12100142 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10570 WHITE FIR CT CON'I'RACI'OR:POUR SEASONS ROOTING PERMIT NO: 12100142
OWNER'S NAM Ii: FONG EDDY S PO RON 1668 DATE ISSI11iD: 1011912012
OWNER'S PHONE: 65 04 00 03 00 SANJOSE.CA 95109 PRONE NO:(408)278-0330
❑ n LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUNIB Ci
Class Lie.9 Y7 2/2-5
) MECH r RESIDENTIAL r COMMERCIAL (J
Contractor Date
hereby n iron that 1 am licensed unde the provisions of 6npter9 JOB DESCRIPTION: RE-ROOF,REMOVE SHAKE&INSTALL PLYWOOD AND
(corn mencing e'ith Section 7000)of Division 3 of the Rusi ness& Professions COhR'
Code and that my license is in full force and effect. SHINGLHS 13 SQ CLASS A
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 the work Ibr 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 die work for which this
permit is issued. Sq.Ft Floor Arca: Valuation:$18000
\I'I'LIC,\N"F CIi R'I'I PICA"PION
I cenify that I have read this application and state that the above information is APN Number:35905117.00 Occupancy Type:
correct. I agree to comply with all city and county ordinances and suite Imus 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 hamtlessthe City ofCupertino against liabilities,judgments, PERMIT EXPIRES IF WORD IS NOT STARTED
costs,and expenses which may acerae against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply WITHIN/I" DAYS OF PERMIT ISSUANCE OR
with all non-p ion source regulations pe the Cupertino Municipal Code,Section 180 DA OM LAST CALLED INSPECTION.
9.18.
Signa tu Date Issue by Date:
�Q
❑ OWNER-RUILDER DECLARATION
hereby affirm that I am exempt from the Contractor's License Law for one of RF: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 obtai ' 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) lG/iGt��
1,as owner of the property,am exclusively contracting with licensed contractors to .Signature of Applicant tea �J
consuuct the project(See.7044,Business'& Professions Code).
I hereby affirm under penalty of perjury one of the following three ALI,ROOF COVERINGS TO BE CLASS"A"OR BE;1-ITR
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's I IAZARDOUS MATERIALS DISCLOSURE
Compensation,as provided for b}•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 Health&Safety Code.Sections 25505,25533,and 25534. 1 will mainmin
Section 3700 of the Labor Code,for theerfamnance of the work for which this compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
p Safety Code,Section 25532(x)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 the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I mill
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 ofCalifomia. If,after making this certificate of exemption,I Ilealth&Safety Code,Sections 25505,25533,and 25534.
become subject to the Worker's Compensm ion provisions of the Labor Code,I must
s car or a hr aed er
Forthwith comply with such provisions or This permit shall he deemed revoked. Date
AI'1'LICAN'I'Cl?R"I'IPICA'I'ION CONSTRUC11ON LENDING AGENCY
I cenify 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 suite laws relating I hereby affmn thin there is a construction lending agency for the performance of cork'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'-,Name
indemnify and keep harmless the City of Cupertino against Iiabilitics,judgments,
costs,and expenses which may acerae 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 ARCIIIT'F.CI"S DECLARATION
9.18.
1 understand my plans shall be used as public records.
Signature Date
Licensed Professional
I21 � vl `� Z
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: -7v /- I DATE: 10/18/2012 REVIEWED BY: jsg
APN: BP#: 'VALUATION: $4,500
*PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Duplex PENTAMATION 1SFDWLROOF
USE: PERMIT TYPE:
NVORK Reroof remove shake instal plywood and comp shingles
SCOPE
FEE ID ROOF AREA
s.f.
1REROOFFRES 1,300
Mach. Plan Check Plumb. Plan Check E1e,Plan Check
hlech. Permit Fee: Plumb. Permit Fee: Elec.Permit Fez:
Other Mcch./asp. Other Plumb Insp. Other Elce.Insp.
Plech.Gap. Fee: Plumb. Insp. Fez: Ficc.htcp. Fec:
A'OTE:.This estimate(toes not includejeer due to other Departments(i.e. Planning, Public Works, Fire,Sanitary Sewer District,School
District,etc T/tete nes are based on the prelintinanN information available and are nob an es7inrnte. Conflict die Dept for nrldn'l info.
FEE ITEMS /Fee Resolution 11-053 Elf. 7///12) FEE QTVfFEE MISC ITEMS
Plan Check. Fee:
Supp/. PC Fee
Plumb.111ech./Elec
Permit Fee: $195.00
Supp/. Insp Fee
Phonb./Adech./F_lec
P1unA1A,1ech./F1et Permit Fee:
Construction Tai:
Administrative Fee:
Work Without Permit? O Yes (E) No $0.00
Advanced Planning Fees:
Travel Documentation Fees:
Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $196.50 $0.001 TOTAL FEE: 1 $196.50
Revised: 10/01/2012
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO.CA 95014-3255
CUPERTINO (408)777.3228•FAX(408)777-3333 • building0cupertino.OnQ
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USE OF ❑ SFD or Duplex 9l Mufti-family ROOF AREA- VALUATION: reg—
STRUCIVRF: [3 Commercial 3 S62. 57'OQ
FXISTMO ROOF Type: ❑BUILT-upRDOp ❑AFPIIALTSHINGLIS AGOOD 91AKFS 13WOOD51HINOLE5 ❑01 HER ISPECIFY)
REMOVE'REPLACE SKYES I IFNO. PLYW'CIDD 'T' ❑ PLYW'D ❑ORD PITCHROOF
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PROPOSED ROOF TYPE: ❑BGILT•UP ROOF y\1SPI{,\Li SNINGLES ❑W'000511AI:f:1 Ll WOOD SHINGLES ❑OTHER ICC-ES REPORT e
DESCRIPTION OF WORK:
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('er}a.;e�oed Presidan�4'�al acrop_._stn_i.ngLsLS_..��i'_o�_C.o�nk�ra�
By my signatom below.I certify to tach of the following; I am Ilia prorKay mvPer or nuthnnzed agent[o ac;on me property ownet's bclwlL I hove read this
applieetior,and the infonnntion 1 have provided In correct, I have rend the Description of work and verify it is accumte. I agree to comply viith oil applicable]oral
ordinances rind Slate laws relating to building coni. irtion. I ay horize rcpresc p tiv 01 Cuperino to en[er the aboveddendllcd property for inscacrion purposes.
Sianawne of ApplicanUAgenr. _r{/� Dnm:
SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONI,V
_ If building is associated with a Hnmc 0\sner a Aksocialion.'pmvide let-as PLAN CHECK TYPE ROUTING SLIP '
ofepptoval from HOA. ❑ OVER-TRECOUNTFR ❑ RImmy.G PLAN RLVIEw
Provide Planning approval to verify,if there any restrictions. ❑ EXPRESS O PLANNING 0AN REvIEw
_ Provide copy oi'Manufocturur's Ins:nllation Specification;. ❑ sT..nnnen ❑ R.Cncrr
Provide signed copy or Cupertino'S Te,0ff Policy. ❑ OTHER:
Rc,o fdpp_2011.doc mvlrvd.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)777-3333•buildlng(a0cuoenina.oro
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NDERSTAND 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 hoar 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 coveting 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 1/0 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 S 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 inn 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. 1 also understand that
smoke detectors and carbon m idc detector e . ired to he installed in accordance with Sections R314 and R315 of
the 2010 California Reside al 1
Signature of Applicant/Agent: 7Date:
Remo./P0Hc.v_1011,doc,'cv1,,cd 02116111