12090166 CITY OF CUPERTINO BUILDING PERMIT
BUILDING.ADDRESS: 21090 WHITE PIR CI' CONTRACTOR:FOUR SEASONS ROOFING PERNIITNO: 12090166
OWNER'S NASI F,: MASTONEII MEDT PO BON 1668 DA'Z'E ISSUED:09/192012
OWNER'S PHONE-: 4089968793 SAN JOSE.CA 95109 PHONE NO:(40S)278-0330
P_ LICENSED CON'fRACfOR'S DECLARATION r r r
O p BUILDING PERtV11T INFO: BLOC ELECT PLUMBLicense Class �---' 3 Lie.# �{ -rQ-(G O U. rj r
�•• 9 q DIECII RESIDENTIALCOMMERCIAL
Contractor�/_� //u C Date
hereby affirm that I am licensed under the provisions of Chapter 9 3OB DESCRIPTION:TEAR OFF EXISTING WOOD SHARE ROOF.INSTALL 13
(commencing with Section 7000)of Division 3 of the Business&Professions SQRS
Code:rad that my license is in full force and effect. 12"CDX PLYWOOD,THEN 30#FELT UNDERLAYMENT.
INSTALL 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 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 Cade,for the performance of the work for which this
permit is issued Sq.Ft Floor Area: Valuation:$4500
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is APN Number:35905096.00 Occupancy Type:
correct. I agree to comply with all city and county ordinances and state lases 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
indemnil'yandkeepharmlessdhcCit-vofCuperlinoagainstliabilities,judgments, PERMIT EXPIRES IF WORD IS NOT STARTED
costs,and expenses which may acerae 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.
c
Signature Date J'��!-12 Issued hy. G/ Date: 'L—
v
❑ OWNI.R-BUILDER DECLARATION
I hereby affirm that 1 am exemptfrom the Contractor's License Lawfor one of RF.ROOFS:
the following two reasons: All 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,1 agree to remove all new materials for
will do the Work,and the structure is not intended or offered for sale(Sec.7044, inspection. Q
Business&Professions Code) /(�/9
I.as owner of the property,am exclusively contracting with licensed conlmClors to Signature of ApplicanC Dale: Z
construct the project(Sec.7044,Business&Professions Code).
hereby affirm under penalty of perjury one of the following three ALL ROOF COVER , GS TO BE CLASS"A"OR BAITER
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUSMATERIALS 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
I have and will maintain Worker's Compensation Insurance,as provided for by California Ilealth S Safety Code.Sections 25505,'_5533•and 25534. 1 will maintain
Section 3700 of the Labor Code,for theerformance of the Work for which this compliance With the Cupertino Municipal Code,Chapter 9.12 and the Health&
V Safety Code.Section 25532(a)should 1 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.Nlanagement District I will
not employ any person in any manner so as to become subject to the Worker's maintain earn Alia are with the Cupertino Municipal Code.Chapter 9.12 and the
Compensation laws of California. If,after making this certificate of exemption,I Ilealth&Safely Code.Sections 25505,25533,and 25533.
become subject to the Worker's Compensation provisions of the Labor Code,1 nnist
forthwith comply With such provisions or this permit shall be deemed revoked. Ownrr ,u Zz d g7rd:
\I'PLICA\I'CER'I'I F'ICAl ION CONSTRUQ ION LENDING AGENCY
I certify that I have read this application and stale that the above information is
correct. I ague 10 comply With all city and county ordinances and state laws relating I hereby affirm that there is a construction lending agency forthe 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 ARCHITF.CI"S DECLARATION
9.18.
1 understand my plans shall be used as public records.
Signature Date
Licensed Professional
CITY OF CUPERTINO
12 FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 211090 White Fir Ct DATE: 09/14/2012 REVIEWED BY: Sean
APN: 3s5 / 0 096BP#: 'VALUATION: $4,500
*PERMITTYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY Multi-Family Dwelling Buildina is PENTAMATION 1R2ROOF
USE: 3 Stories O Yes Q No PERMITTYPE: A
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
Much. Plan Check Plumb.Plan Check Flee. Plan Check
bleeh.Permit Fee: Plumb.Permit Fec: Flec.Permit Fre:
Other Alech.Insp. Other Plumb Insp. Oilier Elee.Insp.
Ale.ch.hep. Fee: 11hnab. /ncp.Fre: Elec.Insp.Fee:
NOTE: This estimate does trot include jeev tlue to other Departments(i.e. Planning, Public Works, Fire,Sanitary Sewer District,School
District,etc. . These feev are based on die prelintinan information available and are onli,an estimate. Contact the Det for addn7 info.
FEE ITEMS (Fee Fee 11-053 Elf LLLIU FEE QTY/FEE MISC ITEMS
Plan Check.Fee:
Supp/. PC Fee. T77 A
Plumh.11fech./Elec
Permit Fee: $195.00
Suppl. Insp Fee
Phnnh./ddech./Elec
P/umh.4fech./Elec Permit Fee:
Construction Tax:
Administrative Fee:
Work Without Permit? O Yes Q) No $0.00
AtIvrutced Planting Pees:
Travel Doctunewalion Fees: t
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
131(g Sids Commission Fee: IBCBSC $1.00
SUBTOTALS: 1 $196.50 $0.00 TOTAL FEE: $196.50
Revised: 07/01/2012
4 1
REROOF PERMIT APPLICATION
COMMUNITYIDEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE-AVENUE •CUPERTINO,CA 95014-3255
CUPERTINO (408)777-3228• FAX(408)777-3333• buildino(&cuoertino ora
PROTECT,\ODRESSAPN^ ' Q d n�� `50��
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01R NAME I a S4A CPHONE a E-NAIL
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STREET.ADDRESS ^ O 6 CI ' STATE,ZIP
L t I FAX
CONTACT NAME
19 PHONE EJIAIL
0 30
STREEr ADDRESS
SC2 S CITY.ST.AI'E.IIP I FAS
3506e CAATII .
❑OWNER ❑ OU%ER-BUILDER ❑ OWNER.AGENT J( CO%TMCTOR ❑CONTRACTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TE6npT
CONTRACTOR INANE LICF,NSEVL'NIBER LICF,NSE I"'PE B ' ^
LS.LI('.. KI�
.COMPANY NAME E-MAIL K
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STREET ADDRESS CIT",$TATE.ZIP
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ARfHI rECTrENGINCER NAME LICENSE NUMBER
BUS.LIC.
COMPANY NAME
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STREET ADORE$$ CIT'.STATE.'r.IP
PHONE
•USE OF ❑ SFD or Duplex ( Multi-Family ROOF AREA: �/ VALUATION:
STRUCTURE: ❑ Commercial ��rr 5 SQ
EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPI IALT SHINGLES r,VOODSHARF.$ ❑W'OODSHINGLES ❑OT HER ISPECIFY)
RCNOVF.:REPLACE YES IF NO. OOD lif ❑ PLYl1'D ❑ OSB Pll"CH: NWF
❑ N VER ICRNE ❑ ra^ TYP
dd )' ASS
PROPOSED ROOF TYPE: ❑BUILT-UPROOF X1SPHALTSHINGLES 13 WOOD SHAKES ❑NOODSHINGLES ❑OTHER I('C-ES REPORT.
DFSCRIMONOFU'OR6:
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By me signature below.I certify to each of the following: I am the Property OWner or authorized agent to act on the property owner's behalf I have read this
application and the intonrmtion 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 start laws relating to building cons� tion. I a''orim represe tiv <of Cupenino to enter the above-identilied property for inspection purposes.
Signature ol'Applieam/I C
Date:
SUPPLEMENTAL INFORMATION RFQUIRED
oFFlFOPLANNING
USEu'
If building is associated with a Home 0\cner's Association.provide letter PLANCHECR TYPEROUTING SLIP
of approval from HOA,
OVER-THE-COUNTER DING PLAN REVIEW'
Provide Planning approval to verify if there arty restrictions.
EXPRESS PLAN REVIEW'Provide copy of Manufacturer's Installation Specifications. sTANDARU DEPT Provide signed copy'ofCupertino's Tear-Off Policy.
ER:
Reroof4pp_201 Ldoc revised 0311611)
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(a)cuoertino.org
PROJECT ADDRESS)/0940 W12/ APNa
OWNER NAM A./ / //• L r PHOS' _ E-MAIL
STREETA ,RF. FAX
66//Y `• ,vo f.'1?- 9s S�
CONTRACTOR NAME LICENSE NUMB. 72/O LICENSE TYPE. J/1 BUS.LIC.9
COMP NY NAME E-MAIL / ('• FAX
StOOSOA.tS
STREET ADDRES�_O n O S / CITY.STATE.zIP PHON On 2 78_O O
•G. I UNDERSTAND AND AGREE TO THE FOLLOWING: T
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 tV4" 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: 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 Applicant/Agent: Date:
HeroojPolicv_201 Ldoc revised 02/1611I