12090169 CITY OF CU13EIlTINO BUILDING PERMIT
BUILDING ADDRESS: 21096 WHITE FIR Cr CONTRACTOR:FOUR SEASONS ROOFING PERMIT NO: 12090169
OW'NER'S NAME: YU IIUI XIAO&YAN QUN SONG PO BOX 1668 DATE ISSUED:09/192012
OWNER'S PHONE: 4084472976 SAN JOSE,CA 95109 PHONE NO:(408)278-0330
ti LICENSED CONTRACTOR'S DECLARATION I-_- [I r
� p BUILDING PERMIT INFO: BLDG ELECT PLUPLUMBLicense Class C ^ :n Lic.4 tJ^-1 /�(aa�� G K [I [I r
1r� � OIECH RESIDENTIAL COMMERCIAL
Contractor rS t` 0 '- Date //"1 i EL-
I
hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION:3'EAR OFF EXISTING WOOD SHAKE ROOF.INSTALL 13
(commencing with Section 7000)of Division 3 of the Business& Professions SQRS
Code and that my license is in full force and effect. I2"CDX PLYWOOD,THEN 304 FELT UNDRRLAYMENT.
INSTALL CERTANTEED PRESIDENTIAL COMPOSITION
hereby affirm under penalty of perjury one of the following two declarations:
1 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 work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of die labor Code,for the performance of the work for which this
permit is issucd. Sq.Ft Floor Area: Valuation:$4500
APPLICANT CF.RIIFICATION
I certify that I have read this application and state that the above information is ARS Number:35905090.00 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 harnlessthe City ofCupertino 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 Issued by: .�:^� Date:
❑ OWNER-BUILDER DECLARATION
1 hereby affirm that 1 an,exempt from the Contractor's License Law for one or RE-ROOFS:
the following two reasons: NI roofs shall be inspected prior to any roofing material being installed. If 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)
1,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: _ Date:
construct the project(Sec.7044,Business&Professions Code).
1 hereby affirm under penalty of perjury one of the following three ALL ROOF COVERI .S TO BE CLASS"A"OR BF-TI'ISR
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's DAZARDOUS MATERIALS IIISCLOSURE
Compensation,as provided for by Section 3700 of the Labor Code,I'or 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,as provided for by California Ilealth&Safety Code,Sections 25505,25533,and 25534. I will maintain
Section 3700 of the labor Code,for the performance of the work for which this compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Safety Code,Section_553_(a)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 L 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,ager making 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
Owner a t o zfd iigem: v
forthwith comply with such provisions or this permit shall be deemed revoked. U.ite.
AITI-ICAN'1'CERTIFICATION CONS'TRUCT'ION LENDAGENCY
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 Imes relating I.hereby aflirnrdhat 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 ARCIIITEC`I"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
2 ADD: ESS: 21096 White Fir Ct DATE: 09/14/201FVIEWED BY: Sean
PNVALUATION:O O '
$4,500
*PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY Multi-Family Dwelling Building is PENTAMATION 1R2R00F
USE: >3 Stories 0 Yes Q No PERMIT TYPE:
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 ROOF AREA
s.f.
1REROOFMRES 1,300
,tech. Plan Check Phwrb. Plon Check Flee. Plan Check
,tech. Permit Fee: Plumb. Permit Fre: Elec.Permit Fee:
Other,tech.Imp. Ocher Plumb Insp. Other Elce.Insp.
A1ech.Dnp. Fee: Phmmh. bepr.Fee: flee.Insp. roe:
NOTE: This wimate roes not include jeer clue to other Departments(i.e. Planning, Public Works, Fire,Sanitary SewerDistrict,School
District, etc. . These ees are based on to relintinan information available and are onle an estimate. Contact the Dei l r addu7 info.
FEE ITEMS (Fee Resolution I1-053 Eff: 7/1/11) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Suppl. PC Fee
Plumb./Adech./Ele c
Permit Fee: $195.00
Supp/. Insp Fee
Phamb./AAech./Elea
Plumh./hlech./Elea Permit Fee:
Construction Ta.1:•
Administrative 1'ee:
Work Without Permit? O Yes 0 No $0.00
Advanced Planning Fees:
Travel Documentation Fees: A
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $196.50 $0.00 TOTAL FEE: $196.50
Revised: 07/01/2012
REROOF PERMIT APPLICATION
COMMUNITYIDEVELOPMENTDEPARTMENT•BUILDING DIVISION
2 10300 TORRE AVENUE •CUPERTINO.CA 95014-3255
CUPERTINO (408)777-3228•FAX(408)777-3333•buildina(wcuoertino ora
PROJECT ADDRESS
.APN.
OWNERNAME I MPHO$'E
n N� aG'7 E-MAIL
STREET ADDRESS G
216 CI STATE,LIP I FAX
G CA m
CDNiACi NOME PHONE
0 3oI E-NIAIL
STREEr ADDRESS
SO2 14.cAnqS CITY,STATE.ZIP FAX
❑OWNER ❑ OU' ER-RUILDER ❑ OU'NER AGENT la coWRACTOR ❑CO\TRACTOR AGENT ❑ ARCHITECT []ENGINEER ❑ DF-VELOPER ❑ TENANT
gARCHIrECT,ENGINEERNA.%IE
AIE LICENSE NCMBER
LICENSE 'PE BUS.LIC..
91 10A
5 E-NIAII
213 Q'I
FAX
Sc 2 CITY.STATE.ZIP PHONE
a ose C B'0
LICENSE NUMBER
BUS.LIC.
COMPANYNA.ME
E.aI AIL FAX
STREET ADDRFSS
CITY,STATE LIP PHONE
USE OF Cl SFD or Duplex Ar Multi-Family ROOF AREA:
VALUATION:
P
STRUCTURE C3 Commercial ,,.�
EXISTING ROOF TYPE: ❑BUILT-UPROOF ❑ASPHALT SHINGLES GOODSHAKFS V❑WOODSHINGLES ❑OTAF.R(SPECIFY) O
REMOVEIREPLACE YES IFNO. PLY11'O0D ❑ PLYWO ❑OSB PITCH;
❑ N A1'F.R KSE ❑ "P C :I Z ROOF
/ A
PROPOSED ROOFTVPE: ❑BUILT-UP ROOF XASPHALT SHINGLES ❑WGOD SHAKES 11\1 ICC-ES REPORT/
OOD SHINGLES ❑OTHER
DESCRIPTION OF\PORK:
M2 n
CDXd
By my signature below.I cenify to each of the following: I am the Property owner or authonwd agent to act on the Property owner's behalf. 1 have read this
application and the information I have provided is Correct. I have read the Description of 0.'orL and verify it is accurate. I agree to comply With all applicable local I
.ordinances and state laws relating to building cons tion. I a oriu represe tiv of Cupenino fo enter the above.identi0edr0
Signature of npplicanVAgene ot p party'for inspection purposes.
Date:
SUPPLEMENTAL INFORMATION REQUIRED
OFFICE USE ONLY ,
If building is associated With a Home 0%%ner's Association,provide letter PLAN CHECK TYPE
of approval from HOA. t�-P RouTIXc sLIP
_ Provide Planning approval to verify if there any restrictions. OVER-THE-COUNTER y.BUILDING PLAN REVIEW
❑ EXPRESS 6 PWNp'Ip'C PWp'REYIEW
_ Provide copy of Manufacturer's Installation Specifications.
❑ STANDARD ❑ FIRE DEPT
Provide signed copy of Cupertino's Tear-Off Policy.
❑ OTHER:
ReroojApp_20/1.doc revised 03/16/1 l
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•buildine@cupertino.oro
PROJECT ADDRESS s APNM
OWNER NAM /t PHON 044111
_ n E-MAIL L/
Ul 7
STREET ADD SCIN STATE_;y//,/10
ZIP FAX
/ /1 /h/ Q s7
CONTRACTOR NAME LICENS %1r Q LICe((�'' - BUS.LIC.•
cOMPA NAME FAX
sE s E-MAIL/ *
STREET DR 5 Md CIN TATE.ZIP 95-111
PHO N 276
1 UNDERSTAND AND AGREE TO THE FOLLOWING: �(f
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: 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 11314 and R315 of
the 2010 California Residential Code.
Signature of Applicant/Agent: Date:
Re,ooJPoliev_201 I.doc reviser!02116/11