II I'12 CLASS A.
I
PROPOSED ROOF TYPE: ❑BCILT-UPROOT //./.{SPH.ALi SHINGLES 0\1'ppDSI14KEs ❑WOOD ICC-ES REPORT.SHINGLES ❑OTHER I
DESCRIPTION OF\CORK: Z Cox
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By in,.signature below.I certify to each of the following: I am the property owner or authortud agent to act on the property o mcr's behalf. I have read this
application and the information I have provided is correct. I have read the Description of Work and verifv it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building cons tion. I a oriu represe tiv of Cupenino to enter the above-identified propert}'`(or inspection purposes.
Signanne of ApplicanUAgcnt: Date:
SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY
_If building is associated\Yith a Home 0%%ner's Association.provide letter PUNCHECH TYPE I ROUTING SLIP
of approval from HOA. ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW
_ Provide Planning approval to veri6v if there any restrictions. ❑ ExPRFss Cl PLANN'INC PLAN REVIEW
_ Provide copy of Manufacturer's Installation Specifications. ❑ STANDARD ❑ FIRE DEPT
_ Provide signed copy of Cupenino's Tear-Off Policy. ❑ OTHER:
Reroojdpp!2011.doc revised 03/16/11
i
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 21099 WHITE FIR CT DATE: 09/05/2012 REVIEWED BY: MENDEZ
a -APN: BP#: 'VALUATION: $4,500
*PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY I PEIVTAIIATION
USE: SFD or Duplex PERi111TTYPE: 1SFDWLROOF
WORK RE-ROOF 13 SQ TEAR OFF WOOD SHAKE AND INSTALL CLASS A COMP, SHINGLES
SCOPE
I
FEE ID ROOFAREA
s.f.
1REROOFFRES 1,300
I
Much. Plan Check Plumb. Plan Check Fl,,. Plan C(wck
hlech. Permit Fee: Plumb. Permit Fee: Flec•.Pennit Fee:
Other-Mech.Insp. Oih<o-Plumb In,e . Ll I Other F.lec,blrcP.
,Ilech.Insp.ree: Plumb. bast.Fee: Elec.Insit.FI c:
NOTE: This estimate does not include fees due to other Departments(i.e. Planning Public li'orks, Fire,Sdnitary Sewer District,School
District,etc). These ces are based on the reliminan'in ornmtinn nvai(able andare onh,an estimate. Contact the Dept or addn'/info.
FEE ITEMS (Fee Resolution /I-053 EO' 711111) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
.Supp!. PC Fee
I
Phtmb.1A1ech.1E1ec
Permit Fee: $195.00
Suppl. Insp Fee
Phimb.11fech.11 lec
Plunth.414ech./F1ee Permit Fce:
Consnmclion Tax:
it dmini.strative Fee:
Work Without Permit? Yes (j) No $0.00
Advanced Planning Fees:
Travel Dotaunenlation Fees: A
Suone Motion Fee: IeSF.ISAfICR $0.50 Select an Administrative Item
13Ida Sids Commission Fee: IBCaSC $1.00
SUBTOTALS: $196.501 $0.001 TOTAL FEE: 1 $196.50
Revised: 07/01/2012
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-buildina(a),cuoenino.org
PROJECT ADDRESS I�^ l APNa
Q99 � G /r
OWNER NAME De A&-i PHONE E-MAIL
s
STREETADDRESSO E CITY. STAT ZIP G Ar 4 FAX
CONTRACTOR NAME LICENSENUMBER LICENag TYPE BUS.LIC.a
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COMPANY NAME E-MAIL FAX
�A IzdaiAA
STREET ADDRESS �ZCITY,STATE. PHONE p
P�CAIAD S2 S'x.76 '03,Q
1 UNDERSTAND AND AGREE TO THE FOLLOWING:
I. 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 Y<" 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. I 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: 9—S 12
ReroofPolicY 2011.docrevised 02116/11