12090211 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21076 WHITE FIR CT CONTRACTOR:FOUR SEASONS ROOFING PERM IT NO: 12090211
OWNER'S NAME: CUI WENYU PO BOX 1668 DA'Z'E ISSUED:09/2512012
OWNER'S PHONE: 4088874259 SAN JOSE,CA 95109 PHONE NO:(408)278-0330
AkY LICENSED CONTRACTOR'S DECLARATION r Cl F7
/1 I. BUILDING PF.RDIIT INFO: BLDG ELECT PLUMB
License Class ComLo
- Lic.4 a. (U ❑ r 1—
p1EC11 RESIDENTIAL COMMERCIAL 'J
Contractor Fs L 10 C - Date �
lT. JOB DESCRIPTION:TEAR OFF EXISTING WOOD SHARE ROOF.INSTALL 112"
1 hereby affirm that 1 um licensed under the provisions of Chapter') CDX
(commencing with Section 7000)of Division 3 of the Business& Professions
Code and that my license is in full force and effect. PLYWOOD&30N FELT UNDERLAYMENT.INSTALL 13 SQ CLASS
A CF-RTAINTEED PRESIDENTIAL COMP
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 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 die performance of Ole work for which this
permit is issued Sq.Ft Floor Area: - Valuation:$4500
APPLICANT CERT'IFICAT'ION
I certify that I have read this application mid state that the above information.is APN Number:35905100.00 Occupancy Type:
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 z
indemnify and keep harmless the City of Cupertino againstImbilitics,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 understandsand 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 �I--� Issued by - Date:e'——
b
❑ OWNER-BUILDER DECLARA'T'ION
I.hereby affirm(hat 1 am exempt from the Contractor's License Law for one of RE-ROOFS:
the following two reasons: All roofs shall be inspected prior to my roofing material being installed.If a roof is
1,as owner of the property,or my employees with wages as 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(Sce.7044, inspection.
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: Date:
construct the project(Sec.7044,Business&Professions Code).
1 hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's )(A)ARDOUS NIATF.RL\LS 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&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 Caperrtino Municipal Code.Chapter 9.12 and the Health&
Safety Code,Section 25532(a)should 1 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 be the Bay Area Air QualilyManagement 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 and the
Compensation laws of Cul iflmia. If,after making this certificate ofexemption,I Ileallh&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. Owner or authorized agen •
D e: f
APPLIC,\NT'CER'1'IFICA'I'ION P S'I'Rllcl'ION LENDING AGENCY
I certify that 1 have mad this application mid state that the above information is
correct.I agree to comply with all city and county ordinances:ad 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 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
grassing of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. ,\RCI I I'I'FCIf'S DECLARATION
1 understand my plans shall be used as public records.
Signature Date
Licensed Professional
o Z
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO,CA 95014-3255
(408)777-3228• FAX(408)777-3333 • buildingpcupertino.oro
CUPERTINO
PROJECT ADDRESS Z1b A%Lr - / T,�_ 1 -
I AP%= 359 o`- , i
r -e r
I
OWNER NAME We C
, PHONE O ) gg _ S E-\:AIL
1
STREET ADDRESS CIT4\STATE.ZIP FAN
7_lo L Gv`1 ;1c �r'� C - I ( ,( -'. ; CA .
CONTACT NAME. PHO\E E-MAIL
c I o - -030
STREET"ADDRESS Sot CITY.STATE.ZIP FAN
ning s+. I Spin Toe-
❑OAAMER ❑ OWNER-efdLDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER L TE ANT
CONTRACTOR NAME LICENSENL'MBER I LICENSE TIDE I BUS.LIC.!
�o.vl 2 0
COMPANYNAME SAmE I 1-MAIL I FAX
STREET ADDRESS Sol I CITY.SLATE 2IP PHONE
w ose C -Z B'O
ARCHrrECTIENGINEER NAME I LICENSE NL?BER I BLS,LIC.
COMPANY NAME I E\LML FAX
STREET ADDRESS , CIT\'.STATE.ZIP PHONE
ESE OF ED `/SFD or Duplex Multi-Family ROOF AREA: d vALLATION:
STRUCTURE. ❑ --Ommercial �/ /j S 'R Ll 5-0o
EXISTING ROOF TYPE: ❑BUILT-EPROO-r ❑ASPHALTSHISGLES ``PCVOODSHAxES ❑NOODSHISGLES ❑OTHER(SPECIFY)
REMOXE:REPLACE Y'F.S IF NO. PLY\\"DOD {.!i O PLYWO ❑ OSB PITCH' ROOF
❑ N n A\'F.R THC
i:NESS ❑ i-E" TYPE• CON -q-:12 LA A
PROPOSED ROOF TYPE: ❑BUILT-UPROOF XASPHALTSHINGLES ❑\0000SHAIES 13"ODD SHINGLES El OTHER ICC-ES REPORT•
DFSCRIPTIOF OF PORN: L ' 1
5_TT�A 6 wcsoA s�n{Le rood`. 2 AS�w ��Z"
30# ' I JE rLndeJal-m-CA _ELA0,ll1_ �+
Cer�oLSnkaed Presider+h s_ 6i�s _ C_olsr : Coon fv Urdv
By me signature below-I certify to each of the following: 1 am the proper'o\\Der or authorized agent to act on the propen owner's behalf. I have read this
application and the intormation I have provided is correct. I have read the Description of Mork and verify it is accurate. I agree to comply with all applicable local
ordinances and state law's relatina to building cons tion. I a OTIZC Tepresen• fir of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicam/Agent. Date: �O
SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY
_ If building is associated\\'ith a Home 0\cner's Association.provide letter PLAN'CHECK TYPE ROUTING SLIP
of approval from HOA. ❑ OYER-THE-COUNTER ❑ BUILDING PLAN REVIEW
Provide Planning approval to verify if there any restrictions. ❑ EXPRESS ❑ PLAN;N'ING PL .N REVIEW
Provide copy of Manufacturer's Installation Specifications. ❑ STANDARD ❑ FIRE DEPT
Provide signed copy of Cupertino's Tear-Off Police. ❑ OTHER:
Reroof.4pp_2011.doc revised 03/16/11
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
Ims ADDRESS: �t d -1 U-1 W %5-'' Y I DATE: REVIEWED BY:
APN; BP#: 'VALUATION: $4,500
*PERD1IT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Duplex PENTAMATION 1SFDWLROOF
USE: I I PERMIT TYPE:
WORK TEAR OFF EXISTING WOOD SHAKE ROOF.INSTALL 112" CDX PLYWOOD& 30# FELT
SCOPE [TEAR
13 SQFT CLASS A CERTAINTEED PRESIDENTIAL COMP p
FEEID ROOFAREA
(s.t)
1REROOFFRES 1,300
e,
- _ - --. -
;lfeeh.Plan Cheek, Plumb. Plan.Chea:k Flee.Plan Check
blerh. Permit Fee: Plumb.Pehmit Fee: Elec. Pernga Fee:
Othe Afeeh.Imp. Other Plumb Insp. Othea.Elea h"p.
La•ch.Ince. Fee: Plumb. Insp.Fee: Flee.Insp. Fee:
,VOTE: This estinhate doer not include fees due to other Depantihents(i.e. Planning,Public 11'orks, Fire,Sanitary Serer District,School
District,etc.). Thesefees are based on the prelininan in ornmtion available and are otdv an estiuute. Contact the Det for addn'l info.
FEE ITEMS (Fee Resolution 11-053 E11 7/1/11) FEE QTY/FEE D11SC ITEMS
Plaut Check Fee:
Suppl.PC Fee
Phunb_,illech_,Tlec
Permit Fee: $195.00
Suppl. Insp Fee
Plunb.:Adech.iFlec.
PlamhJ L&ch.:f7ac Permit Fee:
Coustrucfiun Tac:
Administrative Fee:
Work Without Permit? O Yes (2) No $0:00
Advanced Plmtning Fere:
Travel Documentation Fees: �
Strong Motion Fee: IBSEISAIICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.001 1
SUBTOTALS:, $196.50 $0.00 w.,'• • '' TOTAL FEL., $196.50
Revised: 07/012012