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12090212 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21078 WHI'T'E FIR Cf CONTRACTOR:FOUR SEASONS ROOFING PERMITNO: 12090212 OWNER'S NAME: PANTELY DORA ET AL PO BOX 1668 DATE ISSUED:09252012 OWNER'S CON PHONE: 5128582427 SAN.IOSE,CA 95109 PHONE NO:(409)278-0330 fLICENSED CORACI'OR'S DECLARATION "t BUILDING PERb11T INFO: BLDG r ELECT r PLUMB r License Class C_ S"T Lica - L- 2168 �jf / /a C D1EC11 ( RESIDENTIAL r COMMERCIALContractor i Date I hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION:TEAR OFF EXISTING WOOD SHAKE ROORINSTALL I2" (commencing with Section 7000)of Division 3 of the Business S Professions CDX Code and that my license is in full force and effect. PLYWOOD&304 FELT UNDERLAYMENLINSTALL 13 SO CLASS A CERTAINTEED PRESIDENTIAL COMP 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,Ibr 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:54500 APPLICANT CER'TIFICA'ITON I certify that I have read this application and state that the above information is AI;N Number:35905099.00 Occupancy Type: correct.1 agree to comply with all city and county ordinances and slate 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, 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. p �f'� /1 Signature Date /�ZS �2 Issued by: �- Date:( ' ❑ OW'NER-RUl LITER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for one of RI:ROOFS: the following two reasons: All roofs shall be inspected prior to my 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 suucture is not intended or offered for sale(Sec.7044, inspection. Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: ale:C ZS r�Z construct the project(Sec.7044,Business&Professions Code). 1 hereby affirm under penalty of perjury one of the following three ALL ROOF COVERfN , TO BE CLASS"A"OR BE'fl'ER declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE Compensation,as provided for by Section 3700 of the Labor Code,for the performance of 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 I Iealth&Safety Code,Sections 25505,25533,and 25534. 1 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 Ilealth& 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 forwhich 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 sons to become subject to the Worker's maintain compliance with the Cupertino Municipal Code.Chapter 9.12 and the Compensation laws of California. If,a0cr snaking this certiEcate of exemption,I Ilcalth&Sufcty 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 he deemed revoked Owner or a IhoOwner=c gen0gem: Uate: APPLICANT CERTIFICATION CONS'IRIICI'ION LENDING AGENCYI 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 Imus relating I hereby affirm that there is a canstmction 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 I iabilitics,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 ,\RCII I"I'FCI'S DECLARATION'9.18. 1 understand my plans shall be used as public records. Signature Date Licensed Professional REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO,CA 95014-3255 (408)777-3228- FAX(408)777-3333 - buildino(a)cuoertino.ono CUPERTINO PROJECT ADDRESS TPN_ OWNER NAME i PHONE E-MAIL D A I ) - STREE'I"ADDRESS CITY_STATE.ZIP FAX Z O g �ili�//, :1 e >ri r �.'. ( :I:nem ;..> C:.' =1 SJ I q CONTACT NAME ep0 1.A2.4reS PHO\E�O�I��IO��O E-MAIL STREET ADDRESS sC2 S+. CITY.STATE,ZIP/N� SoS CA - 4s1 ►, FA\ ❑ Oulsk ❑ OWNER-RGILDER ❑ OWNER AGENT / COYTKACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANr C'ONTRACI"OR NAME LICENSE N01BER I LICENSE Tl'PE I BUS.LIC. 2 0 C-OMPANYNANIC MAIL I FAX STREET ADDRESS _ CM-.ST:VE.ZIP PHONE sOi a ose C -z s-o ARCHrrECLENGINCER NAME LICENSE NUMBER BUS.LIC.^ 1 COMPANY NAME I &MAIL FAX STREET ADDRESS I CITY.STATE.ZIP I PHONE USE OF ❑ SFD or Duplex Y Multi-Family ROOF AREA: VALUATION: O STRUCTURE: ❑ Commercial /j SQ. 1 � 5-0o EXISTING ROOF TYPE: ❑BUILT-[PROOF ❑ASPIIALTSHISGLES _r/,V00DSHAlES ❑`AOODSHISGLES 11 OTHER(SPECIFY) RCNIOVF.:REPLACE Y'E.5 IENO. PLY\100D {L::' 11PLYWD 11 058 PITCH: ROOF ❑ N a AN'E.R 'CRNESS 11La" TYPEDS 'I LAr, PROPOSED ROOF TYPE ❑BUILT-UPROOF XASPHALTSHINGLES ❑ANOODSHAlES ❑IIOODSHISGLES ❑OTHER ICC-ES REPORT• DESCRIPTION OF AeORHe rood' _ Z 1111 ye COX wood+{yen 304 �'e' Ik rinde'�e�.—F_i.naLL�wQjrM Cer�atn �asa Pres- '0 4,'n d- Ry my signature below.I cenif y to each of the folIoWing: [am the propemolner or authorized agent to act on the propen o\vDcr's behalf. have read this application and the information I have provided is conect. I have read the Description of Work and serif'it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building cons,- tion. 1 a' orize represe -tiv, of Cupertino to enter the above-identified property for inspection purposes. Signature of ApplicanLlAzent: Date: AZO SUPPLEMENTAL INFORMATION REQUIRED OFFICEUSEONLY _ If building is associated tcith a Home Ovtner's.Association.provide letter PLANCHECATYPE ROUTING SLIP Of approval from HOA. ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW Provide Planning approval to verify if there any restrictions. ❑ EXPRESS ❑ PLANNING PLAN REVIEW Provide copy of Manufacturer's Installation Specifications. ❑ STANDARD ❑ RREDEPT Provide signed copy of Cupcnino's l-ear-Off Policy. ❑ OTHER: ReroofApp_2011.doc revised 03/16/11 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS:� .�� (/10-7 k WhDATE: REVIEtVED BY: APN: BP#: 'VALUATION: $4,500 *PEILMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof PRIMARY SFD or Duplex PENTAMATION 1SFDWLR00F USE: PER,111T TYPE: WORK TEAR OFF EXISTING WOOD SHAKE ROOF.INSTALL 1/2" CDX PLYWOOD& 30# FELT SCOPE UNDERLAYMENT.INSTALL 13 SQFT CLASS A CERTAINTEED PRESIDENTIAL COMP p FEEID ROOFAREA s.L) 1REROOFFRES 1,300 ,Ifeeb.Plan Check Plumb. Plan Cheek Elec.Plan Crack Mech. Permit Fee: Plunrb.Permir Fee: Ela:'. Perini:Fec: Onfier Afech.Insp. Othu.P/uurh ba P. Onto).Fire.brsP. Hech.Imp. Fee: Plunrb.Insp.Fee: F.ler./resp. Fee: NOTE: This estintate does not include fees due to other Departments(i.e. Planning, Public Works, Fire,Sanitary Sewer District,School District,etc.). These fees are baser/on the prelininan in or n ttion available and are mile an estinate. Contact the Dept for addn7 into. FEE ITEMS fF e Resolution 11-053 Ell' 7/1/11) FEE QTY/FEE MISC ITEMS Phan Check Fee: SuppL PC Fee Phanh..,".,Vech.:Elec Permit Fee: $195.00 Suppl. Insp I'ee Phunh..-'Mech.:Elec Phmrh_,Lle clr.:Elec Permit Fre: Construction Tax. .Administrative Fee: Work Without Permit? O Yes (j) No $0.00 Ach-uncedPlanning Fees: Travel Documentation Fees: Strong Motion Fee: IBSEISHICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $196.50 $0.00 TOT'L FEE: $196.50 Revised: 07/01/2012