12080325 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20679 GARDENSIDE CIR CONTRACTOR:BRADSHAW ROOFING INC PERMIT NO: 12080325
OWNER'S NAME: COLEMAN JOSE M AND JUDY C 1821 S BASCOM AVE PMB 160 DATE ISSUED:09/042012
OWNER'S PHONE: 4082530596 CAMPBELL,CA 95008 PHOSEN0:(408)246-9930
LICENSED CONTRA^C`TOR'S DECLARATION BUILDING PERMIT INFO: BLDG 1_ ELECT r. PLUMB r
License Class —3 Lia 4 7 / 1 7 G r� r r
14-t
` , � MECH RESIDENTIAL COMMERCIAL
Contractor Dale If
hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION:RE-ROOF 12 SQ-REMOVE EXISTING ROOF SYSTEM,
(commencing with Section 7000)of Division 3 of the Business&Professions INSTALL NEW CLASS A ASPHALT SHINGLES,AGED BARE
Code and that my license is in full force and effect.
1 hereby affirm under penalty of perjury one of the fallowing 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:36232001.00 Occupancy Type:
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
correct.1 agree to comply with all city and county ordinances mid state 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 laid 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 egu aliams per the Cupertino Municipal Code,Section nTG
9.18. ,r (/ Issued by /✓ rd Date: !�
Signature z�tet/ 2- Date q&_12
_
❑ OWNER-BUILDER DECLARATION RE-ROOFS:
All roofs shall be inspected prior to my roofing material being installed.If a roof is
hereby affirm that 1 am exempt from the Contractor's License Law for one of installed without first obtaining an ins a on,I 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, 711,111.z
will do the work,and the structure is not intended or offered for sale(Sec.7044, Signature of Applicanl:, � Date:
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 COVERINGS TO BE CLASS",V'OR BETTER
hereby affirm under penalty of perjury one of the following three
declarations: IIA7-ARDOUS MATERIALS 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 Health&
I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should 1 store orhandle 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 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 for which this permit is issued,I shall Health&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 certificate of exemption,1 0¢'mr oar rze
d d nt:
become subject to the Worker's Compensation provisions of the Labor Code.I must FF//rr1�f,
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
APPLICANT CER TI F'ICATION I hereby affirm that there is a construction lending agency for the performance of work's
I certify that I have read this application and state(hat the above information is for which this permit is issued(Sec.3097,Civ C.)
correct. I agree to comply with all city am]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 ARCII ITECT'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
5
0�2
b� CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION 1 v
ADDRESS: GARDENSIDE CIR DATE: 08/31/2012 REVIEWED BY: SYLVIA
97APN: BP#: -VALUATION: 1$6,000
*PERMITTVPE: Minor Building Per PLAN CHECK TYPE: Re-roof
PRIMARY PENTAMATION
USE: SFD or Duplex PERMITTYPE: 1SFDWLROOF
WORK RE-ROOF 12 SQ- REMOVE EXISTING ROOF SYSTEM INSTALL NEW CLASS A ASHPALT
SCOPE SHINGLES AGED BARK
FEE ID ROOFAREA
s.f.
1REROOFFRES 1,200
Mech. Plan Check Phonh. Plan Check - Elee. Plan Check
mech.Permit Fee: Plumb.Permit Fec: Elec. Permit Fee:
Other,Meeh. Insp. Other Plumb Insp. Other Elce. /mvp.
.blade.Imp,Fee: Plumb. beep. Fee: E•lec.Inp. Pec:
NOTE: This estimate does not includejees due to other Departments(i.e. Planning, Public Works, Fire,Sanitary Sewer District,Set not
District,ere). These feav are based on doe preliminanv information available and are adv at estimate. Contact the Dept for addn'I info.
FEE ITEMS (Fee Resolution I1-053 E/L 7/1/11) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Suppl. PC Pec
Phatb./Jlech./Elec
Permit Fee: $180.00
SuppL htsp Fce
Plunth./hle ch./Elec
Plunth./Mech./Eley. Permit Fee:
Construction Tax:
Administrative Fee.:
Work Without Permit? O Yes 0 No $0.00
Advanced Planting Fees:
Travel Documentation Fees:
Strong Motion Fee: IBSEISMICR $0.60 Select an Administrative Item
Bldg Sids Commission Fee: IBCBSC $1.00
SUBTOTALS: $181.60 $0.001 TOTAL FEE: $181.60
Revised: 07/01/2012
REROOF PERM11 i APPLICATION
COMMUNITY DEVELOPIbfENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 µms^
CUPERTINO (408)777-3228 • FAX•(408)777-3333•buildina(acuDertino.ora
PROIERD,(](I( C r e,'1 ` r- .APN° 3 a - a - oo .
OWNER NAABE ^J �-e— "til a(;3—ncq4
E44AIL
STREET.ADDRESSYZi
�SICC, C FAX
CONTACT NAME PHONE E-ALAIL
STREET ADDRESS CITY,STATE. ZIP FAX
❑OWNER ❑ 0\4lTA BLIlDER ❑ Ol%N RAVENF CONIR\LTOR ❑CONTRACrORAOENT ❑ ARCHITECT ❑ETCAIEER ❑ DFVELOPER ❑TEHANI'
CONTRACT RNAJIE LICENSENU\tBER LICENSE TYPE BUS LIC.=
joG
COMPANYNAA¢ -,wU �C Ac FIX
i1
�jj
STREET ADDRESS _' CITY.STAiE [P PHONE
ClCa S�oK
ARCHITECTIENGLYEERNAME c LICENSE NUAm ER BUS.LIC,d
CONa ANY NAME E.UR FAX
STREET ADDRESS CM%STATE.ZIP PHONE
USE OF ❑ SFD or Duplex ❑ A•fuld-Family, ROOFAREA: VALUATION://��
STRUCTURE. ❑ CoUrnercial. f���� S C4 / E no o f
EXISTINGROOFTYPE ❑BUILT-UPROOF ❑ASPHALT SHINGLES hdWOOD SHAKES ❑WOODSHINGLES ❑OTHER(SPECTY)
REMOVE/REPLACE 94ES IF YO, /It PLY:':DOD 13<V ❑ PLMD EJ OSB PUCK ROOF
❑ No a L F Rc L If NES.- ❑ :S' I TNVE ❑ r13X 1 1 1) ASS. A
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT:
DESCRIPTION OF WORK: ,i
CACaaaA c
L r
By my signature below,I certify to each of the fallowins: I am the property owner or authorized agent to act on the proper, o:\ner's behalf. I have read this
application and the infarmationI have provided is correct. I have read UK Description of Wort:and verify it is accurate. I agree tOcomply with all applicable loc I
ordinances and state laas relating to buil�in an. on. 1 au oriz epresentatives of Cupertino to enter the abo/ve-iden Il d property for inspection purposes.
Signature of.4ppficanJ.-Agenr. (As, Date: :2 ate anl�-
SUPPLEMENTAL INFORALkTION REQUIRED OFFICE USE ONLY
_ If building is associated With R Kone O\:TIerS ASSOCIadOO,provide letter PLAN CRECK-ME ROUTING SLIP
UI approval from[{OA.
r^-
El ❑ BUILDrXGPLAXREVTEW
_Provide Planning aprovnl en verity'inhere arty restricdonS. ❑ EXPRESS ❑ PLANM:NG PLAN REVIEW
Provide Copy Of NiMulfaCnlrer S Installation Specifications. ❑. STANDARD ❑ FIRE DEPT
_Provide signed copy of Cuper ino s Tear-Off Policy. ❑ OTHER:
Rerooflpp_?011.aoc rwised O3.%76ilI
REROOF TEAR-OFF POLICY
2 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-buildinggp' upertino.orq
APN 0 36a _ 3,)- o o
OWNERNS (a P ONE _ E-MAIL
STREET ADDRESS CITY.STATE,Z FA%
SI C,r r.o (J) SO
C CTO NA. E LICENSE NUMBER LICENSE TYP BUS.LIG N.
COMPANY NAME E-MAI Ve FAX - v
STREET DRESS ` , t C! CITY.STATE,ZIP ONEI 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 '/4" 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: 1 am the property owner or authorized agent to act on the
property owner's behalf. I understand and agree to coinply 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:
ReroofPolin,_701 Ldoc m ised 02/16111
1