12090241 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21060 WRITE FIR CT CONT'RACT'OR:FOUR SEASONS ROOFING PERMIT NO: 12090241
OWNER'S NAME: KOVVURU DIIANAM 1 ANDTI IOTA LAXMI N PO RON 1668 DATE ISSUED:09272012
OWNER'S PRONE: 4082714218 SAN JOSE,CA 95109 PHONE NO:(408)278-0330
❑ LICENSED CON FRACI'OR'S DECLARATION BUILDING PERMIT INFO: BLDG C ELECT(—J PLUMB r.
License Class Lic.N
M ECII (✓ RESIDENTIAL❑ COMMERCIAL -
Contractor Date
I hereby affirm than 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION:TEAR OFF EXISTING WOOD SHAKE ROORINSTALL
(commencing is kh Section 7000)of Division 3 of the Business&Professions I2'CDX
Gide and Thal all.license is in full force and effect. PLYWOOD&309 FELT UNDERLAYh1ENT.INSTALL 13 SQ
CERTAINTEED PRESIDENTIAL COMP
hereby affirm under penalty of perjury one of the following hyo 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.FI Floor Area: Valmdion:$4500
APPLICANT'CF.RTIFICATION
1 certify that I have read this application and slate that the above information is APN Number:35905108.00 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
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 conmply 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 Issued by: Date:
❑ OWNER-BUILDER DECLARATION
hereby affirm that I am exempt from the Contractor's License Lawfor one of RE-ROOF'S:
the following two reasons: All roofs shall be inspected prior to any 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,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 w'idm licensed contactors to Signature of Applicant: Date:
construct the project(Sec.7044,Business&Professions Code).
1 hereby afftnn under penalty of perjury one of the following three ALL ROOF COVERINGSTO BE CLASS"A"OR BETTER
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's RA•J.ARDOUS NIATERIAIS 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 o1'the Labor Code,for theertomance orthc work for which this compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
F Safely Code,Section 25532(x)should I store or handle hazardous material.
pennil is issued. Additionally,should I use equipment or devices which emit hazardous air
I certify that in the performance of die 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 California. If,after making this certificate of exemption,I Dcalth&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 agent:
Date:
APPLICANT CERTI FICATION CONSTRUCTION LENDING AGENCY
I 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 laws relating I hereby,it-rim that there is a construction lending agency for the performance of work's
to building construction,mid hereby authorize representatives ofthis 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
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section ARCHITFCI"S DI.CLARATION
9.18.
1 understand any plans shall be used as public records.
Signature Date
Licensed Professional
2,0 �z�l
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO, CA 95014-3255
CUPERTINO (408)777-3228• FAX(408)777-3333 •buildina(a)cupertino.org (7'
PRUIECi:\UOk§55 D.; ^ G APN:
0 AME J/u- O PHONE 2� E-MAIL L]
STREE'I ''AUI S O CI STATE.ZIP FAX
a Sa
CONTACT NAME E-HAIL
e PHONE14 62-7_18 0 301�
STRELTADDRE S02 S CIMSTATF_ZIPqt�aA FAX
"Orfling❑OWNFR ❑ OWNER-RUILDER ❑ OWNER AGENT A CONTRACTOR ❑COYMACrOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME LICF.NSENUNIBER LICENSE t PE BUS,LIC•
COMPANY NAME [..MAIL FAX
STREET ADDRESS CITY.STATE ZIP PHONE
SflZ a oS2 C -o
ARCHrrECTIENGINEER NAME LICENSE NUMBER BUS.LIC e
COMPANY NAME E-NIA11. FAX
STREET ADDRESS d I CT',STATE ZIP PHONE
USE OF ❑ SFD or Duplex F MOI[I-FamII\' ROOF AREA: +P� VALUATION:
STRUCTURE: ❑ Commercial 13 5' 5"0
EXISTING ROOF TYPE: 11 BUILT-UP ROOF ❑ASMIALTSHINOLES �OWOOD SHAKES ❑`A'OODSHINGLES ❑OTNF.R[SPECIFY)
RCMOVE!REPLACE YF.S IF NO. PLYWOOD /l':f" ❑ PIBWD ❑ OSB PITCH ROOF
❑ YF.R I 'NF ❑ /8" TYPE .K '(? A A
PROPOSED ROOF TYPE: ❑BUILT-UPROOF 1RASPH.A1_T SHINGLES ❑N'OOUSIIAAES 11 WOOD SHINGLES ❑OTHER ICC-ES REPORT
DESCRIPTION OF WORK:
oX . Z AS4to►11 "Iz c r
I wood +6ea 304* Ae1-1- finder( t►r� •_F_ie�.l�_�—ie
olerk ,S440A Qrestdeok+,"t tonin ,bin es _ 00617 CQUACY GrO.1
By my signature below.I certifv to each of the following; 1 am the property m mer or authorized agent to act on the propery owner's behalf. I have read this
application and the information I have provided is correct. I have read the Description of work and verify it is aceurnte. I agree to comply with all applicable local
ordinances and stale laws relative to building cons lion. I a Drize represe tiv of Cupertino to enter the a ve-identified property for inspection purposes.
Signature of ApplicandAgenc Date: O
SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY
_If building is associated with a Home Owners Association.provide letter PLAN CHECK TYPE -ROUTING SLIP
ofapproval from HOA. ❑ ,OVER-THCCOUNTER ❑ BUILDING PLAN REVIEW
Provide Planning approval to verifi'if there any restrictions. ❑ EXPRESS ❑ PLANNING PIAN REVIEW
Provide copy of Manufacturer's Installation Specifications. ❑ STANDARD ❑ FIREDEPT
Provide signed copy of Cupertino's Tear-Off Policy. ❑ OTHER:
Reroojdpp_2011.doc revised 03/16/11
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS:.�2LO Loci (.J-�� ( DATE: REVIEWED BY:
Em's APN: BP#: "VALUATION: 1$4,500
*PERMITTYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Duplex PENTAMATION 1SFDWLR00F
USE: PERMIT TYPE:
(YORK 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
Afech.Phu;Cheek Plumb. Plan Chrrk Flea Plan Check
biech. Permit Fee: Plumb.I comi:Fee: Ekc. Permit Ree:
Other dfe:h.insp, Other Plumb lasp. Other Flec. Imp.
A-f•:'h./rtgt. Fee: Plumb.lnep.Fee: Flee.Insp.Fee:
NOTE: This ertitnate rocs not include jeer due to other Departments(i.e. Planning,Public Works, Fire,Sanitary Sewer District,School
District,etc.). These fees are based on the preliainan in onnntion available and are otdv an estimate Contact the De t or addn7 info.
FEE ITEMS (Fee Resolution 11-053 F_1L 7/1/11) FEE QTl'/FEE MISC ITEMS
Plan Check, Fee:
Suppl.PC Fee
Phunb./Huch..ilee
Permit Fee: $195.00
S11ppL Insp Fee
Plumb.,•"Mech.:Ekc
P1umh. Llcch.'Elec Permit Fee:
Coustntclion Tax:
Administrative Fee:
Work Without Permit? O Yes (F) No $0.00
Aelvuneed Plunning Fees:
Trirvel Docrtmerticttion Fees: �
Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item
Bide Stds Commission Fee: IBCBSC $1.00
SUBTOTALS_. $196.50 $0.00 ,-;.„• TOTAL FEE:,. $196.50
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•building(cDcupertino.org
PROTECT D FSS APN a
OW 1 AME P{{ON -7 E-MAIL
4 a.�
STREET ADDRESS .STATE. R 0 FAX
COYiRACTO E LICENSE NUMBE LIC TYPE BUS.LIC.
—
COM � ME E-MAIL FAX
STREETADD S C L _
I UNDERSTAND AND AGREE TO THE FOLLOWING: C
1. There-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 I/<" 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. 1 understand and agree to comply with the re-roof policy stated above. I also understand that
smoke detectors and carbon m xide detectors are required to be installedin accordance with Sections R314 and R315 of
the 2010 Califomia Reside it de.
Signature of Applicant/Agen Date:
RerooJPolicv_201 Ldoc revised 02116111