12090242 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRIiSS: 21058 WHITE FIR CT CONTRACTOR:FOUR SEASONS ROOFING PERMITNO: 12090242
OWNER'S NAME: TANG LIZHONG AND HE SHA PO BOX 1668 DATE ISSUED:09/27R012
OWNER'S PHONE: 4086295132 SAN.IOSE,CA 95109 PHONENO:(408)278-0330
❑ LICENSED CONTRAC/T�O�R''S DECLARATION BUILDING PERMIT INFO: BLDG 1_ ELECT r PLUMB
License Class_ Lie.H 7 /a/6/yo r r r
/� 7_ Date NIECH RESIDENTIAL COMMERCIALContractorYS' Z
I hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION:TEAR OFF EXISTING WOOD SHAKE ROOF.INSTALL
(commencing with Section 7000)of Division 3 of the Business&Professions 12"CDX
PLYWOOD&304 FELT DENTIA LAYMENT.INSTALL 13 SQ
Code and that my license is in full force and effect.
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,for the
performance of 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 Fluor Area: Valuation:$4500
APPLICA\1'CFRTIFICATION
I certify that I have read this application and slate that the above information is APN Number:35905109.00 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 die above mentioned property for inspection purposes. (We)agree to save
indemnify and keep harmless the City ofCuperinoagainst 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 I = INSPECTION.
9.18.
Signatu Date - 97— 2 Issued by: Date:
❑ OWNER-BUILDER DECLARATION
hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS:
time 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) 0/c
1,as owner of the property,am exclusively contracting with licensed contractors to Signature of ApplicaWZ_ � Date:
constmet the project(Sec.7044,Business&Professions Code). //
1 hereby affirm under penalty of perjury one of the following three ALI,ROOF COVIiRINGS TO BE CLASS"A"OR BETTER
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 the work for which this permit is issued I have read the hazardous m:deriah requirements tinder Chapter 6.95 of the
I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505.25533,and 25.534. 1 will maintain
Section 3700 of the Labor Code,Ibr the perfonnancc of the work I'or which this compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Safety Code,Section_553_(x)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 for which 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 so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Compensation laws of Cali forma. If,after making this certificate ofeaemption,1 Health&Safety
Code,Sections 25505.25533,and 2555334.
become subject to the Worker's Compensation provisions of the Lobar Code,I must j�.�
forthwith comply with such provisions or this permit shall be deenned revoked. +' er or an r eat: oC
me:
APPLICANTCERTIFICATTON CONSTRUCTION LENDING AGENCY
I certify that 1 have read this application and state that the above information is
correct.I agree to comply with all city and county ordinances mid 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 accmc 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 ARCI IIT ECI"S DECLARATION
9.18.
1 understand my plans shall be used as public records.
Signature Date
Licensed Professional
Zv � Z4Z-
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINO (408)777-3228• FAX(408)777-3333•buildina(atcupertino.ora
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OWNER NAME halve PHONE ,IQ / ✓` E-N.AILd Y� 1
SIREE'I'ADDRE- / CI" STATE,ZIP t FAX
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CONTACT NAME. PHONE "Q 30l E-MAIL
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STREET ADDRESS O n CITI'.STATE.ZIP AN
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❑OW'NF.R ❑ OWNER-RUILDGR ❑ O\1' TOR ❑CONTRACTOR AGEVr ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
C'ONTRACT'OR NAME LICF.NSENUNBER I LICENSE T PE BUS.LIC.-
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY.STATE.ZIP I PHONE
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ARCH; ECTrNGINCER NAME LICENSE NUNIBER BUS.LIC.
COMPANY NAME E-MAIL FAX
STREET ADDRESS I CITI'.ST.ATE ZIP PHONE
USE OF ❑ SFD or Duplex j, MUltl-Fam1IC ROOF AREA: VALUATION:
STRUCTURE: ❑ Commercial '13S SO
EXISTING ROOF TYPE: []BUILT-UPROOF ❑ASPII.ALTSHINGLES Pe"OODSHAKES ❑W'OODSHINGLES ❑OTHF.RtSPECIFY)
RGMOVEIREPLACE 1F.S IF NO. PLYVI'OOD �1E" ❑ PLY
❑OSB PITCH'. ROOF
❑ NO +Ln\•F.R IfKSE ❑ Z9' t PB C S '�? CLASSA
PROPOSEOROOFTYPE: ❑BUILT-UPROOF PCISPHALTSHINGLES ❑N'OOUSHAKES ❑\1OODSHINOLES ❑OTHER ICC-ES REPORIv
OFSCRIPTION OF WORK: 1/Z t,
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By my signature below.I cerif-v to each of the IN lowing: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the inturmation I have provided is coneet. 1 have read the Description o1'WorR and veofy it is accurate. I agree to comply with all applicable local
ordinances and state laws relmin t to building core tion. I a orize represe IN of Cupertino to enter the above-identified property for inspection purposess.
Signamrc of ApplicanUAgent: Dalt: StO
SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY
_If building is associated with a Home Owner's Association.provide letter .PLANCHECK TYPE .ROUTENG SUP
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 ❑ FIRE DEPT
Provide signed copy of Cupenino's Tear-Off Policy. ❑ OTHER: '
ReroojApp_2D11.doc revised 03/16/11
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)777-333`3•buildingCcDcupertino.org
PROIECf R Sa g. APN n
OWNS AME P N `7 E-MAIL
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STREETADDRESS �A CITY, TATEP21P ' FA%
CONTRACfO ME /�e LICENSE NUMBER LICENSE TIRE BUS.LIC.4
COMPA ' E / E.MAIL FAX
STREET RESSTY T T PON ^�
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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 Y" 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 to be installed in accordance with Sections R314 and R315 of
the 2010 California Reside al C de. I
Signature of Applicant/Agei Date:
RerooJPo1icv_2011.doc revised 02/16/11
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: [l7�R l ,� r! I DATE: REVIEWED BY:
LMI, APN: BP#: "VALUATION: $4,500
*PERMIT TYPE: Minor Building Permit PLAN CII ECK TYPE: Re-roof
PRIMARY SFD or Duplex PENTA'1IATION 1SFDWLROOF
USE: PE TYPE:
WORK TEAR OFF EXISTING WOOD SHAKE ROOF.INSTALL 1/2" CDX PLYWOOD &30# FELT
SCOPE LIN DERLAYM ENT.INSTALL 13 SQ CERTAINTEED PRESIDENTIAL COMP SHINGLES:COLOR: p
REE ID ROOF AREA
(s.I.
1REROOFFRES 1,300
:t tear. Pl:w Check Plumb. Plan cher:k Elea Plmr Check
:ilech. Pern;h Fee: P—h.Permit Fee: Elec. Pemrir Fee:
Other Heelr.Imp. Oti:er Plumb Insp. Other Flee. lisp.
,Iyeelr.last). Fee: Plmnb. Inop.Fee: Elea Invp-Fee:
NOTE: This estimate does not include fees due to other Deparunents(i.e. Planning,Public Works, Fire,Sanitary Sewer District,School
District,etc.). These fees are based on the prelininan in onnation available and are on/v at estimate. Contact the Dept or addn7 info.
FEE ITEMS (Fee Resolution 11-053 E2 7/1/11) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
SnppL PC Fee
Phnnh.Ailech.;Tkc
Permit Fee: $195.00
Suppl. htsp Fee
Plumb,Alech.%'Flee
PLvnhJ_blach.:Eley.Permit Fee:
Construction Tar:
Administrative Fee:
Work Without Permit? O Yes 0 No $0.00
Arh•unced Planning Fees.
Travel Documentation Fees:
Strong Motion Fee: IBSEISA17CR $0.50 Select an Administrative Item
Bldg Stds Conmmission Fee: IBCBSC $1.00
196.50 TOLFE:SUBTOTALS:. $ $196.50
Revised: 07/01/2012