12080326 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20680 GARDENSIDE CIR CONTRACTOR:BRADSHAW ROOFING INC PERMIT N0: 12080326
OWNER'S NAME: SHIRLEY WANG 1821 S BASCONI AVE PNIB 160 DATE ISSUED:09/042012
OWNER'S PHONE: 4087770268 CAMPBELL,CA 95008 PHONE NO:(709)2469930
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG C ELECT C PLUMB
License Class C_39 Lic.4 /1 / S 2 tJ r I— r
�'] ( p MECH RESIDENTIAL COMMERCIALConte(�St _Kll Date- -I� L`_
1 hereby affirm.thael.am licensed under lhe.procisions of Chnpter.9 JOB DESCRIPTION: RE-ROOF 12 SQ-REMOVE EXISTING ROOF SYSTEM,
(commencing with Section 7000)of Division 3 of the Business S ProfessionsINSTALL NEW CLASS A ASPHALT SHINGLES,AGED DARK
Code and that my license is in full force and effect
I 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:$6000
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
.APN Number:36232011.00 Occupancy Type:
API'LICAN'I'CISR'1'IPICATION
I certify that I have read this application mid state that the above infommtion is
correct.1 agree to comply with all city and county ordinances and slate laws relating
to building construction,and hereby authorize representatives of this city to enter PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION.
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source regal ims per the Cupe it Municipal Code,Section .r,/ �nr
9.18. Issued by: 5_5 / �7 Date: 9•'f��
Signature` f — -- Date/
❑ O\VNER-RUILIIF,R DECLARATION RE ROOFS:
All roofs shall be inspected prior to any roofing material beimg installed.If a roof is
hereby affirm that 1 am exempt from the Contractor's License Low for one of installed without first obtaining an ins eclion,I agree to remove all new materials for
the following two reasons: I inspection.
I,as owner of the property,or my employees with wages as their sole comlxnsation,
will do the work,and the structure is not intended or offered for sale(Sce.7044, Signature of Applicant: Dale:
Business d Professions Code)
I,as owner of property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business R Professions Code).
--------ALU ROOF COVERINGS TO BE CLASS"A"OR BETTER'
I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's 1 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 R 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 R
I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material.
,Additionally,should 1 use equipment or devices which emit hazardous air
Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will
permit is issued. maintain compliance with the Cupertino Jtunicipal Code,Chapter 9.12 and the
I certify that in the performance of the work for which this permit is issued,I shall Health S Safety Code,Sections 25505.25533,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 ceniBeme of exemption,I ( iivnr riz gent:
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.
CONS'IR11C1'ION LENDING AGENCY
APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's
I certify thatLI have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.)
correct.I agree to comply with 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 aceme against said City in consequence of the ARCHITEC71"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
I I Signature of Applicant/Agent. [�/(�L� ��J��s//�� Date's
RernaJPolin' ?0l/.dor revised 02//6/11
CITY OF CUPERTINO I I,LO`b
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: GARDENSIDE CIR DATE: 08131/2012 REVIEWED BY: SYLVIA
APN: BPH: 'VALUATION: $6,000
*PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Duplex PENTAMATION 1SFDWLR00F
USE: PERMIT TN'PE:
NVORK RE-ROOF 12 SQ- REMOVE EXISTING ROOF SYSTEM INSTALL NEW CLASS A ASHPALT
SCOPE SHINGLES AGED BARK
FEED) ROOFAREA
s.f.
1REROOFFRES 1,200
Meeh. Plan Check Plumb. Plan Cheek F.lec. Plan Check
,Wech. Permit Fee: Plumb. Permit Fee: EiecPermil Fee:
Other M&A Trop. Other Plumb Insp. Other Etec.Imp.
.Wech.hup. Fee: Plumb. Insp. Fee: Elco lay-Fee:
NOTE: This estimate does not include jeer due to other Departments(i.e. Planning, Public Works, Fire,Sanitary Sewer District,School
District,etc.). These fees are baser/on the reliminaninformation mailable and are only an estimate. Contact the De ! or addn'/info.
FEE ITEMS (Fee Resolution 11-053 ED' 7/1111) FEE QTY/FEE MISC ITEMS
Plan Chec%Fee:
S'uppl. PC Fee
Plmnb./1lech./6lec
Permit Fee: $180.00
Suppl. Insp Fee
Phmib.41,1ech./Elec
Plunih./Meeh./Elec. Permil Fee:
Construction Tax:
Administrative Fee:
Work Without Permit? O Yes (j) No $0.00
Advanced Planting Fees:
Travel Documentation Fees: A
Strome Motion Fee: /BSEISMICR $0.60 Select an Administrative Item
Bldg Stds Commission Fee: IeCaSC $1.00
SUBTOTALS: $181.60 $0.001 TOTAL FEE: $181.60
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•buildingecuoertino.arg
PROJECT ADD O C
APN
OM'N�FI[NAM1AC, 1 ^ PHONE "J / QIo E-MAIOLC• `l 1
STREETY DRESS r , ` fITV.STVAJTE,Z "t b O FAX
sI Gr no LA SO lq
C Cm NA,IE LICENSE NUMBER LICENSE TYP BUS.LIC.M.
M 1L \ t� `,_
COMPANY NAME E-MAI M FAX -12 - _
C�sSTREET ADORFSS ` ' ` , t C� f1TY.STATE ZIP 1 S ONE U
^
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-Oft'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.
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 5126.00. 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. 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:
RerooJPolicv_:01l.doc revised U/16/Il
REROOF PERMIT APPLICATION 1/
COty MUNITY DEVELOP11dENT DEPARTMENT•BUILDING DIVISION ,..�(`1 bo
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255riV-N�
(408)777-3228 • FA:((408)777-3333•buildinq(@(;uoertino.Drg
CUPERi INO
PROJECT.. V Z: O r eq) kV__- `
APN0 /1 / _(? O
OWNER NAME \_ 1!, C P E ^ ,�J EMAIL
Yr � l
STREET ADDRESS ]enSl c Y. srATE.zlnn cn FAX
CONTACT NAf'IE �5 PHONE E-ALAIL
STREETADORESS CITY,STATE.ZIP FAX
❑ OWNER ❑ OWNER-BCTLDER Cl O%VNERAGENT CONTRACTOR 11 COM1TRACIDRAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER Cl TENANT
CONTRACT RNAAW LICENSEN MBER LICENSE TYPE BUS.LIC.a jO
COMPANY'NAME E"6LA (\G FAX
STREET ADDRESS CITY,STATE.;IP PHONE
r C n •�
ARCHITECT/ENGINEER NAME LICENSE NTRaBER BUS.LIC.a
CONIPANY NAME E.%IAIC FAX
STREET ADDRESS CT',STATE,ZIP PHONE
USE OF ❑ SFD or DupteX ❑ D'Iuld-Family, ROOF dREA: VALUATION:
.. C]STRUCTURECOnintercial POO S • C4 �(J �•
EX[STINGROOFTYPE: /CIBUILTIJPROOF ❑.ASPHALT SHINGLES �G2'WOOD SWVCES 11 WOOD SHINGLES ❑OTHER(SPECTY)
REMOVE/REPLACE DYES IF NO. /A1 PLY0..00D f.7 V ❑ PLriYD ❑ OSB PITCH: ROOF
❑ O a6 Y RS' y THICKNSS � ❑ VSA TtPB ❑fpX '(, A
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF 2 ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC ES REPORT
DESCRIPTION OF WORK: C.
By my signature below,I tertiry W each of the following: I am the property owner or authorized agent to act on the proper,owner's behalf. I have read this
application and die information I have provided is cored. I have read the Description of%VorR and verify it is accurate. I agree m complywith all applicable local
ordinances and state laws relating to bbuili/ng cons/9-+�q�on. 1 au riz zpresentatives of Cupertino ro enter the abo/vo-idcntif d property for inspet[ion purposes.
Sigdatureol'Applicant/Agent:�.(/lAii�f_7't-C Date: 710��o��Z�Z
SUPPLEbtENf.4LINFOP ATIONREQUIRED OFFICE USE ONLY
U building is associated with a Horne Owners Association,provide letter PLANCRECKTY'PE ROUT-UNG SLIP
1
of approval from HOA. ❑ OVER.THE-COUNr6R ❑ BUILDING PLAN RcvTEw
Provide Planning approval to verity if there any restrictions. ❑ EXPRESS ❑ PLANNING PLAN REYIEw
_Provide copy of maufacturers Installation Specifications. ❑ TAdDARD ❑ FU E DEPT
Provide signed cop,of Cupertino's Teat-Off Policy. ❑ OTHER:
Reroofdpp_011.doc revised 03.'16!11
W