12100075 CITY OF CUPERTINO BUILDING PERMIT
BILI LDING ADDRESS: 10594 WHITE FIR Cf CONI'RACI'OR:FOUR SEASONS ROOFING PERMITNO: 12100075
OWNER'S NAME: CHEN SHI AND SHUN CAILAN PO BOX 1668 DATE ISSUED: 10/11/2012
OWNER'S PHONE: 4082073779 SAN.IOSE,CA 95109 PI IONF-NO:(408)27x-0330
❑ . LICENSED CONIRACFOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUDIB
License Class •/9 Lie.# b r r r__1j NECK RESIDENT L\I. CCOMMERCIALContractor Datej //
I hereby affirm that I am licensed un a the provision. of Chapter 9 306 DESCRIPTION:PEAR OFF IiXISTING WOOD SHAKE ROOF.INSTALh NEW
(commencing with'Section 7000)of Division 3 of the Business& Professions IR"
Code and that my license is in full force and effect. CDX PLYWOOD AND 300 FELT UNDERLAYMENT.INSTALL 13
SQ NEW CERTAINTEED PRESIDENTIAL COMPOSITION
I hereby affirm under penalty of perjury one of the following hon 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 for which this permit is issued.
I have and rill 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 Floor Arca: Valuation:54500
AI'PLICAN I'CER'I'IpICA'I'ION
I certify that I have read this application and state that the above information is APN Number:35905129.00 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 it. Additionally,the applicant understands and will comply WITHIN I DAYS OF PERMIT ISSUANCE OR
with all non-poo source regulations per the Cupertino Municipal Code,Section 180 DAYS
' D2 LAST CALLED INSPECTION.
9.18.
Signatu Date - V Is (t by: Date:
11O\VNIiR-BUILDER DECLARATION O
I hereby affirm that I am exempt from the Contractor's License Lax'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
I,as owner of the properly,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(See.7044, inspection.
Business&Professions Code) J
1,as owner of the property,am exclusively contracting with licensed contractors to Signature of Date: -
construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three ALI,ROOF COVERINGS TO RE CLASS"A"OR Isla"1'ER
declarations:
I have and will maintains Certificate of Consent to self-insure for Worker's IIA'/-ARDOUS I1IATERIAIS 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 Health&Safety Code.Sections 25505,25533,and 25534. I wi11 maintain
Section 3700 of the Labor Code,for the performance of the work for which this compliance with(he Cupertino Municipal Code,Chapter 9.12 and the Ilealth&
Safety Code.Section 2553.(x)should I store or handle hazardous material.
permit is issued. Additionally,should I use equipment or devices which emir 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 1 will
not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Munici pal Code.Chapter 9.12 and the
Compensation laws of California. If,after making this certificate of exemption,1 Health&Safety Code,Sections 255115.25533,and 25534.
become subject to the Worker's Compensation provisions of the Labor Code,I must
errorDrize /
forthwith comply with such provisions or this permit shall be deemed revoked. G Date:
APPLICANT CERTIFICATION CONSTRUC-PION 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 allirn 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
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,.Section ,\RCII I'1'FCI"S DECLARATION9.18.
I understand my plans shall be used as public records.
Signature Dale
Licensed Professional
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)777-32288- FAX(408)777-3333•building(d)cuoertino.org
PROLE �/ APN a
O E ^ PH 'O� 07 - E-MAIL
STREET ADDRESS \ /I�.A, r CI S?A7E,ZI d i^/ FAX
CO Z LIC!l p BER / LIC -Cl BUS.LIC.•,2 /�i 3
CO. AME E-MAIL t� ) FAX o� ✓f.,I
STRS C /// 7�
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 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$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 a ree to comply with the re-roof policy stated above. I also understand that
smoke detectors and carbon o xide dei r ere2-be installed in accordance with Sections R314 and R315 of
the 2010 California Resi nti Code.
Signature of Applicant/A en Date:
ReroofPolicv 7011.doc reviser/0211611
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 10594 White Fir Ct. DATE: 10/10/2012 REVIEWED BY: Sean
97APN: - BP#: 'VALUATION: $4,500
*PERMITTYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY Buildina is PENTAMATION
USE: Multi-Family Dwelling >3 Stories 0 Yes Q No 1 PERNIITTYPE: 1R2R00F
WORK Tear off existing wood shake roof. Install new 1/2" CDX plDvood and 30#felt underla ment. Install
SCOPE new Certainteed Presidential composition shingles. Color: Country Gray.
FEEID ROOFAREA
s.f.
1REROOFMRES 1,300
Mech. !'Man Check Plumb. Plan Cheek Elec.Plan Check
btech. Permit Fee: Plumh. Permit Fee: 6lec•. Permit Fee:
Other H ch.Insp. Other Plumh Insp. Other Elec.Insp.
Jdech.Insp.Fee: Plumb. loop.Fee: filet. Insp.Pec:
A'OTF: This estimate noes not include jeer due to other Departments(i.e. Planning, Puhlic If orks, Fire,Sanitary Sewer District,School
District.etc. . Thesefees are based on the prefintinan information available and are only an estimate. Contact the Dept for adeln l in o.
FEE ITEMS (Fee Resolution /1-053 FIX 7/1/12) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Sapp 1. PC 1,
Phtmb./A4eclUrlec
Permit Fee: $195.00
Suppl. Insp Fee
Plumb./Adech./Flee
Plunth./hlech./Flet Permit Fee:
Construction Tax:
Administrative Fee:
Work Without Permit? 0 Yes Q No $0.00
Advanced Planting Fees:
Travel Docnrrtentation Fees:
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
I31de Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $196.50 $0.001TOTAL FEE: $196.50
Revised: 10/01/2012
EMREROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE -CUPERTINO.CA 95014-3255
GUPERTINO I (408)777-3228• FAX(408)777-3333•huildino(dcupertino.oro/
PROIECTIU0RE {p\0 9 n
L
OWNER NAA PHDNE E-MAIL
�1 G'8" 07
STREET AIIDRE'SCIT' STATE.ZIP FAX
t r S-0 114
CONTACT NAME PHONE E-}f AIL
STREEIADDRESS�O^ S ,./ CITY.STATF ZIP ga.
FA\
❑OWNFR ❑ OWNER-R`UILDER 11OWNERAGENT J( CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TEti\Nr
CONTRACTOR NAME LICENSE NUMBER LICENSE PE BUS.LIC.a
or SgaS.ai 4-17.10
COMPANY SAME ,MAIL
$ FAk
STREET ADDRESS CITY.SLATE ZIP PHONE
Soz a ose C 8-0
ARCHI'rECT/ENGINEER NAME LICENSE NUMBER BUS.LIC.a
COMPANY NAME I E-MAIL FAX
STREET ADDRESSI CIT'.STATF_ZIP PHONE
./
USE OF ❑ SFD or Duplex ja Multi-Family ROOF AREA: +� YALCATION: 0
STRUCTURE: Cl Commercial ^J SQ
EXISTING ROOF TYPE: ❑BUILT-UPROOF ❑ASPIIALTSHINGLES 0W'ODDSHANES 13 WOOD SHINGLES ❑OTHER(SPECIFY)
REN:O%F,REPLACE YFS IF N'0. PLYWOOD . ' ❑ PLYWD ❑OSB PITCH ROOF
❑ NO AY
THTC-\ S ❑ (" TYPE
COY 'l 7 CLASSA
PROPOSED ROOF TYPE: ❑BUILT-UPROOF JCASPH.ALT SHINGLES ❑WOOD SHAKES 11 WOOD SHINGLES 13 OTHER ICC-FS REPORT
DESCRIPTION OF WORN; Z"
7rearSt7olie� Cox
s�ws�� inert 30#
Snksed Qrz.UAAA+L"A come s6inwles_ Calor : Cnunit�(AI
Hy my signature below.I certify to each of[he following: I am the property owner or authorized agent to act on the properp'owmcr's behalf. I have rend this I
application and the information I have provided is correct. I have read the Description of Work and verify it is accuram. I agree to comply withal]applicable local
ordinances and slate laws relating to building cons tion. I a oriu represe Iiv of Cupertino to enter the above-identified property for inspection purposes.
Signature of ApplicanUAgent: Date: IRO
SUPPLEMENTAL INFORMATION REQUIRED OFFICE USEONLY
If building is associated with a Home Owner's Association.provide letter PLANCHECRTYPE ROUTING SLIP
ofappmvaP from HOA. I� O\'ER-TNGCOIMT'ER �BUILDING PLANREYIE'N'
Provide Planning approval to verify if there any restrictions. 6 FapRE55 PLANNING PLAN REVIEW
Provide copy of Manufacturer's Installation Specifications. ❑ srnnnARn ❑ FIRE:nEPT
Provide signed copy of Cupenino's fear-Off Policy. ❑ OTHER; '
XeroojApp_201 I.doc revised 03116//1
REROOF TEAR-OFF POLICY -
I��I COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS: 10590 WHITE FIR CT CO\fRACFOR:FOUR SEASONS ROOFING PERMITNO: 12100073
OWNER'SNAME:-CHIN SONNYCIIEIN 1'0[ION 1668 DATE ISSUED: 10/112012
OWNER'S PHONE: 4087184626 SAN.IOSE,CA 95109 PHONE.NO:(408)278-0330
❑ LICENSED CON`fRAC`FORR''S DECLARATION .BUILDING PERMIT INFO: BLDG (- ELECT❑ PLUMB IJ
License Class Lie.N
DIECII (- RESIDENTIAL r COMMERCIAL r
Contmctbr Date —O I /
1 hereby affirm that I am licensed un the prorisions of Chapter 9• 30R DESCRIPTION:TEAR OFF EXISTING WOOD SHAKE ROOF.INSTALL I2"
(fom meneing with Section 7000)of Division 3 of the Business&Professions CDX
Code and that inr license is in full force and effect. PLYWOOD AND 30q FELT U ENTIALYMEN'f.I TION L 13 SQ
Nfa4'CERTAINTEED I'RESIDEN'TIAI-COMPOSITION
I hereby affirm under penalty of perjury one of the following(wo 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,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 perf rimnee of the work for which this
permit is issued. Sq.Ft Floor Arca: Valuation:54500
APPLICAN I'CF,RTIFICAT'ION
1 certify that I have read this application and state that the above information is ANN Number:35905127.00 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 comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR
with all non- out source regulations per the Cupertino Municipal Code,Section I$Q DAYS
9.18M LAST CALLED INSPECTION.
.
Sign Date Issyed g: Date:
❑ OWNFR-RIIILDF,R DECLARATION lOO eL
hereby affirm that 1 am exempt front the Contractor's License Law for one of RF--ROOFS:
the following two reasons: Allroofs 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 simcture is no[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 Appli� Date:
construct the project(Sec.7044,Business&Professions Code).
hereby affirm under penalty of perjury one of the following three ALI,ROOF COVERINGS TO BE CLASS"A"OR IIF; TER
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's IIAZARDOUS MATERIALS DISCLOSURE
Compensation,as provided for by Section 3700 of the Labor Cade,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 Workers Compensation Insurance,as provided for by California Ilcalih&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
Section 3700 of the Labor Code,Tor the performance of the work for which this compliance with the Cupertino Municipal Code,Chapter 9.12 and the liealth&
Safety Code,Section 2553_(x)should I store or bundle hazardous material.
permit is issued Additionally,should 1 use equipment or devices which emit havardous air
I certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Buy 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 Cuperlinn Municipal Code,Chapter 9.12 and the
Compensation laws of Califamia. 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. v mer ort t r riz .� t
Datey��
APPLICAti I'CF,RT'IFICATION CONS'IRtICI'ION LENDING AGIiNCY
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 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 hamicss 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-paint source regulations per the Cupertino Municipal Code,Section ,\Rfl II'fFCf'S DECLARATION9.18.
I understand my plans shall be used us public records.
Signature Date
Licensed Professional
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
` ADDRESS: 10594 White Fir Ct. DATE: 10/10/2012 REVIEWED BY: Sean
APN: V BP#: 'VALUATION: $4,500
*PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY Multi-Family Dwelling Buildina is PENTAMATION 1R2R00F
USE: 3 Stories O Yes 0 No PERMITTVPE:
WORK Tear off existinq wood shake roof. Install new 1/2" CDX plywood and 30#felt underla ment. Install
SCOPE new Certainteed Presidential composition shingles. Color: Country Gray.
FEE ID ROOFAREA
s.f.
1REROOFMRES 1,300
t a i L
Meeh. Plan Check Phanb. Plan Cheek Flee.Plan Check
hlech. Permit Fee: Plumb. Pcrmu ree: Flea Pennil Fee:
Other Afech.Insp. Other Plumb Insp. Other Elcc.Insp. Li
.11ech.
Insp.Fac:• Plumb. btsp. Fee: Elcc.Dup.Fee:
NOTE: This estimate does not includejees due to otter Departments(i.e Planning,Public Works, Fire,Sanitary Sewer District,School
District, etc). Thesefees are based on the prelindnat3 information mailable and are only an estimate Contact the De t or addn 7 info,
FEE ITEMS(Fee Resolution 11-053 EIL 7/1/12) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Suppl. PC Fee
Plumb./.•1/e ch./Elec
Permit Fee: $195.00
Suppl. lnsp Fee
Pham b.I.Heclt.fEl ec.
Phmth.4fech./Elec Permit Fee:
Construction Tax:
Administrative Fee:
Work Without Permit? O Yes (j) No $0.00
Advanced Planting Fees:
Travel Docannenia ion Fees:
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
a ;SUBTOTAL'S:: $196.50 $0.001 $196.50
Revised: 10/01/2012
( Z ( 00 ,
EMREROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO,CA 95014-3255
CUPERTINO I (408)777-3228•FAX(408)777-3333 • building0cupertino.orct
PR'I A/25CQ /) APN'c f-.� 0
0-51W-
W - N£'-'- YY / PHONE je / E-NAIL
STREET 1110 " 0 CIT STATE.ZIP FAX
JJ (( " e r S
CONTACT NAME PHONE E-S1.AIL
STREETADDRESS ^ CITY.STATE,ZIP FAX
❑OWNER ❑ OWNER-RUILDER ❑ nwNF.RAGENT A("N RACTON ❑CON7RdCr0RAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENAM
CON'rRACTOR NASIE LICENSE NUMBER LICENSE PE BUS LIC..
FAL1f s$wseA3 12m�'i I710
COMPANY NAME E-MAIL FAX
SAME
STREET ADDRESS S"07- CIT\'.STATE-ZIP Q C PHONE
O$e C en
ARCHI I-ECTiENGINEER NAVE LICENSE NUMBER BUS.LIC.r
COMPANYNAME I E-MAIL FAX
STREET ADDRESS I CITY.STATE ZIP PHONE
USE OF ❑ SFD or Duplex AI Muld-Family ROOF AREA; ; VALUATION:
109—
STRUCTURE: [ICommercial 1 13 S 7so
EXISTLNGROOFTVPE: ❑BUILT-UPROOF ❑ASPI IALT SHINGLES ��PGOODSHAKES ❑WOOD SHINGLES 11O1'UBR(SPECIFY)
REMOVE. REPLACE vFS IF NO. PLYWOOD /1tr' ❑ PLYWD ❑OSB PITCH ROOF
❑ N +L YF.R (CANE ❑ r8" 'YP: CDX -q-:12 AS A
�/
PROPOSED ROOF TYPE: ❑BUILT-UPROOF y�45PHALTSHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES El OTHER ICC-ES REPORT.
DESCRIPTION OF WORK: `/Z e f
t o A S�1w�0 roo� _ SAS
coy-
wo oA + /e�e► 3 0# �' 1 n�-etlgyx� -.��esll.,�_�—i&C A-0A�
se Pres l-Azfi+zsi Como S61nale `Calftr CnuA4ry CA ro-y
By my signemre below,)certify to each of the following: I am the property owner or authonmd 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 accum:e. I agree to comply Ivith all applicable local
ordinances and state laws relating to building cons lien. I a orize represe tiv of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applianl/AgenC Date: O
SUPPLEMEN"FAL INFORMATION REQUIRED OFFICE USE ONLY
If building is associated with a Home Owner's Association.provide letter PLAN CHECK TYPE ROUTINGSLIP
of approval from HOA. 1 OVER-THE-COUNTER L71 BUILDING PLAN REVIEW
Provide.Planning approval to verify if there any restrictions. F-11EXPRESS ❑ PLANNING PIAN REVIEW
Provide copy ofManufacturer's Installation Specifications. ❑ STAND.RD '❑ nREncP•r
Provide signed copy of Cupertino's Tear-Off Policy. ❑ OTHER:
NeroojApp_2011.doc revised 03ll6/l I
CUPERTINO I (408)777-3228•FAX(408)777-3333• buildino(aDcuoertino.orcl
PROTECT AP,I'k
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10588 WHITE FIR CT CON'I'RACI'OR:FOUR SEASONS ROOFING PERMIT NO: 12100071
OW'NER'S NAME: WILSON GUY C TRUSTEE 110 BOX 1668 DATE ISSUED: 10/112012
OWNER'S PHONE: 4087725147 SAN.IOSE,Cy 95109 PHONE NO:(408)278-0330
.❑ LICENSED CO\IRACI'OR'S DECLARATIONCi
�� BUILDING PERMIT INFO: BLDG r ELECT❑ PLUDIB
License Class` Lie.N r r r
� I-nf AfECFI RESIDENTIAL COMMERCIALContractor ,n rrt/. lA Date o z -L--
hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:TEAR OFF EXISTNG WOOD SHARE ROOCINSTALL NEW
(commencing with Section 7000)of Division 3 of the Business& Professions Int
Code and that my license is in full force and effect. COX PLYWOOD AND 30p FELT UNDERLAYAIENT.INSTALL 13
- SQ NEW CERTAINTEED PRESIDENTAIL COMPOSITION
hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a cenificate 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 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 Floor Area: Valuation:54500
APPLICA�'%'I'C1iR'r1F'ICy'1'10N
1 certify that I have read this application and state that the above information is AI�N Number:35905126.00 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 CityofCupeninoagainst liabilities,judgments, PERMIT EXPIRES IF WORK IS NOT STARTED
costs,and expenses which may accme against said City in consequence of the
granting ofthis permit. Additionally,theapplicam understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR
wilhallnon- am[sourceregulatimsl rthe Cupertino Municipal Code.Section 180 DAYS M LAST CALLED INSPECTION.
9.18. /_J///,�!�
Signa
Date Issued 12 Date:
❑ OWNER-BILI LDF.R DECLARATION U
hereby affirm that 1 am exempt from the Contractor's License Loy for one of RF:ROOFS;
the following two reasons: All roofs shall be inspected prior to any roofing material being installed.Ifo marts
1,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining un inspection,I agree tore rove all new materials for
will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection. 7
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to Signalure of Applicin.
construct the project(Sec.7044,Business&Professions Code).
1 hereby affirm under penalty of perjury one of the following three ALI-ROOF COVERINGS TO 13E CLASS"A"OR BETTER
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's HA7.ARDOUS MATPRIALS DISCLOSURE
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the ivork 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 I Iealth&Safety Code.Sections 25505.25533,and 25534. I will maintain
Section 3700 of the Labor Code,for the performance of them ork for which this cum plia nee with the Cu pertino Municipal Code.Chn pier 9.12 and the Ilealth&
Safety'Code,Section 25532(n)should I store or handle hazardous material.
permit is issued Additionally.should 1 use equipment or devices which entit hazardous air
I certify that in the performance of the work forwhich this permit is issued,1 shall contaminants as defined by the Bay Arca Air Quality Management District I will
not employ any person in any manner so as to become subject to the Worker'smoi -n compliance with the Cupertino Municipal Cop.Chapter 9.12 and the
Compensation laws of Califrmia. If,after making this cenificate of exemption,1 feint &Safer Tda
ectih s 2 5 25533,and 255 J.
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. 0 er or a hurm . 7�
Dole
APPLICAN1'CERTIFICATION
CONS'fRUC110IN LENDING AGENCYI 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 Imus relating I hereby attain that there is a construction lending agency for the performance ofmwrk'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
granting of this pernit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Sectian ARCHITECT"S DECLARATION
9.18.
I understand my plans shall be used as public records.
Signature Date
Licensed Professional
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 10594 White Fir Ct. DATE: 10/10/2012 REVIEWED BY: Sean
APN: BP#: -VALUATION: $4,500
*PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY Multi-Family Dwelling Building is PFNTANIATION 1R2ROOF
USE: >3 Stories O Yes (F) No PERMITTYPE: At
WORK Tear off existinq wood shake roof. Install new 1/2" CDX plywood and 30# felt underla ment. Install
SCOPE new Certainteed Presidential composition shingles. Color: Country Gray.
FEE ID ROOF AREA
(s.L)
1REROOFMRES 1,300
n:T�.aJ.-_
Mesh. Plan Check Phanb. Plan Check Flec.Plan Check
,f ch. Permit Fee: Plumb.Permit Fee: tiles. Permit Fee:
Other Ak h.Insp. Odrer Plumb Insp. Other Elec.Lisp. El
,Mech. Lisp.Fre: Plumb. hasp.Fee: Elec.Insp.Fee:
NOTE: This estimate does not include fees due to other Departments(i.e Planning, Public /Forks, Fire,Sanitary Sewer District,School
District,etc.). These fees are based on the preliminan information available and are only an estimate Contact the De t or addn't info.
FEE ITEMS (Fee Resolution I1-053 Fff 7/1/12) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Suppl. PC Fee
Pennb.611'ech./F_lec
Permit Fee: $195.00
Suppl. Insp Fes
Plumb.I.Hech./Flec
Plumh./A•!ec/r.iElec Permit Fee:
Consimcdon Tux:
Administrative Fee:
Work Without Permit? O Yes (2) No $0.00
Advonced Planning Fees:
Travel Docmnemation Fees:
Strong Motion Fee: IBSFISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SU6T_O.TAL3 $196.50 $0.00 TOTAL REE..:` $196.50
Revised: 10/01/2012
EMREROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO,CA 95014-3255
CUPERTINO (408)777-3228•FAX(408)777-3333 • buildingocuperlinOOM
PRO/EC ADO $JR) APN e �5 0 " I
VV y G I
OWNER NAM
''JJ An �� / - PHONE -MAIL
STREEr ADD eS- \/..Cy l/ CIT' STATE.LIP FAX
(((vim 0 a AIA;4e- -r So
CONTACT NAS\IE PHONE E-]TAIL
STRELT ADDRESS5,62— S I CIT).STATE ZIP qjrj II�FAX
❑OWNER ❑ OWNER-RUILDER ❑ OWNF.RAGENT J( CON;RACTOR ❑CO8, RACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TE AW
CONTRACTOR NAME LICENSENCNIBER LICF.NStT PE BUS.LIE.
FALar SeosaAs 117ak 2 0
COMPANYN'AME SAME
E-NIHIL FAX
STREET ADDRESS CITY.STATE ZIP PHONE
SoZ a oSe C -O
ARCHIrEc,riE.NGL\EE0.NA?IE LICENSE NUMBER Bus.LIC A
COMPANY NAME E-MAIL FAN
STREET ADDRESS I CITY.STATE ZIP PHONE
USE OF ❑ SFD or Duplex je Multi-Family ROOFAREA; VALUATION:
STRUCTURE: ❑ Commercial S 01
SO
EXISTING ROOF TYPE: ❑BUILT-(:PROOF ❑ASPIIALTSHINGLES ��;tWOODSHAAE.S OW'OOOSHINGLES ❑O1TtF.R(SPECIFY)
REN1OYF.(REPLACE jrY, IF NO. PLYWOOD /l:T' ❑ PLYW'D ❑OSB PITCH ROOF
❑ NO + YFR THICNNE S ❑ i - TYPE -Dx .12 1A5 A
PROPOSED ROOF TYPE: ❑BUILT-UPROOFICC-ES REPORT9
45PHALTSHINOLES Cl WOOD SIL41:E5 ❑ROOD SHINGLES ❑OTHER
DESCRIPTION OF N'ORK: Z„
acid sklifc
� l�o_od 4L�n 3 0# -� l� n_de cl.wye_n+.�'n— 1 l I 1 Inc It
.e+sed PreSideft+;ol Coni&54+i� ,_Coler : CouAry Crew
By my signature below.I certify to each of the following: I am the property owner or authorized agent to act on the property ommcr's behalf. 1 have read this
application and the information I have provided is correct. I have rcad 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 tion. I a orize rePrcsS6wIiy.Q of Cupertino to enter the above.identif ied property for inspection purposes.
Signature of Applicant/Ageni: � Dam: O
SUPPLEMENTAL INFORMATION REQUIRED OFFICeuSE ONLY
_If building is associated with a Home Owner's Association.provide letter PLAN CHECK TYPE �[ ROUTING SLIP
of approval from HOA. {�}.`_,tP OYER-TITc-COt,NT'ER IxJ BUILDING PLAN REVIEW
Provide Planning approval to verify if there any reSIrIGti OnS. L! EXPRESS PLANNING PLAN REVIEW
Provide copy of Manufacturer's Installation Specifications. ❑ 9ANnARu ❑ FIRE DEPT'
Provide signed copy of Cupertino's Tear-Off Policy. ❑ OTHER:
ReroofApp 20/Ldoc revised 03/16/11