12080327 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20676GARDENSIDECIR CONTRACTOR:BRADSHAW ROOFING INC PERMIT NO: 12080327
OWNER'S NAISIF-: NELSON WILLIAM T 1R AND JACKLE 1821 S BASCOM AVE PMB 160 DATE ISSUED:09/04/2012
OWNER'S PHONE: 4089963829 CAMPBELL,CA 95008 PHONENO:(408)246.9910
GIV ///LIIIICENSEED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r r ELECT PLUMB r
License Class Lic.4 /(� e r M1IEC11 RESIDENTIAL COMMERCIAL
Contmetar LJ!'fx C S�et/ Date _� •
hereby affirm that I am licensed order 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 BARK
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.
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.
ANN Number:36232012.00 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 the above mentioned property fur 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 mid will comply
with all non-point source re ulations per the Cupertino Municipal Code,Section
9.18. �/ Issued by:9 �Ei�/✓ T/�/� Date:GJ �•f�
Signature Date IfZ
❑ OWNER-BUILDER DECLARATION RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed.If a roof is
hereby affirm that I 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 fallowing two reasons: inspection.
I,as owner of the property,or my employees with wages as their sole compensation, — /�/ 2
will do the work,and the structure is not intended or offered for sale(Sec.7044, Signature of Applic int' Date:
Business&Professions Code)
I,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 CUSS".\"OR BETTER
hereby affirm under penalty of perjury one of the following three
ILA"'/.ARDOUS\I,\9'ERI,\IS DISCLOSURE
declarations:
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 Codeand 25534. 1 will maintain
,for the California Health&Safety Code,Sections 25505,25533,
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 I store or handle hazardous material.
Section 3700 of the Tabor 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 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 any manner so as to become subject to the Worker's /f
Compensation laws of California. If,after making this certificate of exemption,I O ner c r 1 izpJi'gent:
become subject to the Worker's Compensation provisions of the Labor Code,1 must (/ Gam. Date: Z
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING.AGENCY
APPLICANT CERTIFICATION 1 hereby affirm thin there is a construction lending agency for the performance of work's
I certify that I have read this application and state that the above information is for which this permit is issued(See.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 liabilitics,judgments,
costs,and expenses whence of the ARCIIITF.CI"S DECLARATION
granting of this pemmil.Additionally,the applicant understands and will comply
which may accrue against said City in consequence
with all non-point source regulations per the Cupertino Municipal Code,Section 1-understand my plans shall be used as public records.
9.18.
Licensed Professional
Signature Date
• l o
N19 CITY OF CUPERTINO ^Db
�O FEE ESTIMATOR - BUILDING DIVISION \
ADDRESS: GARDENSIDE CIR DATE: 08/31/2012 REVIEWED BY: SYLVIA
APN: BP#: -VALUATION: $6,000
*PERMIT T)'PE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Duplex PENTAMATION 1SFDWLROOF
USE: PERMIT TYPE:
)VORK RE-ROOF 12 SQ- REMOVE EXISTING ROOF SYSTEM INSTALL NEW CLASS A ASHPALT
SCOPE SHINGLES AGED BARK
FEE ID ROOF AREA
s.f.
1REROOFFRES 1,200
bfceh. Plan Check Plumb.Plan Check Flee. Plan Check
blech. Permit Fee: Plamh. Permit Fee: Elec.Permit Fee:
Other A1ech. Insp. Other Plumb/nsp. Other Flce.Insp. Ll
Adech.lase.Fee: Plumb. buji. Fee Elec.Insp.Fee:
NOTE: This estimate Anes not include fees due to other Departments(i.e. Planning, Public I1'orks, Fire,Sanitary Sewer District,School
District.etc. . These eev are based on the reliminan information available and are only an estimate. Contact the De 1 or athin'I in a.
FEE ITEMS (Fee Itesohaian 11-053 0' 7/1/111 FEE QTY/FEE MISC ITEMS
Plan Check Fee:
SnppL PC Fee
Plumb.Gldech./Elec
Permit Fee: $180.00
.Suppl. /nsp Fc e
PlumbAllech./Elec
Plumb./A%ch./Elec Perntir Fee:
Consnvction Tar:
Administrative Fee:
Work Without Permit? Yes Q No $0.00
Advanced Pltnnhing Fees:
Trewel Dowunentaliun Fees: A
Strone, Motion Fee: IBSF.ISAIICR $0.60 Select an Administrative Item
Blde,Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $181.60 $0.00 TOTAL FEE: 1 $181.60
Revised: 07/01/2012
REROOP PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO.CA 95074-3255
CUPERTINO (408)777-3223 - FA.((408)777-3333•buildino(acupertino.oro 1�
PROJECT C
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0 EANAP� S ^ r I ('r` ` ,yA, ` co 1 EM1IAIL
STREET.•1DDRESS 'f�f1SI C STATE,Zi b FAX
CONTACT NAME �j PHONE E-KAIL
STREET ADDRESS CITY,STATE.ZIP FAX
❑OttTER ❑ OAVNER•BUM OER ❑ DB'NERAGENr COItMICTOR ❑CON'iRACTCRAGEIN ❑ ARCmiEL7 ❑ENOwEER ❑ DEV9.OFea ❑TENANT
CON'rRiCT RNAME LICENSEMNSER LICENSE TYVE BUS,LIC.: '
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COMPANY NAA ,L\ t\c
.. b� F.iX
STREET ADDRESS C(TT.STA IP PHONE
ILA C_, ne�
ARCHfTEC tENGLYEER NAME LICENSE NM(BER BUS.UC.a
COAVANY NAME E.LVL FAX
STREET ADDRESS CT',STATE.ZIP PHONE
USE OF ❑ SFD or Duplex ❑ Muld-Family, ROOF AREA: VALUATION:
Peg S . F4
STRUCTURE. C3Convnerci;d �_/�
EXISTWO ROOF TYPE ❑BUILT.UP ROOF ❑ASPHALT SHINGLES ha WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY,
REFIOVEIMPLACE R,�ES IFNO. /,I1 PLY�:'OOp !v ❑ PLYWD ❑ OSB PfTCH: ROOF
❑ a ', RS. Y 'KNE<. ❑ <J- 9E ❑r X :I2
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF e ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT:
DESCRIPTION OF WORK: _
1 a
By my signature below,I cendy W each or the foliating: I am the property owner or authorized agent to act on the property owner's behalf. I have read this '
application and the information I have provided is correct. [have read the Description of YVorA and verify it is accurate. I agree to comply with all applicable Ictal
ordinances and state taus relating mebuil in to 'on. I au rig epresenratives of Cupertino to enter the above•idcntifted property,for inspection purposes.
Stgnamre ofApplicandAgenC �AJ Date: 5
SUPPLEMEYT.aL INFORDL•YTION REQUIRED OFFICE USE ONLY
_If building is associated With a Home OWners Associadon,provide letter PLAN CBECK TYPE . ROUTING SLIP
ofapproval from HOA. ❑ OVER-THE-COUNTER ❑ BUILDING PLANRIVTEW
_Provide Plouning upprov0l to veriN if there ally rppTlCdOnS. ❑ EXPRESS ❑ PI,ANhTNC PLAN RENEW
Provide copy Oflylanufacturers Installation Specificafi0ns. ❑ SrAND.aRD ❑ FHIEoEPT
,1 1
Provide signed copy of Cupenino's Tear-0R'Poli y. ❑ OTHER:
Rerooj4pp_?0I i.doc revised 03.•'1611
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-buildino(ocuoertino.org
PROIECT D SS( CI 7Pd
WNEft CME PHONE Ct
� —�� E-MAIL
RE55 CITY. STATE,2 FAX
s t Gr no LA SO
C Ci0 NA. E LICENSENU?IBE UCENSE TYPA. BUS.LIC.
COMPANY NAME E-MAI FAX 1-) - _
TET ADDRESS CIW.STATE,LP HONE Ni
U T s ce ' 1 5
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.
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 8314 and R315 of
the 2010 California Residential Code /
Signature of Applicant/Agent: Date: _Z]
RerooJPolic _2011.doc mvised 02116111