12090244 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21054 WHITE FIR CT CONTRACTOR:FOUR SEASONS ROOFING PERMIT NO: 12090244
OWNER'S NAME: REN FEIYAN PO BOX 1668 DATE ISSUED:09272012
OWNER'S PHONE: 4083721101 SAN.IOSF.,CA 95109 PHONE NO:(408)278-0330
❑ LICENSED CONTRACTOR'S DECLARATION' BUILDING PERMIT INFO: BLDG r. ELECT r PLUMB Ci
License Class - 3� Lic.9 [. rl.2 �C3
M
�J �? ECH r RESIDENTIAL r COMMERCIAL F.
Contractor js- 2c_ Date
1 hereby affirm that I am licensed under the provisions of Chapter 9 .JOB DESCRIPTION:TEAR OFF EXISTING WOOD SHAKE ROORINSTALL
(commencing with Section 7000)of Division 3 of the Business& Professions 12"CDX
Code and that my license is in full force and effect. PLYWOOD&309 FELT UNDERLAYMENT.INSTALL 13 SQ
CERTAINTEED PRESIDENTIAL COMP
hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent m 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 perfommnce of die work for which this
permit is issued. Sq.FI Floor Area: Valuation:$4500
APPLICANT CERTIFICATION
I certify that 1 have read this application and state that the above information is AI;N Number:35905111.00 Occupancy Type:
correct.I agree to comply with all city and county ordinances and state lays 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 WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this perinit. Additionally,the applicant understands and will comply
with all non-point source regu lots per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION.
9.18.
Signm Date 'a7 IZ Issued by: T Date:
❑ O\VNER-BUILDER D1'CLARATION
I hereby offann that 1 am exempt from the Contractor's License Low for one 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 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(Sec.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).
hereby affirm under penalty or perjury one of the following three AEI-ROOF COVERINGS TO RE CLASS"A"OR BE PIER
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's ILC-/.ARIIOUS JIAT'F.RLU S 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. I will maintain
Section 3700 of the Labor Code,for the performance of the work for which this cons plia nee with the Cupertino Al unicipal Code,Chapter 9.12 and the Health&
Safety Code.Section 25532(a)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 are work for which this permit is issued,I shall contaminants as defined b) the Bay Area Air Quality planagement District I will
not employ any person in any manner so as to become subject to the Worker's tan intaiis complitmre with the Cupertino Municipal Code,Cho pier 9.12 and the
Compensation laws of Cal ifomia. If,after 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
Dare: /
APPLICANT CF,RTI FICAT'ION CONSTRUCITON LENDING AGENCY
I certify that I have read this application and state that the above information is
correct.1 agree to comply with all city and county ordinances mad state laws relating I hereby amrm 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 sae Lender's Name
indemnify and keep harmless the City of Cupertino against habililies,judgments,
costs,and expenses which may accrue against said City in consequence of the Lender's Address
granting of permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section ARCHITF.CI"S DECLARATION
9.18.
I understood my plans shall be used as public records.
Signature Date
Licensed Professional
- I2v0( c>zyq
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO,CA 95014-3255
CUPERTINO (408)777-3228• FAX(408)777-3333 •buildinO(Dcuoertino.orO
PROJECT ADDR 210
APN4
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OWNER NA. 1/4 Al PMONE0 _ E-MAIL
STREETADDR CI ITATE,ZIP FAXO. G S_0
1114
CONTACT NAAIF PHONE 30� IL E-NIA
CeS -0
STREETADDRESS 5,62- a5 CITt'.STATE:ZIP CAATI FAX
❑ OWNER ❑ OWNER-RUILDER ❑ OWNER AGENT J( CONTRACTOR ❑CONTRACTOR AGEII ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TEN.Wr
C'ONTRACTORN4UE LICF.NSENCNIBEft I LICENSE T'PE BUS LIC.-
Fe,uir -7-mos 2139-A
COMPANY,NAME E-MAIL FAX
STREET ADDRESS Sot. wosC
CITY.STATE.ZIP I PHONE 9_O
e
ARCHTTECTCENGINCER NAME LICEX'SE NUNUIER BUS,LIC.r
COMPANY NAME E-NIAIL FAX
STREET ADDRESS I CITY.STATE,ZIP PHONE
USE of ❑ SFD or Duplex j, Multi-Family ROOF AREA: je VALUATION:
STRUCTURE: ❑ Commercial 5 `R �O
EXISTING ROOF TYPE: ❑BUILT-UPROOF ❑ASPIIALTSHINGLES r`YOODSHAKES ❑W'OODSNINOLE.S 130110ERISPECIFY)
REMOVEtREPL\CE YF.S I IFNO. PLY\GOOD �ti ❑ PLYW'D ❑Os8 PITCfP ROOF
❑ N FR I 'NF . ❑ TYPECD '1 AS A
PROPOSED ROOF TYPE: ❑BCILT.UPROOF 91SPH.ALTSHINGLES ❑N'OODSH.AKES ❑aOODSHISGLES ❑OTHER ICC-ES REPORT
DESCRIPTION OF WORK: '4" COX f
7rear Ing n a Wood 66al e. rocX _ 'T ilS4All
uxoA +'taco 30# �eik �IIr�er cy� Fyn �_ieS�w
cer.lrAokkoea PresideRk;ol come S610 es G'olnC . 0.
BY my signature below,I certify to each of the following: 1 am the property owner or au•,horlud agent to act on the property owner's behalf. I have read this
application and the information I have provided is correct, 1 have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building cons lion. I a orivt represe tiv of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Dam: 071 sto
SUI PLEMENTAL INFORMATION REQUIRED OFFICE use ONLY
_If building is associated\vith a Home Owner's Association.provide letter PLAN CHECK Tl PE -ROUTING SLIP
of approval from HOA. ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW
Provide Planning approval to verify if there any restrictions. ❑ EXPRESS - ❑ PIJ N;N'ING PLANREVIEN'
_ Provide copy of Manufacturer's Installation Specifications. ❑ STANDARD ❑ FIRE DEPT
Provide signed copy of Cupertino's Tear-Off policy. ❑ OTHER:
ReroojApp 2011.doc revised 03/16/11
CITY OF CUPERTINO
FEE ESTIMATOR IMATOR - BUILDING DIVISION
2 (�� WK>-UL, Y DATE: REVIEWED BY:
ADDRESS: '
\ APN: BP#: *VALUATION: 1$4,500
*PERMITTYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Duplex PENTANIATION 1SFDWLR00F
USE: PERMIT TYPE:
NVORK TEAR OFF EXISTING WOOD SHAKE ROOF.INSTALL 1/2" CDX PLYWOOD &30# FELT
SCOPE UNDERLAYMENT.INSTALL 13 SQ CERTAINTEED PRESIDENTIAL COMP SHINGLES,COLOR.
FEEID ROOFAREA
(s.L)
1REROOFFRES 1,300
- - -- --
dleeh.Plan Cheek Plumb- Plan Clark Elan Plan Check
b eah. Permit Fee: Plumb.Peonir Fee: Elle.Perndr Fee:
Otlrrra.•rl�.
frill. Other Plumb Insp. Ll I Otlrra-F.7ec. lap.
Alech.Inrp. Fee: Plumb. In,<p.Fee: Fier.lnvlr..Fee:
NOTE: This estinate does not include fees due to other Departrrren[s(i.e.Planning, Public Works, Fire,Sanitary Sewer District,School
District.etc). These fees are based on the prefininailr infort ation available and are on/v an estimate. Contact the Dept for addn'I info.
FEE ITEMS (Fee Resolution 11-053 Ell 7111111 FEE QTY/FEE MISC ITEMS
Plan Check Fee:
SuppL PC Fee
Ph anb.;:llerh.;'F,lec
Penn it Fee: $195.00
Suppl. lrtsp Fera
Phtmb.i'.A,1ech.:E1ec
Phar?`).!b/ech.:Elec Permit Fee:
Construction Tac:
Administrative Fee:
Work Without Permit? O Yes (D No $0.00
Athanced Planning Fees:
Travel Documentation Fees:
A
Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
• `SUBTOTALS;.' $196.50 $0.001LTOTAFEE:' $196.50
Revised: 07/01/2012
!J
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•building(Dcupertino.org
PROJECT ADDRESS. APNM
OWNERN ME , PEI
E-MAIL
/ 6 —i a
STREET A PR S / r / CI .STATE.ZIP 9,v J FAX
OC 115�5 JA
CONTRACTORN E LICE'S WE() IUM
_ E� BUS.LIC0
04 Aa�l
COMPA E E-MAIL FAX
M
STREET CI Z S//L- HO1�pr/0 �7 C/
I UNDERSTAND AND AGREE TO THE FOLLOWING: (/
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/<" 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: I am the property owner or authorized agent to act on the
property owner's behalf. I understand and agree to comply with the re-roof policy stated above. I also understand that
smoke detectors and carbon monoxide detectors are required t e installed in accordance with Sections R314 and R315 of
the 2010 California Resident'
Signature of Applicant/Agent:_ Date:�`4��•-
ReroaJPo1icv_201 Ldoc revised 02116/11