12090172CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRI?SS: 21102 WHITE FIR CT CONTRACTOR: FOUR SEASONS ROOFING. PERMITNO: 12090172
OWNEWSNAME: PIiTOVSKYIIRI AND MICIiIKO 110 BOX 1668 DA'Z'E ISSUED: 09/1912012
OWNER'S PIIONE: 4 082 534 03 7 SAN JOSE, CA 95109 1`1101NF-NO: (408)278-0330
LICENSED CON"FRAC-l'OR'S DECLARRATIONT7fy
License�Class—�li — J .Lic. d - �-I al.0 r�
Contractor-1�'a - ! Date
I hereby.afTirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000) of Invision 3 of the Business & Professions
Code and that my license is in full force and effect.
hereby affirm under penalty of perjuy 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 to Work for which this
permit is issued.
,\I'I'LIC,\\ 1' CI?R'I'IPIG\"PION
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
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned properly for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilitics,judgnments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, tile applicant understands laid will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18. �.
- — Date
❑ O%V- iRiR41tn LDER DECLARATION
hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
I, as owner of the property, or my employees with wages as their sole compensation,
will do the work, and the structure is not intended or offered for sale (Sec.7044,
Business & Professions Code)
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044. Business & Professions Code).
hereby affirm under penalty of perjury one of the following three
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.
1 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.
I certifythat in the performance of die work for Which this permit is issued, I shall
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California. If, after making this certificate of excerption, I
become subject to the Worker's Compensation provisions of the Labor Code, I nuns[
forthwith comply with such provisions or this pennit shall be deemed revoked.
APPLIC ANI' CERTIFICATION
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
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,
costs, and expenses which may accrue against said City in consequence of the
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.
Date
BUILDING PERMIT INFO: BLDG I- ELECT Cl PLUMB rl
DIECII r RESIDENTIAL ❑ COMMERCIAL 17
JOB DESCRIPTION: TEAR OFF EXISTING WOOD SHAKE ROORINSTALL 112"
CDX
PLYWOOD THEN 30# FEI.T UNDERLAYMENT.INSTALL 13 SQ
CERTAINTEED PRESIDENTIAL COMPOSITION
Sq. Ft Floor Area: I Valuation: 54500
APN Number: 35905087.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: r' /C/ t ' " " Date:
RI: ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection. /f
Signmure'of'Ap'plicrn—t:—/��i�DbiC: e)
ALI, ROOF CO\'ER1 GSFO'1fE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
have read the hazardous materials requirements under Chapter 6.95 of the
California Ilealth & Safety Code, Sections 25505. 25533, and 25534. 1 will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Ilealth &
Safety Code. Section 25532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defied by the Bay Arca Air Quality Management District I a ill
maintain compliance with the Cupertino Municipal Code. Chapter 9.12 and the
Ilealth & Safety Code. Sections 25505, 25533, and 25534.
::51-/5-/2
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCIII'ITCP'S DECLARATION
I understand my plans shall he used as public records.
Licensed
REROOF PERMIT APPLICATION
COMMUNITYDEVELOPMENTDEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildino ancupertino oro
.Zo9 o I I z
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PROJECT ADDRESS
• �
3S os- v�r-7
OWNER NAME U
E -.NAIL
PHOSE560
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1 e O V i S3- 03
STREET ADDRESS
ZII02C CIT' STATE. ZIP FAX
CONTACT NAME.
PHONE E-MAIL
IO OI
STREET AnORESS
1,02-
S
CITY. STATE, ZIP FA\
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OUNFR ❑ OWNER --BUILDER ❑ OWNER .AGENT J( COWRACTOR ❑ CO]TRACTOR AGENT ❑ ARCHITECT ❑ ENGINF.F.R ❑ DEVELOPER ❑ TENMT
CONTRACTOR N'A,IE LICENSE NUMBER
LICENSE 'PE
BNS, LIC.
COMPANY NAME E NAIL
CJ
FAX
STREET ADDRESS CITY. STATE. ZIP
S'07.;A
PHONE
ase C
g_o
ARCHITEC ,ENGINEER SAME LICENSE NUMBER
BUS. LIC. •
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CIT\'. ST.>TE ZIP
PHONE
:USE OF ❑ SFD or Duplex /a. Multi -Family ROOF AREA: VALUATION;UCTURE:
❑ Commercial
S
O
,a�y/
EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ ASP[[ALT SHINGLES rw'OODSHAKES ❑WOODSHI,NGLES ❑ DINER(SPECIFY'
RLNIOVEFREPL.ACE 1'ES IFNO. PLY\\'000 ❑ PLY\\'D ❑OSB PITCH: ROOF
12
CLASS
PROPOSEDROOFTYPE ❑BUILT-UPROOF (/.ASPHALT SHINGLES ❑N'ODD SIIAKES 13 %\001) SHINGLES 11 OTHER ICC -ES REPORT.
DESCRIPTION OF \\ 'ORA;
"I2t1
e
6
By my signature below. I cenify to each of the following: I am the property Owner or amhnnzed agent to act on the property owner's behalf. I have read this,
application and the information I have
provided is conect. I have read the Description of Wort: and verify it i
ordins accurate. I agree to comply with all applicable local
ordinance and state IaWs relating to building tons 1
lion. e oriZe represe tiv of Cupertino to enter the above -identified property• for inspection
purpose.
Signature of Applicant/Agent:
Date: p
SUPPLEMENTAL INFORMATION REQUIRED
OFFICEUSEONLY
If building is associated \with a Home 0"ner's Association.
provide letter
of approval from HOA.
PLAN CHECK TYPE
ROUTING SLIP
OVER-THE-COUNTER
EXPRESS
BUILDING PLAN REVIEW
Provide Planning approval to verify if there any restrictions.
Provide copy of Manufacturer's Installation Specifications.
PLANNING PLA\ REVIEW
❑ STANDARD
❑ FIRE DEPT
_ Provide signed copy of Cupenino's Tear -Off Policy.❑
'oTHEn:
.
ReroojApp 2011.doe revised 03/16/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
JAFADDRESS:
21102 White Fir Ct
DATE: 09/14/2012
REVIEWED BY: Sean
blech. Permit Fee:
APN:3S� dL off I
I BP#:
'VALUATION:
$4,500
*PERMIT TYPE: Minor Building Permit
PLAN CHECK TYPE: Re -roof
PRIMARY Multi -Family Dwelling
USE:
Buildina is
3 Stories O Yes o No
PENTAMATION 1R2RO0F
PERMITTYPE:
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
NOTE: This estimate does riot includefees clue to other Departments (i.e. Planning, Public (Forks, Fire, Smtitny Server District, School
District. etc.). These lees are based on lire nreliminan, information available and are onh, an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-051 Eff 711/11)
,Wech. flan Check
Plumb. Ilan Check
Flee. Plan Check
blech. Permit Fee:
Plonth. Permit Fee:
Elec. Permit Fee:
Other ,ifech. Insp.
Other Plumb Insp.Li I
Other Elce. Insp.
Uech. hay. Fac:
Plumb. hrsp. Fee:
Elco. Insp. Fee:
NOTE: This estimate does riot includefees clue to other Departments (i.e. Planning, Public (Forks, Fire, Smtitny Server District, School
District. etc.). These lees are based on lire nreliminan, information available and are onh, an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-051 Eff 711/11)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
suppl. PC Fee
Plumb./iblech.A_'l ec
Permit Fee:
$195.00
Suppl. Insp Fee
Plumb./d•1ech.1Elec
Plttnih./tb1ech.1Elec Permit Fee:
Construction Tax:
Administrative Fee:
Work Without Permit? O Yes (D No
$0.00
Advanced Planning Fees:
Travel Documentation Fees:
Strong Motion Fee: 111SEISHICR
$0.50
Select an Administrative Item
Bldg Stds Commission Pee: IBCBSC
$1.00
SUBTOTALS:
$196.50
$0.00
TOTAL FEE: 1
$196.50
.Revised: 07/0112012
CUPERTINO
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
(408) 777-3228 • FAX (408) 777-3333 • buildinD(a)cupertino.oro
PROJECT ADDRESS
APN•
3,5 ✓
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OWNER NA ME
PHO _
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EMAIL
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STREET ADDRESS//01
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FAX
I'Cf
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wo
CONTRACTOR NAME
LICENSE NUMB
LIO('NS TNTE
BUS. LIC.a 5
P J✓� J
A
COMP'Y NE
E-MAILFAX
STREETADDRFS
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CITY STATE.•LP
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PHO
0330
1 UNDERSTAND AND AGREE TO THE FOLLOWING:
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.
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 I/<" 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 11314 and R315 of
the 2010 California Residential Code.
of
Date:
RerooJPolicv_201!.clot revised 02/16/11