12090067 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21104 WIi ITE FIR CT CONTRACTOR:FOUR SEASONS PERMIT NO: 12090067
ROOFING
OWNER'SNAMF: SAJEYORTE)ALUPADIIYAY PO BOX 1668 DA'Z'E ISSUED:09/1312012
OWNER'S PIIONE: 4082916705 SAN JOSE,CA 95109 PHONE NO:(408)278-0330
LICENSED CONIRACFOR'S DECLARATION •TOR DESCRIP'T'ION: RESIDE\1'1AL U COMMERCIAL
License Class C�3 `jq
Lic.q - (R I Og TEAR OFF EXISTING WOOKSHAKE AND INSTALL 1/2"
COX
Contrucmr rS 1 - INC • Date — 3' a PLYWOOD THEN 30# FELT UNDERLAYMENT, INSTALL
I hereby affirm that 1 alicensed under the provisions of Chapter 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 the Labor Code,for the
performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$4500
1 have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 ofthe Labor Code,for the performance of the work for which this
ANN Number:35905086.00 Occupancy Type:
Permit is issued.
API'LICANI'CF:R'1'IFIC'I'ION
I certify that I have read this application mid state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinancesand 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 mlF�T CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against Iiabilities,judgments,'
costs,and expenses which may accrue against said City in consequence of the 3�/7
granting of this permit. Additionally,the applicant understands and will comply Issued by: Date: 'C�
with all noo-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature Date 9—/3— ;L All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed without first obtaining an inspection,1 agree to remove all new materials for
inspection.
❑ OWNER-RIIILDFR DECLARATION
Signature of Applicant: Date:
1 hereby affirm that 1 am ezem fa from the Contractor's License Law formic of
the following two reasons: ALL ROOF COVE .'G '1'O Bli CLASS"A"OR BETTER
I,as owner of the property,or my employees with wages as their sole comp:nsation,
will do the work,aid die simcturc 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 IIA7,ARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business 8•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
I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: 1lcalth&Safety Code,Section 25532(x)should I store or handle hazardous
1 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 be the Ray Area Air Quality Management District I
performance of the work for whichlhis 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 2550 ;VW,mnd25534.
Section 3700 of the Labor Code,for The performance of the work for which this
Ow ace or authorized ager • Dat
permit is issued.
Date:
I certify that in the performance of die work for which this perhit is issued,I shall
not employ any person inmry manner so as to become subject to the Worker's
Compensnlion Imvs of Califomia. If,after making this certificate of exemption,I CONSTR F1CI'�IEN)1NG AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this perrtil shall be deemed revoked. w'ork's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANI'CERTIFICATION Lender's Address
I certify that I have read this application and state�thal the above information is
correct.I agree to comply with all city and county ordinances and state laws reining
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property far inspection purposes.(We)agree to save ARCIII'I'ECI"S DECLARATION
and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of die 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•building(gv)cupertino.org
PROJECT ADDRESS APN#
W47-le-
OWNER NAME C ,i r , PHONE D - — O E-MAIL
J G 0. lJ
STREET ADDRESS CITY, ST E-YIP FAX
5 CA DqMl�j
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC.x
PCO"PANYNAMIE ` E-MAIL FAXS CITY.STATE.ZIP PHONE
SOrL f •Sse- CA $-O
1 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 S 126.00. The re-inspection fee shall be paid before another inspection
can be scheduled.
By my signing below, 1 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 R314 and R315 of
the 2010 California Residential Code.
Signature of ApplicanUAgent: Date: —
Rero J/Polic —?0l l.doc revised 021161/
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 21104 White Fir Ct DATE: 09/11/2012 REVIEWED BY: Beth
APN: 35905086 BP#: 12090067 VALUATION: $4,500
*PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Duplex PENTAMATION 1SFDWLR00F
USE: PERMIT TYPE:
WORK [siMle family residential re-roof
SCOPE
FEE ID ROOFAREA
(S.f.
1REROOFFRES 1,300
Mech. Plan Cheek Phanb.Plan Clneek Elee. Plan
Atreh. Permit I%.+a: Plumb, Pernvir Fee: Elea. Pcrnrir 17cc:
Other Alech. Insp. Other Plumb Insp. El
01her Elec Imp.
M•ch.Gr,p.Fee: Phanh.Iup. Fee: Elm Insp.Fee:
NOTE: This estimate doer not include fees clue to other Departments(i.e. Planning, Public Works, Fire,Sanitary Sewer District,School
District, etc.). These fees are based on the prelitninan•information available and are ooh,an estimate. Contact the Det for addn'I info.
FEE ITEMS (Fc:e Reourian 11-053 Eff 7/1/11) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Suppl.PC Fee
Plumb.iAfech..Flee
Permit Fee: $195.00
Srrppl. /rzp Fee
Phuuh_%ddcc•h_!Elec
Plumb.• lech.;Elee Permit Fee.:
Construction Tac:
Adminisir•ative Fee:
Work Without Permit? O Yes No $0.00
:I dviurced Plunning Fees:
Travel Documentation Fees:
Strong Motion Fee: IBSEISAIICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $196.501 $0.00 TOTAL FEE: $196.50
Revised: 07/01/2012
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO,CA 95014-3255
CUPERTINO (408)777-3228• FAX(408)777-3333•buildinD D(v)cuoertino.orD
/'�qDgo06 r7
PROJECT ADDRESS APS• '
Z//o s QS-
OWNER NAME PHONElf(l E-MAIL
.q
STREETADDRESS V I CI STATE.ZIP FAX
e rCA . CZS-014
CONTACT NAME PHONE E-MAIL
- 18-0330
STREET ADDRESS CITY.STATE.ZIP
S FAN
❑OU']FR ❑ Ow NER-BUILDER ❑ Ou'NERAGERT ArCONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENOMF.F.R ❑ DR-ELOPER ❑ TENINT
CONTRACTORSAME LICF.NSENLNIBER _12,1 I LICENSE 'PE I BUS.LIC
COMPANY\AMC S 6NINL FAX
STREET ADDRESS CITY.STATE.ZIP PHONE
S"07- a ose C 8-0
ARCHI TECT�ENOINEER NAME LICENSE NUMBER BUS,LIC.
COMPANY NAME E-MAIL
FAX
STREET ADDRESS CITY,STATE,ZIP
PHONE
GSE OF ❑ SFD or Duplex X Multi-Family ROOF AREA: w/ VALUATION: �y
STRUCTURE. CI Commercial J� W
S
EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPIIALTSHINGLES OWODDSHARP.S ❑WOODSHINGLES ❑OILIER ISPECIFYJ
REMOYE:REPLACE 01yFS IFNO. PLYWOOD ❑ P0WO ❑OSB PITCH' ROOF
❑ N AA'FR ICRNE S ❑ 5'" TSP x :1 � rLAsq A
PROPOSED ROOF TYPE: ❑BLILT-UPROOF ASPHALT SHINGLES El WOOD SHAKES ❑WOOD SHINGLES ❑OTHER IMES REPORT.
DESCRIPTION OF\TORI::
+I,%OA 41+ n.�er4Lt'�,_F;nal�l inC�a
a yl
By my signature below.I cenire to each of the follo%%ing: I am the property ovner or authorized agent to act on the property owner's behalf. I have read this
application and the inflamunion I have provided is correct 1 have read the
ordinances and state laws relating w building cons ZiDescription of work and verify it is accurate. oca
agree to comply with all applicable ll
on. I a' oriu represe tic •of Cupertino to enter the above-identified property'for inspection purposes.
Signature of ApplicanliAgentl Date: O
SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY
If building is associated With a Home OWner's Association.provide!ever PUN CHECK TYPE ROUTIN'C SLIP
of approval from HOA. ❑ OVER-THE-COUNTER ❑ BuILDINO PLAN REVIEW
_ Provide Planning approval to verify ifthere any restrictions.
❑ EXPRESS ❑ PLANYIFC PLA.\'REVIEW
_ Provide copy of Manufacturer's Installation Specifications. ❑ STANDARD ❑
FlRE DEPT
_ Provide signed copy of Cupenino'S Tear-Off Policy. ❑ orxeR:
Reroof4pp_201 I.doc revised 03/16111