12090068 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21106 WHITE FIR CT CONTRACTOR:FOUR SEASONS PERMITNO: 12090068
ROOFING
OWNER'S NAME: ZHIBIAO WU OR QIN ZHU PO BOX 1668 DATE ISSUED:09/132012
OWNER'S PIIONF: 4082916705 SAN JOSE,CA 95109 PHONE NO:(408)278-0330
LICENSED CON I RACI'OR'S DECLARATION •1011 DESCRIPTION: RESIDENTIAL❑ COINIERCLU,
11
License Class C-31 Lie.# -{1 Gi�Vd TEAR OFF EXISTING WOOKSHAKE AND INSTALL I/2"
COX
Contractor �. / �1�`��/ Date C —LiJ PLYWOOD THEN 30# FELT UNDERLAYMENT, INSTALL
I hereby affirm that 1 am licensed under the provisions ofChapter 9 CERTAINTEED PRESIDENTIAL COMP SHINGLES
(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 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 die Labor Code,for the
performance of the work for whichthis 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 die performance of die work for which this
AIi\Number:35905085.00 Occupant)Type:
permit is issued.
Al'l'I,ICANT CER'1'IpICAI'ION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.I agree to complywith 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
granting of this permit. Additionally,the applicant understands and Will comply Issued by: Date:
with all non-point source re latices per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature Date 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.
/Z1❑ OWNER-RUILDER DECLARATION nC 9
Signature of ApplicaDate: '13 —/2-
1
hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: ALI,ROOF COVE S•r0 BE CLASS"A"OR BETTER
I,as owner of the property,or my employees with wages as their sole comfcnsation,
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 with licensed contractors to IIAZARDOIIS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Ilealth&Safety Code,Sections 25505,25533,and 25534. 1 will
hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code.Chapter 9.12 and the
declarations: Ilealth&Safety Code,Section 25532(a)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should 1 use equipment or devices which emit hazardous
Compensation,as provided for by Section3700 of die Labor Code,for the air contaminants as defined by the Bay Area Air Quality Dlanagemcat District 1
performance of the work for whichthis 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 Cade,Sections 2,5,505,255 3.and 25. 4.
Section 3700 of the Labor Code,for die performance of the work for which this C,_ /�[��•
Owner or authorized agent:gent: Uate:
permit is issued.
I certify that in the performance of the work for which this permit is issued.I shall
not employ any person inany manner so as to become subject to the Worker's
Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCT LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must 1 hereby affirm 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
APPLICANTCF,RTI FICATION Lender's Address
I certify that I have read this application and state that the above information is
coffee[.1 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 ,\RCIII'TF,CI"S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
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
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•buildingPcugertino.org
PROJECT ADDRESS 2/ O APNN
OWNER NAME PHONE E-MAIL
-2hijIAa op-2-SI
_60
STREET ADDRESS
CITY.STATE.��JPP,, 1 CA FAX
5,4A4e C�� ctrliYo
CONTRACTORNAME LICENSENUMBER LICENBUS.LIC.0
4 to
COMPANY NAME E-MAIL ` •7� FAX
5 ecu
STREET ADDRESS �Z l CITY.STA Tial PHONE
^ Ca 1 1 08-2�fr 0330
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 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$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 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: — O /2
Re,woJ71o1ico_2011.doc revised 02/16/11
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO,CA 95014-3255
C V PERTINO (408)777-3228• FAX(408)777-3333•buildinGCalcupertino.orG
PROJECT ADDRESS 24/04 111ALlAPN.
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OWNERNANIE • • PHONE E-MAIL
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STREET ADDRESS CI STATE.ZIP FAX
Z G So ;
CONTACT NAME. PHONE EJL{IL
-0 30
STREET ADDRESS ScZCITY.STATE.ZIP
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&LA Tose, CA 51Fa
12
130u'NFR 13Ow'FER-BUILDER ❑ OWNERAGENT JS,�/011RACTOR ❑CO\'TRACTOR AGENT ❑ ARCHITECT ❑ENGINFER ❑ DEVELOPER ❑ TEN.NT
CONTRACTORN'AfIE LICF-NSENCNIBER _17,1 OR LICENSE 'PE_59 BUS.LIG•
COMPANY N,{MEE-.\IAIL
5 FAX
STREET ADDRESS CITY.STATE.ZIP PHONE
S'07- w o5¢ C 1?-0
ARCHITECTrENGINEER NAME LICENSE NUMBER BUS,LIC.
COMPANY NAME EMAIL
FAA
STREET ADDRESS CITY.STATE ZIP PHONE
USE OF ❑ SFD of Duplex jr Multi-Family ROOF AREA: �/ vALL•A ION.. # p
STRUCTURE: ❑ Commercial $ s�
EXISTING ROOT TYPE: ❑BUILT-CPROOF ❑ASPI(ALT SHINGLES PCOODSHAAES ❑UOODSHINOLES ❑OTHERISPECIFY)
REMOVF.:REPLAI YES IF NO. :1 lif! ❑ FLYWD ❑ OSB PITCH: ROOF
❑ N .LAYF0. K1 SS' ❑ TYPE' 2(rDX l CLAS- A
PROPOSED ROOF TPE: ❑BCLLT-UP ROOF ASPHALT SHINGLES ❑%%ODD SI IAKES ❑ROOD SHINGLES ❑OTHER IMES REPORT.
DESCRIPTION OF WORE:
I�Ztt
0-ct-lroliirt
as
a
H}'my signature below.I cenifs'to each of the following: 1 am the property owner or authorized agent to act on the property owner's behalf. 1 hase read this
application and the information I have provided is correct. 1 have read the Description of work and verify it is accurate. I agree to comply with all applicable local
ordinances and state lazes relaling to building cons r lion. I a orize represe [iv of Cupertino to enter the above-identified property'for inspection purposes.
Signature of Applicant/Ag ru: Date: go 12
SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY
If building is associated Leith a Home Owner's Association,provide letter PLANCHECKTYPE ROUTING SLIP
of approval from HOA. ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW
Provide Planning approval to verify if there any restrictions.
❑ ECPRFSS ❑ PLAN:\INCPLASREVIEW
Provide copy of Manufacturer's Installation Specifications. ❑ STANDARD ❑ FIRE DEPT
Provide signed copy'Of Cupenino•S bear-Off Policy. ❑ OTHER:
Reroojdpp_201 Ldoc revised 03116111
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
9ADDRESS: 21106 White Fir Ct DATE: 09/11/2012 REVIEWED BY: Beth
APN: 35905085 BI'#: 12090068VALUATION: $4,500
"PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY .SFD or Duplex 13ENTAMATION 1SFDWLR00F
USE: PERMIT TYPE:
WORK �sinqie family residential re-roof
SCOPE
FEEID ROOFAREA
s.f.
1REROOFFRES 1,300
.Nath. Platt Cheek Plumh,Plan Check Flee. Plan Clue,
bte.In.Permit Fee: PLrmh.Permit Fee: Lor. Permit Fcc•:
Other dfech. Itup. Oth.r Plumb lisp. Other Flee. Imp.
Meek]its/).Fee: P/uanh. Insp. Fee: Eley.Insp. Fee:
NOTE: This estimate does not includejees due to other Departments(i.c Planning, Public Works, Fire,Sanitary Server District,School
District,etc. . These fees are baser/tan the prelindnarl•information mailable and are only nn estinmte. Contact the De t or(itiflit'I in a.
FEE ITEMS (Fez Resohaion 11-053 EB' 711111) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Sitppl. PCPee
Plumb./Afech.lElec•
Permit Fee: $195.00
Snppl. ltup Fee
Phtuh./Mech.:'Elec
Phmtb,/Mech.;21ec Permit Fee:
Construction Tccc: 777
Ada r i n is t rat i ve.Fee.'
Work Without Permit? O Yes (F) No $0.00
:I tivemced Plati ning Fees:
Travel Documentation Fees:
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: 1 $196.501 $0.00 . TOTAL FEE: 1 $196.50
Revised: 07/0112012