12090069 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21108 WHITE FIR CT CONTRACTOR:FOUR SEASONS PERMITNO: 12090069
ROOFING
OWNER'S NAME: FA-LIEN HUANG CHUNG PO BOX 1668 DATE ISSUED:09/13/1012
OWNER'S PHONE: 4082916705 SAN JOSE,CA 95109 PHONE NO:(408)278-0330
LICENSED CONT'RAC'T'OR'S DECLARATION JOB DESCRIPTION: RF,SIDF,NfIAL 11 COMMERCIAL
License Class C_3� Lic.N Y-79, 109, TEAR OFF EXISTING WOOKSHAKE AND INSTALL 1/2"
� (( COX
Contractor) Dateg- �3-�a PLYWOOD THEN 30# FELT UNDERLAYMENT, INSTALL
I hereby affirm that I am licensed under the provisions of Chapter CERTAINTEED PRESIDENTIAL COMPSHINGLES
(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 the Labor Code,for the
performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:&1500
1 have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for die performance of the work for which this
\I'N Number.35905084.00 Occupancy Type;
permit is issued.
AI'PLIC\NI'CP:R'1'IFICA"PION
I certify that l have read this applicationand state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.I agree to complywith all city mal 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 DAYSYROM.LAST CALLED INSPECTION.
indemnify and keep hamiless the City of Cupertino against liabilities,judgments,
costs,and expenses which may acerae against said City in consequence of the (7 3
Issued by: Dale:
granting of this permit. Additionally,the applicant understands and will comply I Z
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature Date — 3'I2 Ail 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.
❑ OWNER-RUILDER DECLARATION
Signature of Dale:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: ALL ROOF COVE :S I'O BE CLASS"A"OR BUITER
I,as owner of the property,or my employees with wages as their sole comp:nsation,
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUSMATERIALS 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. I 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: Health&Safeq 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 I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality lilanagement District
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 Code,Sections 25505.25533,and 25534.
Section 3700 of the Labor Code,for die performance of the work for which this
(hvncr or authorized agent: Date:
permit is issued.
1 certify thin in the performance of die work for which this permit is issued,I shall
not employ any person many manner so as to become subject to the Worker's
Compensation laws of California. If,after making this certificate of exemption,1 CONS"IRUCHON'LIiNDING AGENCY
become subject to the Worker's Compensnion provisions of the Labor Code,1 must I 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 work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLIC\N I'CERTI FICTION Lender's Address
I certify that I have read this application and stale 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 ,\RCII I'I'FCI"S DFCI,.\R.\TION
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
CUPERTINO 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255
(408)777-3228• FAX(408)777-3333• building(adcuoertino.org
PROJECT ADDRESS APN0
2 'r
OWNER NAMEPHONE E-MAIL
^n Cir, ' 1.in o - 6- 37
STREET ADDRESS SAME C ..STA 7 FAX
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC.Y
COMPANY NAAfE E-MAIL FAX
STREET ADDRESS CITY,ST LP PHONE
Sb 22 4b rA1
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. I also understand that
smoke detectors and carbon monoxide detectors are required to be installed in accordance with Sections 11314 and R315 of
the 2010 California Residential Code.
Signature of Applicant/Agent: Date: q-/0-/V
ReroofPolicv_2011.doe revised OJl611l
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
12-11 ADDRESS: 21108 White Fir Ct DATE: 09/11/2012 REVIEWED BY: Beth
APN: 35905084 BP#: 12090069 'VALUATION: 54,500
"PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Duplex PENTAMATION 1SFDWLR00F
USE: PERMIT TYPE:
WORK sin le family residential re-roof
SCOPE
FEE 11) ROOF AREA
s.f.
1REROOFFRES 1,300
Mach. flat Chztk Plumb. Phm Check Fleo. Phmo Check
3hech.Pernrfl Tar: Plumb.Permit Fee: F_ler,. Pcrmir Pec:
Other Afech. Imp. Other Phonh lose. Ll I Otber Flee. lnsp.
Aa•cn.Gu7t.Fee: P/ulnh. Irup, Fee: Eke. Insp. Fee:
NOTE: This estimate does'trot include fees due to other Departments(i.e. Planning, Public Works, Fire,Sanitary Server District;School
District, etc.). These fees tyre based on the prelintityarl information available and are ouh,nn evi mate Contact the Det or«thin'!info.
FEE ITEMS (Fee Resmlulinn l/-053 Eli: iii/l 11 FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Smppl,PC Fee:
Plumb,'Afach..flee
Permit Fee: $195.00
Snppl. lrr p Fee.
Plrumb..Alech.r"Elec
Phimb.Llleeh.'Elee Permit P•ee:
Coaviruction Tae:
Adnli uieir•nlive.Fee:
Work Without Permit? O Yes (D No $0.00
Advanced Plwmim;Feces:
Travel Doc•tnnenta/ion Fees
Strome Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bide Stds Commission Fee: IBCBSC $1.00
1 1
SUBTOTALS: $196.501 $0.001 TOTAL FEE: 1 $196.50
Revised: 07/01/2012
REROOF PERMIT APPLICATION
COMMUNIT3(DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO.CA 95014-3255
CUPERTINO (408)777-3228• FAX(408)777-3333•buildinD(okuoertino.orD
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PROIECi:\UDRES$ _{px
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OWNERN{ME r PHONE E-MAIL
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STREEI'.ADORESS I STATE.ZIP I FAX
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CONTACT NAME PHONE E-NTAIL
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STREETADORESS SCZ S CITY.STATE.IIP FAS
❑OWNFR ❑.OWNER.BLRLDER ❑ O0.NERAGENT A CONTMCrOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME LICENSE NC.MBER I LICENSE 'PE BUS.LIC.
Al 1
COMPANY NAME E-NIAIL FAX
STREET.{ODRF.SS CITY,ST.\TE.ZIP PHONE
S"07- a ase C 8-0
ARCHITECT,ENOINEER NAME LICENSE NUMBER BUS.UC.•
CONIP{NINAME E-MAIL
FAN
STREET ADORFSS CITY,STATE IIP PHONE
USE OF ❑ SFD or Duplex it Multi-Family ROOF AREA: VALUATION:
STRUCTURE: ❑ Commercial0 !yRR,� S SQ
EXISTING ROoFTYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES PGOODSHAKES ❑WOODSHINGLES ❑OaHF.RISPECIFYI
RCNIOVE:REPLACEYES I IF N0. PLYWOOD .- ❑ PLYw'D ❑OSB PITCH; ROOF
❑ N • AYFR ICKN ❑ .B- TYPE, :) A A
PROPOSED ROOF TYPE: ❑DCILT-UPROOF AC>SPHALT SHINGLES ❑WOOOSIAKES ❑%%OODSHINGLES ❑OTHER I(Yh[$REPORT.
DFSCRIPTIONOF\\'ORK:
1/Z(I
d +1{en 30# AI+ VpdQrlw�c•� F' A0,111
•� raeAf 001047 CowACY CA r&
B% my signature below.I certify to each of the following: 1 am the property owner or authorized agent to act on the propem•owner's behalf. I have read this
application and the information 1 have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating_to building cons tion. I a orize represe tis' of Cupertino to enter the above-identified property for inspection purposes.
Signature of ApplicandAgenC Date: O
12
SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY
_•If building is associated with a Home Owner's Association.provide letter PLAN CHECK TYPE ROUTING SLIP
of approval from HOA. ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW
Provide Planning approval to Yeri ry if there any restrictions. ❑ EXPRESS ❑ PLANNING PLAN REVIEW
_ Provide copy of Manufaclnrer's Installation Specifications. ❑ STANDARD ❑ FIRE DEPT
_ Provide signed copy Of Cupertino'S Tear-OITPolicy. ❑ OTHER:
ReroojApp_2011.doc revised 07/16/11