12090165 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21088 WHI'rE FIR CI' CONTRACTOR:FOUR SEASONS ROOFING PFR?II'l'NO: 12090165
OWNER'S NAME: CHEN YU CHEN R LI-DR WANG PO BOX 1668 DA'Z'E ISSUED:09/192012
OWNER'S PHONE: 6509101291 SAN,)OSE,CA 95109 PHOSEN'O:(408)278-0330
LICENSED CONTRACTOR'S DECLARATION G r r
1 J n BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class e_ � Lie.q Ll?o-(0y
n R-(q -ICL i11EC11 r RESIDENTIAL Cl COMMERCIAL r
Contractor P1`' '�G Dale
I.hereby affirm that I am licensed under the provisions of Chapter') .106 DESCRIPTION:TEAR OFF EXISTING WOOD SHARE ROOF.INSTALL 13
(commencing with Section 7000)of Division 3 of the Business&Professions SORS
Code and that out license is in full force and effect. IQ"CDX PLYWOOD,THEN 30M FELT UNDERLAYMENT.
INSTALL CERTAINTEED PRESIDENTIAL COMPOSITION
I 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 die 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:$4500
APPLIC.\N'I'CER'1'IFICA'fION
I certify that I have read this application and state that the above infonuation is APN Number:35905095.00 Occupancy Type:
correct. I agree to comply with all city and county ordinancesand state laws relating
tobuilding construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save
inicomify and keep harmless the City of Cupertinoagainst 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 \ Date Issued bDate:
❑ OWNER-BUILDER DECLARATION
Thereby affirm that I am exempt from the Contractor's License Law for tine 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 all 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(Scc.7044, inspection.
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant, Date. 7—/9—/2
construct the project(Sec.7044,Business&Professions Code).
1 hereby affirm under penalty of perjury ane of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BrTIT,R
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's IL\'/,AKDOUS 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
I have and will maintain Worker's Compensation Insurance,as provided for by California Ilealth&Safely Code.Sections 25505.25533,and 25534. 1 will maintain
Section 3700 of the Labor Code,for the performance of die work for which this compliance with the Cupertino.Niunieipal Code,Chapter 9.12 and the Ilealth&
Safely Code,Section_553_(.1)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 Municipal Code,Chapter 9.12:rad the
Compensation laws of Calilomia. 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
forthwith comply with such provisions or this permit shall be deemed revoked. O"'°rr or mth r'zed•ogem: ^ _/ 17
Date `� `
AI'1'LIC.\NI'CEK'I'1 FIG\'110,\ CONSTRUCTION LENDING AGENCY
I certify that I have read this application mid 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 ollhis 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 Cil 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 ARCIIITF,CT'S DECLARATION
9.18.
I understand m•plans shall be used as public records.
Signature Date
Licensed Professional
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 21088 White Fir Ct DATE: 09/14/2012 REVIEWED BY: Sean
Us APN: t 9 OV,5 I BP#: .0�10/&5 VALUATION: $4,500
*PERMITTYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY Multi-Family Dwelling Buildina is PENTARLiLTION 1R2R00F
USE: 3Stories Yes Q No PER1111TT1'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
blech. /Yon Check Plumb. flan Check Ele:. Plan Cheek
Mech.Permit Fee: Plumb.Permit Fac: rlec.Permit Fee:
Other Atech. Insp. Other Plumb Insp. Other Elec.Insp.
A/ech.Insp.Fee: Plumb. bisp. ret: Elcc.Insp.Fee:
NOTE: This ertintate does not include jeer due to other Departments(i.e. Planning, Public Works, Fire,Sanitary Sewer District,School
District,etc. . These fees are based on the preliminan information available and are onh,an estinmte. Contact the Dept for attdn 7 info.
FEE ITEMS (Fee Resolution 11-053 Eli' 7/1/1/1 FEE QTY/FEE MISC ITEMS
Plan Cheek Fee:
Sttppl. PC Fee
Plumb.61/ech./F.lec
Permit Fee: $195.00
.Supp/. Insp Fee
Plunib.hblech./Elec
Plumh.lklech./Elec P6rnlh Fee:
Construction Tax:
Adminisirevive Fee:
Work Without Permit? C) Yes (F) No $0.00
Advanced Planning Pecs:
Travel Docutnentalion Fus: A
Strong Motion Fee: 711SEISMICR $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
rW �•ql
REROOF PERMIT APPLICATION
E ;
• COMMUNITY,pEVELOPMENT DEPARTMENT• BUILDING DIVISION
E! i
70300 TORR AVENUE ,CUPERTINO,CA 95014.3255, - i
CUPERTINO (408)777-3228•FAX(408)777-3333-building(Mcupertino.org
/ao9,o/lis
PROJECT ADDRESS 2 O APS•
5 L
OWNER NAME Gl-Df •PHONE E-NIAIL
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STREEr ADDRESS ?-loge CI ' STATE.ZIP
CONTACT NAh1F. PHONE EAIAIL '
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STREET ADDRESS�On CITY.STATE.lIP
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❑OUNER ❑ OWNER BUILDER ❑ OWN'ERAGENT A(CONrRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME LICENSE NL'NIBER it t"PE BUS LIC.
COMPANY NAMG SAmE C-M.AIL
i FAX
.STREET ADDRESS SEER5 1
CITY.STATE.ZIP e C PHONE
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ARCMITECT•ENGINt
NAME LICENSE NUMBER BUS.LIC.• '
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CONIPANY NAME E-MAIL
FAN
STREET ADDRESS CITY•STATE.21Y
PHONE
ESE OF ❑ SFD or Duplex Illf Multi-Family Roof AReA: / VALUATION:
STRUCTURE: ❑ Commercial11,Ry/ JCC �0
EXISTING ROOF TYPE: C3 BUILT-LP ROOF ❑ASPHALT SHINGLES PICVOODSHAKFS V❑WOODSHINGLES 001HERISPECIFYI
FRRENIOVE:REPLACE IF NO. PLYWOOD .i� ❑ P'LYWO ❑
-IAY
N 'N 1) 1VP
PROPOSEDROOFTYPE: ❑BUILT-UPROOF 4SPHALTSHINGLES 0WO0DSIIARES ❑NOODSHINGLES ❑OTHER ICC-ES REPORT.
DESCRIPTION OF I%ORK:
COX
e
• S
1
By my signature below.I cenify to each of the following: I amthe propertyowner or authorized agent to act on the property owner's behalf. 1 have read this
na
application and the inforlion I have provided is correct. I has.e read the Description of Work and verify itis arcuate. I agree to comply with all applicable local
ordinances and state laws relating to building cons tion. I a orize represe tiv Of Cupenino to enter the above.identified property far inspection purposes.
Signa[urt o(ApplieanVAgent: Date: O
SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY
_ If building is associated with a Home Owner's Association,provide letter PLAN CHECK TYPE ROUTING SLIP
of approval from HOA.
OVER-THE-COUNTERF� BUILDING PWN REVIEW
_ Provide Planning approval to verily if there any restrictions. ❑ EXPRESSLf_J PLANNING PLM'REVIEW
_ Provide copy of Manufacturer's Installation Specifications. ❑ STANDARD ❑ FIRE DEPT
_Provide signed copy of Cupenino's Tear-Off Policy. ❑ OTHER:
t
Reroof4pp_2011.doc revised 03/16/11 1
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•buildinaCadcuoertino.org
PROJECT ADDRESS 2
/0
86 k 1h 1Z lt/� AP\a 3 C 0 -5
•C O 5_
OWNER NAM PONE J E-MAIL
/o-/z
STREETADDT/S / CITV. S TEZIP FAN
/ f
CONTRACTOR NAME LIC E,\SE Nj.7y/O LIC Ed E BUS.LIC.a �/ ��
COMPA ''NAME E-MAIL FAx
STREET ADDRES�02 CS' CIN STATE.ZIP PHO —a
1 UNDERSTAND AND AGREE TO THE FOLLOWING: V
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$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. 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: —L
ReraaJPolicv_2011.doc revised 02/16/11