12090163 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21084 WHITE PIR Cf CONIRACI'OR:FOUR SEASONS ROOFING PERMIT NO: 12090163
OWNER'S NAME: SHIRLEY YANG PO BOX 1668 DATE ISSUED:09/192012
OWNER'S PIIONE: 4089712139 SAN JOSE,CA 95109 PHONE NO:(408)279-0330
R' LICENSED CON-RAC`FOR'S DECLARATION 1,-' r I-
�(� BUILDING PERMIT INFO: BLDG ELECT' PLUMB
License Class Lic.d r r. r
MECH RESIDEN9'L\L COMMERCIAL
Contractor `3 1e.. , N� • Date —I r� a
JOB DESCRIPTION:TEAR 017E EXISTING WOOD SHARE ROOF.INSTALL 13
1 hereby affirm[hill 1 am licensed under the provisions of Chapter 9 SQRS
(commencing with Section 7000)of Division 3 of the Business S Professions IP"CDX PLYWOOD,THEN 30#PELT UNUERIAYMIiNT.
Gude and that my license is in toll force and effect INSTALI.CERTAINTEED 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 the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:54500
A PP LI CA\I'CERTIFICATION
I certify that I have read this application and stale that the above information is ,\PN Number:35905093.00 Occupancy Type:
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.
Signature Datc • � l� Issued by: Date:
❑ OWNI7A-05ILLIF,R DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License law for one of RE-ROOFS:
the following two reasons: All roofs shall be inspected prior to any rooting material being installed.11'a roof is
I,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 not 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: Date:
construct the project(Sec.7044,Business&Professions Code). /' T
hereby affirm under penally of perjury one of the following three ALL ROOF COVERINGSOBE CLASS'S\"OR BE:l-TER
declarations:
I have and will maintain a Certificate of Consent to sclGinsure for Worker's IIA%\RDOUJ MATERIALS S DISCLOSURE
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued. 1 have read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain Worker's Compensation Insurance,is provided for by California health&Safety Code.Sections 25505,25533,and 25534. 1 will maintain
Section 3700 of the Labor Code,for the performance of the work for which this compliance with the Cupertino dlunicipal Code.Chapter 9.12 and the I lealth&
Safety Code.Section_553_(x)should I store or handle hazardous material.
permit is issued. Additionally,should I 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 dlnnicipal Code,Chapter 9.12 and the
Compensation laws of California. If,after ranking this certificate of exemption,I Health&Safety Code.Sections 25505,25533,and 25534.
become subject to the Worker's Compensation provisions of the Labor Code,I must
forthwith comply with such provisions or this permit shall be deemed revoked. Owner un nufh rlTeil agent: /•�
Date: 47= /9 �f•
APPLICAN"f CERTIFICATION CONSTRUC`1'I0N LENDING AGFNC\'
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 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 Cit'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
9.18. ARCIII'I'ECI"S DECLARATION
I understand my plans shall be used as public records.
Signature Date
—
Licensed Professional
REROOF TEAR-OFF POLICY
0 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•buildinaCadcupertino.org
PROJECT ADDRESS ^ / / APNM D� U
OWNERNAME S 'T PHONE E-MAIL
e -a 3
STREET ADDRESS ZIP FAX
Z/p� WL1'4-t F; CITY',$T, c4. ,; . C4 J-0
CONTRACTOR NAME LICENSE NUMB5 08 IF LICENSE BUS.LIC.0
at
COMPANY NAME EMAIL O FAX oC
4S0 S
STREET ADDRESS CITY,STA�I P PHON
SO2 r S c> .. ace- 4 I -03 O
I 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%" 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, 1 certify each of the following is true: I am the property owner or authorized agent to act on the
property owner's behalf. 1 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:
ReroofPolicv_2011.doc revised 02/16111
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 21084 White Fir Ct DATE: 09/14/2012 REVIEWED BY: Sean
APN: �S 0S' � BPIi: /e. 6 9D�� VALUATION: $4,500
*PERMITTYPE: Minor Building Permit PLAN CIIECK TYPE: Re-roof
PRIMARY Multi-Family Dwelling Building is 1R2ROOF
USE: >3 Stories Yes No PER111TT1'PE:
WORK Tear off existing wood shake roof. Install 1/2" CDX plywood then 30# felt underla ment. Install
SCOPE Certainteed Presidential Composition shingles. Color: Country Gray.
FEE ID ROOFAREA
s.f.
1REROOFMRES 1,300
Mech. Plan Check Phunh.Plan Check Flee. Plan Check
"ech. Permit Few Plumb. Per•mir Fee: Flec. Permit Fee:
Other,tlech./nrp. Orlrer Plumb/ncp. Other Flec.Insp.
Alech. Imp. rec. P1mub. hup. Fee: Flee.bup.Fee:
NOTE: This estinmte does not include jeer due 6r other Departments(i.e. Planning, Public Warks, Fire,Sanitary Sewer District,School
District.etc.). These fees are bused on lite prelitninarl information available and are onh,at estimate. Contact the De t or adda'I info.
FEE ITEMS (Fee Revohaion 11-053 E/T 7/1/11) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
SaPPI. PC Fee
I'lunib./Alech.lWe e
Permit Fee: $195.00
Supp/. Insp Fee
P1umb.1j1/ech./L•lec
Plunrh.hblech./F.lec Permit Fee:
Consavrclion Tm:
Administrative Fee:
Work Without Pennit? O Yes 0 No $0.00
Advanced Plarming Fees:
Travel Documentation Fees:
Strong;Motion Fee: 1BSFISAf1CR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $196.501 $0.001 TOTAL FEE: $196.50
Revised: 07/01/2012
I
REROOF PERMIT APPLICATION
COMMUNITY IDEVELOPMENT DEPARTMENT• BUILDING DIVISION
I
10300 TORRB AVENUE •CUPERTINO.CA 95014-3255
CUPERTINO (408)777-3228• FAX(408)777-3333•building(c)
/d v90 / 63
PROJECT:ADDRESS Z/o _APS= U) . -3� a
OWNER NAME PHONE E-MAILe o8
STREET ADDRESSCI STATE.ZIP I FAX 1
Q ^ G CL .
CONTACT NAME PHONE EJIAIL
STREET ADDRESS Sot S CIT'.STATE, ZIP I FAX
❑ON'RFR ❑ OWNER-81.11,0ER ❑ OU'NER AGENT /( CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTR,\CTOR NAME LICENSE NUMBER LICF.SSE 1"PE' BLS.LIG
COMPANY NAME E-MAIL FAN
SAME
STREET ADDRESS Y.STATE.ZIP PHONE
Sot w ose C 8-0
dRCHITECirENGI]EERXAN[E LICENSE NUMBER BUS.LIC.
COMPANYN'AME I E-MAIL FAX
STREET ADDRESS I CIT'.STATE.ZIP PHONE
USE OF ❑ SFD or Duplex jif Multi-Family ROOF AREA: yl/ VALUATION: A[f
STRUCTURE: ❑ Commercial �/rCl•s 5-0
❑ j
EXISTING ROOF TY PE: BUILT-UP ROOF ❑ASPII.ALTSHINGLES POODSHAKES ❑WOODSHINGLES ❑DINER
REMOVF.:REPLACE YES I IF NO.
❑ TPLY\ OD ❑ PLYWD ❑ PITCH: OF
LAN 1FR X
INP
12 A
.PROPOSED ROOF TYPE: ❑BUILT-UP ROOF J/dd ASPHALT SHINGLES ❑\1'ppU SIIARES ❑HOOD SHINGLE$ El OTHER ICC-ES REPORT.
I
DFSCRIPTION'OF U'9RK:
1�2 l l
as
a
By my signature below.I certify to each of[he following: I am the properrowner or authorized aeent to act on the property owner's behalf. I have read this i
application and the infomuttion I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinance and state laws rclatina to building cons tion. I a orize represe tiv of Cupenino to enter the above-identified property for inspection purposes.
Signature of ApplicandAgent'. Dale: O I
SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY
_If building is associated With a Home Owner's Association,provide letter Pi CHECK TYPE .�-y ROUTING SLIP
of approval from HOA. OVER-THE-COUNTER UC BUILDING PLAN'REVIEW
_ Provide Planning approval to verify if there any restrictions.
El /❑`PLANNING PLAN REVIEW
_ Provide copy of Manufacturer'S Installation Specifications. ❑ STANDARD ❑ FIRE DEPT
Provide signed copy of Cupertino's Tear-OfT Policy. ❑ OTHER:
ReroofApp_201 l.doc revised 03/16/11