12090168 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21094 WHITE•FIR Cf CONTRACPOR:FOUR SEASONS ROOFING PERMITNO: 12090168
OWNER'S NAME: BECK PAUL PO BOX 1668 DATE ISSUED:09/192012
OWNER'S PHONE: 4085612998 SAN JOSE,CA 95109 PHOSENO:(308)278-0330
:i?— LICENSED CON`FRACI'OR'S DECLARATION BUILDING PERAMT INFO: BLDG (_ ELECT rl PLUMB r
License Class C--J 1 Lie.k (4*1 2 1 0!
IM MECH r RESIDENTIAL r COMMERCIAL r
Contractor Iv 1r�r1__ I rJC. Date I"
9 —I'?—
1 JOB DESCRIPTION:TEAR OFF EXISTING WOOD SHAKE ROOF.INSTALL 13
hereby nffinn that I am licensed under the provisions of Chapter 9
(commencing with Section 7000)of Division 3 of the Business&Professions SQRS
Code and that my license is in full force and effect. 12"CDS PLYWOOD.THEN 30N FELT UNDERLAYMENI'.
INS IALL CERTAINTELD PRESIDENTIAL COMPOSITION
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
Section 3700 of the Labor Code,for die performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:54500
AI'PI.ICAN'I'CER'I'IFICA'1'ION
I certify that 1 have read this application mid state that the above information is APN Number:35905091.00 Occupaney'L'ype:
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
indemnify and keep harmless the City of Cupertino against liabilities,judgments, PERMIT EXPIRES IF WORK IS NOT STARTED
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR
with all non-point source regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION.
9.18. Q /Q r7
Signature Ihte /—// —/[� Issued by:
❑ OW'NER-B,�I rD DECLARATION
1 hereby affirm that I am exempt from the Contractor's Liccnse Law for one of RE-ROOFS:
the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
1,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for
will do the work,and the structure is nor intended or offered for sale(Sec.7044, inspection.
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to
Signature of Applicant. _ Dale:
construct the project(Sec.7044,Business&Professions Code). /
I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERIYGti'f0 BF-CLASS"A"OR IIF;PIER
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's IIAZARDOUS MATERIALS DISCLOSURE
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 read the hazardous materials requirements under Chapter 6.95 of the
1 have and will maintain Worker's Compensation Insurance,as provided for by California Ilealth&Safety Code,Sections 25505.25533,and25534. 1 will maintain
Section 3700 ofthe Labor Code,for the performance of the work for which this compliance with the Cupertino Municipal Code,Chapter 9.12 and the Ilealth&
Safety Code,Section_553_(e)should I store or handle hazardous material.
permit is issued. Additionally,should 1 use equipment or devices which emit hazardous air
I certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I will
not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Compensation laws of California. If,after making this certificate of exemption,I Ilealth&Safety Code,Sections 25505,25533,and 25534.
become subject to the Worker's Compensation provisions of the Labor Code,I must �
r•utl rze"tl,igcnC
Forthwith comply with such provisions or this pemtit shall be deemed revoked. Owner o?'t
A 1'1'1.1 CANT CERTIFICATION CONSTRUCTION LENDING AGENCY
I certify that I have read this application and stale than the above information is
correct.I agree to comply with all city and county ordinances and state Imes relating I hereby affirm that there is a construction lending agency for the performance of work's
to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.)
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the Lender's Address
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section ARCHI'fISCI"S DECLARATION
9.18.
1 understand my plans shall be used as public records.
Signature Date
Licensed Professional
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 21094 White Fir Ct DATE: 09/14/2012 REVIEWED BY: Sean
APN: S C sQ BP#: Aj2W& 'VALUATION: $4,500
*PERMITTYPE: Minor Building Permit PLAN CIIECK TYPE: Re-roof
PRIMARY Multi-Family Dwelling Buildina is PENTAMATION 1R2ROOF
USE: 3 Stories 0 Yes (D No PERMITTYPE:
1vORK Tear off existing wood shake roof. Install 1/2" CDX plywood then 30#felt underla ment. Install
SCOPE Certainteed Presidential Composition shingles. Color: CountryGray.
FEE ID ROOFAREA
s.f.
1REROOFMRES 1,300
Mesta. Plan Check Plumb. Plan Check F.lec.Plan Check
Alech. Permit Fee: Plumb. Permit Fec: F.lec.Permit Fee:
Other Mech.ln.rp. Other Plumb Insp. Li I Other Elce.Lap.
,Meeh.lump. Fec: Plumb, hixp. Fes Mer.Insp.Fee:
A'OTE: This ewimate does not include jeer due to otter Departments(i.e. Planning, Public Works, Fire,Sanitary Server District,School
District,etc.). These feav are based on the prelitninan information available and are only an estimate. Contact the De t or add n7 info.
FEE ITEMS (Fee Resolution I1-053 EfL 711111) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Sttppl. PC/,-cc
Phanb.111ech./1,lee
Permit Fee: $195.00
SuppL Insp Fee
Plnmb.1.4,lech.lrlec
PlunhJdiecb./Glee Permit Fee:
Construction Tar:
Administrative Fes:
Work Without Permit? O Yes (2) No $0.00
Advanced Planning Fees:
Travel Docmnenlalion Fees:
Strong Motion Fee: IBSEISABCR $0.50 Select an Administrative Item
131de Stds Commission Pec: IBCBSC 1 $1.00
1 1
SUBTOTALS: 1 $196.50 $0.00 TOTAL FEE: F $196.50
Revised: 07/01/2012
REROOF PERMIT APPLICATION
COMMUNITY IDEVELOPMENT DEPARTMENT•BUILDING DIVISION
2 10300 TORRE AVENUE.-CUPERTINO.CA 95014-3255
CUPERTINO (408)777-3228-FAX(408)777-3333•buildingpcuoertino ora
�a0 Q
PROJECT ADDRESS nlO .AP`-
'4-110
' - 3S9 9509
OWyER NdME
QO I "!C-40?)
HONE E-MAIL
nPm �ir
oS6STREEF.AUDRESS CISTATE.ZIP2/o UW+ M FAX
J v
CONTACT NAME PHOXE -
-Q 3o E-NIAIL
STREET ADDRESS
SC 2 CIT\'.STAI E.ZIP FAX
CA qr, iL2
❑OWNER ❑ OWNER-RVILDER ❑ OMNERAGENT A CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINF.F.R ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME LICENSE NUMBER '?
LICENSE 'PE
Four -5zeas
BLS.LIC.
COMPANY SAME E-MAIL
5 iA\'
STREET ADDRESS CITY.STATE.ZIP
PHONE
Q O$li:. (i $�Q
ARCHITECT,EUGINEER SAME LICENSE NUMBER
BUS.LIC.
'COMPANY NAME
MAIL FAX
STREET ADDRESS CIT\'•STATE ZI P
PHONE
LSE OF ❑ SFDorDuplex r. Multi-Family RODE AREA: VALUATION:
STRUCTURE: ❑ Commercial ��rr $ SQ
EXISTING ROOF TN PE: ❑BUILT-CP ROOF ❑ASPI IALT SHINGLES Xk%OODSHARES ❑\s'OODSHINGLES ❑OT'HF.RISPECIFYI
RENIOVF,:REPLACE YES IF NO. PLY\MOOD ❑ PLYW'D ❑OSB PITCH:
❑ N AVER ft00F
AC
I 'N ❑ YP r X :I2 A55 A
PROPOSED ROOF TYPE: ❑BUILT-UPROOF ACASPHALT SHINGLES ❑WOOD$I IARES ❑MOOD SHINGLES ❑OTHER ICC-ES REPORT:
DESCRIPTION OF\FORA:
lA if COX
# in
s�
Hy in) signature below.I ceni(,.�to each of the iollowingl I am the property miner or autho
application and the innzed agent m act on the propem'ownu's behalf. (have read this
Portnation I have provided is eortecL I have read the Description of Work and verify it is aceuram. I agree to comply with all applicable local
ordinance and start laws relating to building cons tion. I a oriu represe IN of Cupertino W enter the above-identified property for inspection purposes.
Signature of ApplicantlAgene O I
Date: 1.2
SUPPLEMENTAL INFORMATION REQUIRED
OFFICE USE ONLY
_ If building i
sd\vith a Home Owner's Association.provide letter -
PLAN--HECKTYPE .ROUTINGSLIP
Of approval .
L OYER-THE{OU\TER A{.I BUILDING PLAN REVIEW' 1
Provide Plaroval to verify if there any restrictions. /nom
EXPRESS PldRN1N'C PLAN REVIEW
Provide copInstallation Specifications.
STANDARD - ❑ FIREDEPT I
_Provide sigf Cupertino's Tear-Off Policy. ❑ OTHER: I
Xeroof.4pp_201l.doc revised 03//6/11
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•buildingocupertino.ora
PROJECT ADDRES / APNP 13 D
OWNER NAME Y PHON O -n^� E-MAIL
STREET ADD S CI .STATE,ZI 4Y TAX
2 y a C /uo
CONTRACTOR NAME UIENSEN A1BE LIC SE UPE BUS.LIC.N�jJ�
COMP 'Y NAM E-MAIL FAX
�-S /Il h/
STREETADDRFc� n CIS.STATE.ZIP _/ PH ON 27 '0
U/_ 1 UNDERSTAND AND AGREE TO THE FOLLOWING:
I. 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 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 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 11315 of
the 2010 California Residential Code.
Signature of Applicant/Agent: Date:
ReroofPo1icv_201 Ldoc revised 02116111