12090174 . i
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20655 GARDENSIDE CIR CONTRACTOR:BRADSHAW ROOFING INC PERMITNO: 12090174
ON1'NER'S NAME: I'IUH JUN YOUNG AND PAK SUK CHA 1821 S BASCOM AVE PMR 160 DATE ISSUED:09/192012
OWNER'S PHONE: 4088610760CAM PBFLL,CA 95008 PHONE NO:(408)2469930
LICENSED CONI'RACI'OR'S DECCLLAPLUMB(RRATION BUILDING PERMIT INFO: BLDG ELECT rl PLUMB rl
License Class f Lic.# ( _X�
MECH C .RESIDENTIAL C COMMERCIAL r
Conlmcl : 'Date 2--
I
I hereby affirm that I am licensed trader the provisions of Chapter 9 JOB DESCRIPTION: REMOVE EXISTING WOOD SHAKE ROOF AND INSTALL
(commencing with Section 7000)of Dil inion 3 of the Business&Professions NEW
Code and that my license is in full force and effect. COM POSITION SHINGLES(AGED BARK)CLASS A 12
SOFT
1 hereby affirm under penalty of perjury one of the following two dcclaratioos:
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 the work for which this pemtit is issued. '
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 ofthe Labor Code,for the performance of the work for which this Sq.Ft Floor Area: Valuation:$6000
permit is issued. .
APPLICNN'I'C4:R'1'I1:ICATION ARN Number:36232007.00 Occupancy Type:
I certify that I have read this application.rad state that(he 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 PERMIT EXPIRES IF WORK IS NOT STARTED
indenmify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regu tions per the Cupertino Municipal Code,Section
9.18. 'J
Signator Issued by: _� �✓ i9Tl/�/ Date:
Date__�C.
❑ ONVNF.R-BUILDER DECLARATION
RE-ROOFS:
I hereby affirm that 1 am exempt from the Contractor's License Law for ane of All roofs shall be inspected prior to any roofing material being installed.If a roof is
the following two reasons: installed without first obtaining an ins Lection,I agree to remove all new materials for
I,as owner of the property,or my employees with wages as their sole compensation, inspection.
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code) Signature of Applicant: JZJ 4 Date:
I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS 7'O BE CLASS"A"OR BETTER
I 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 11.\%.NRDOIIS\LN"I'ERLNIS DISCLOSURE
Compensation,as provided for by Section 3700 of the Labor Code,for the 1 have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California IIeallh R Safety Code.Sections 25505,25533,and 25534. 1 will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the I Icalth&
Section 3700 of the Labor Code,for the perfomtance of the work for which(his Safety Code,Section 255312(a)should I.store or handle hazardous material.
Additionally,should 1 use equipment or devices which emit hazardous air
permit is issued. contaminants as defined by the Bay Area Air Quality Management District 1 will
I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino
.75�RMunicipal Code,Chapter 9.12 and the
an
not employ any person in y manner so as to become subject to the Worker's Ilcalth&Safely Code.Sections 25505, }
' and' "34.
Compensation laws of California. If.ager making this certificate of exemption,I
become subject to the Worker's Compensation provisions of the Labor Code,I must Owner or authorize)
forthwith comply with such provisions or this permit shall be deemed revoked. Date:
CONSfRIK-FION LENDING AGENCY
APPLICANI'CISRTH-'ICrr10N
I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's
correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.)
to building construction,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupeninoagainsl liabilities,judgments, Lender's Address
costs,and expenses which may accrue against said City in consequence of
granting of this permit.Additionally,the applicant understands and will comply ARCIIITEC`I"S DECLARATION
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. I understand my plans shall be used as public records.
Signature Date Licensed Professional
v
jjog0F7q
REFZOOF PERMIT T APPLICATION
".. COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO.CA 95014-3255
CUPERTIlJO (408)777-3228 • FAX(408)777-3333•buddina(acuoerlino.or(i
PROJECT ADDRESS ss
J C K
N
APN. 3 �/
OWNERNk1,M ...-� MONO?,O ( U MAR
n y -
SRIEETADDRESS O CS rCIT STATE ZIP f.7 FAX
cr
CONTACT NAME PHONE - E-MAIL
STREET ADDRESS I CRY,STATE,ZIP FAX
❑OWER ❑ OWNER-MaLDER ❑ MWERACENT NNMICroa ❑CONTTtACTORAGEHr ❑ ARCRrmcr ❑ENGINEER ❑ DLVFLOPE4 ❑TENANT
CONTRACT RNAN2 LICE:NSEN\OBER LICENSE TYPE BUS.LIC.d W� M
COMPANY NAaM E.'LA (\Clt FAX
hC - M3
STREET ADDRESS _ C(LY,STATE PHONE
t nCi (4CjZ)C
ARCHITECr/ENOIN'EER NAME LICENSE NWBER BUS.LIC.0
COsTANY NAME Ev LAR FAX
STREET ADDRESS CITY.STATE,ZIP PHONE
USE OF ❑ SFD or Duplex Multi-Familq ROOF WEA: VALUATI - OQ
STRUCTURE. ❑ Conunercial "' W
ECISTINOROOFTYPE: ❑BUILT-UPROOF ❑ASPHALT SHINGLES hStS'OODSHAKES WOnDSHING1.ES ❑OTHER(SPECIFY)
REMONEfdEPLACE 94ES IF NO, /,II PLY'NOOD 15" ClPLIIWD 1:1053PfTCH: ROOF
❑ D R<r Y f`K <.: ❑ ;S- E ❑ DX :i ASS,
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF 2 ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT e
DESCRIPTION OF WORK: ` R
e d- fS,,r � 1
By my sigrmture 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 Nis
appOcadon and the information[have provided is correct. I have read Elie Description of Work and verify itis accurate. t agree w comply With all applicable IDcal
ordinances and since laws relating to oulligi/n$co restoratives I au�oriz/q�raprestoratives of Cupertino to enter Ne—abbove-identir#property for inspection purposes.
SignaareofApplicandAgenr. CA�-fu' yt-E '[i Date: ./�e1 Co/ on1Z
SUPPLEMENTAL INFOM-LATION REQUIRED OPYSCE USE ONLY
_If building is associated widt a Horne OTrners Association,provide letter PWN CHECKTYPE RODTLN'G SLIP
ofapproval from HOA. ( OVER-THE-COUNTER BUILDING PLN REVIEW
_Provide Planning approval to verity if there any restrictions. /❑ EamRlss PLAHmNc PLAN ReFiEw
Provide copy Of Manufacturers Installation Specifications. ❑ sranoAnD ❑ FEREDEPT
Provide signed copy DF Cuprtino's Tear-Off Policy. ❑ OTHER:
Reroaj4pp_30ll.doc revised O3,`I d'll
CiTY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
12 ADDRESS: 20655 Gardenside Cir. DATE: 0 911 912 012 REVIEWED Bl': Sean
APN: 1 I BPP: 'VALUATION: $6,000
*PERNIITTYPE: Minor Building Permit PLAN CIIECKTVPE: Re-roof
PRIMARY PENTANIATION
USE: SFD or Duplex PERNIITTYPE: At
1SFDWLROOF
WORK Remove existinq wood shake roof and install new composition shingles (Aged Bark).
SCOPE
FEEID ROOFAREA
s.f.
1REROOFFRES 1,200
Meth. Plan Check Plumb.Plan Check Elee. Plan Check
Mech.Permit Fee: Plumb.Permit Fee: Elec.Permit Fee:
Other Much.lasp. Other Plumb Insp. Other Elce.Imp.
Mech.hup. Fee: Phamb. hisp.Fee: Eler,hap.Fee:
A'OTE: This estimate does not include fees Clue to other Departments(i.e. Planning, Public I{'orks, Fire,Sanitary Sewer District,School
District,etc). These feev are based on the relindnaninformation available and are only an estinmte Contact rite Dept for athln'I info.
FEE ITEMS (Fee Resohnion 11-053 Eq' 7/1/11) FEE QTY/FEE MISC ITEMS
Plun Check Fee:
Suppl. PC Fec
Plumb.lHech.lElec
Permit Fee: $180.00
.Supp!. !nsp Fee
Plumb.lA•lech.lElec
Plumh.lXlech.lElec Permit Fee:
Consnitction Tax:
Administrutiee Fee:
Work Without Permit? O Yes (F) No $0.00
Advanced Planning Fees:
Travel Doetanenlation Fees: i
Strong Motion Fee: /BSEIS,U/CR $0.60 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $181.60 $0.001 TOTAL FEE: $181.60
Revised: 07/01/2012
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•buildingtacupertino.org
PROJECT ADDRESS SS CV l G APNM �- Q
OWNER NAM E— \ 1^ HONE E-MAIL
STREET ADDRESS�)O (' L- CITY UTE.ZIP Q1-,r 711 Q FAX
C 'TRACTO NA.1E LICENSE NUMBER LICENSETYP BUS.LI p
C t 1-)
COMPANY NAME E-MAI `- M F -n - `-)^S3
r Y 1 --)CI
S3
131
I a ADDRESSCITY.STATE ZIP HONE
�l C d CE S Q
I UNDERSTAND AND AGREE TO THE FOLLOWING:
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 1/<" 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: lam th'e property owner or authorized agent to act on the
property owner's behalf. 1 understand and agree to comply with the'rle-roof policy stated above. 1 also understand that
smoke detectors and carbon monoxide detectors are required to be i rstaP led in accordance with Sections 8314 and R315 of
the 2010 California Residential Code
Signature of Applicant/Agent: Date:
ReivoJPolicv_2011.doc reaixed 02/16/11
Building Department
4 City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
C U P E RT I N O Fax: 408-777-3333
i
CONTRACTOR / SUBCONTRACTOR LIST
rGAENDDRCSS: N!82j
B ADDRESS:- PERMIT#
WNER'S NAME: PHONE#
ERAL CONTRACTOR: BUSINESS LICENSE #
t CITY/ZIPCODE: q
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL RE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO '
BUSINESS LICENSE. 7 R/� 2
am not.using any subcontractors: a
L�� /�
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
r
M
Electrical �..f
Excavation
Fencing y
Flooring/ Carpeting
Linoleum% Wood
Glass /Glazing
Heating
Insulation
Landscaping
Lathing .
Masonry
Painting/ Wallpaper
Paving
Plastering Y�
Plumbing
Roofing
Septic Tank
Sheet Metal
-Sheet Rock
Tile
~ Owner7 Contractor Signature Date
i