12080159i
CITY OF CUPERTINO BUILDING PERNUT
BUILDING ADUHFSS: 21063 RED PIR CI" c0S•'I RAcrult: POUR SE'ASON'S I'ClolITNO: 12080159
80017 I NG
O,A'S vSNAau':: 1PASUNJEAN 110 13O 1663 I)xrl: Isslin):08/20/3013
O\\m lt's I'IIONh: 4085921127 SAN JOSE, CA 95109 IVO.NF NO:(.109)278-0330
I
LICENSED COM'RACl'OR'S DECLARATION r r r
C� c/ It1IILDING I'Flt>II"I'INFO: ,LDC F.LF.Cr Pt.0?lit
License Class C— 3 ( Lic.d 12(o n r r r
n ?IECII RF.SIDEN1 IM. COMMERCIAL
Contractor � Dalc 9-20-17—
JOTS DESCRIP I'IUN: 13 SORS T12AR OFF I:NIS'rING WOOD SHAKE ROOF,
I hereby affirm that I ant licensed under the provision.ol'Chapter')
(co ntimicinL,with Section 7000)of Di,iAon 3 ufthe Iiu,iness\ P,oFessioas IC'CUS I'1.1'l\'OOI7'1'I IIiN 30u Plil.lJt`DIiHI.:\1'VIiR'I'.
Code:][](] 111a1 ty license is in fall firer and liver. INSI'A LL CIiIi'I)\IN'lliliU I'H IiSIDIiN'I'AI.CO.\f l'SIIINGLHti.
I hereby affirm under penalty or perjury one ul'tile]III l...ing I'm declarations:
I have cul will maintain It certificate of consent hl scl-insure fin Worker's
Compensation,as provided for by Section 3700 of the Labor Code,fur the
performance of the work for which this permit is issued. Sq.FI Fluor Arca: Valuation:51500
I have and will maintain Worker's CompcnSaiOn InSmrallcl•,as provided lin by
Section 3700 of[lie Luther Code.for the performance of the work lin which this
\I'N Number:35905060.00 (Irrnp:ory''1}'pc:
permit is issued.
A PPLICAN"I'CERTIFICA ION
I certify that l have read this application and slnte that lire above information is PERfN91T EXPIRI'S IF WORK IS NOT STARTED
correct. l agree to comply with all city and county ordinances and slate law's relating WITHIN 180 DAYS OF PERD'IIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon me alun c mentioned properly for inspeclionpurpnseS. (We)agree to save 180 DAN" FRONI LASI" CALLED INSPE TION.
indenituly and keep harmless the CityofCuperlinu against liabilitics.judgnlrnts. res
costs.and expenses which nay accrue against said City in consequence offlic UA
granting of this permit, Additionally.the applicant understands laid will comply Issued he: k Date:
with all mon-point source regulations per we Cupertino Municipal Code.Section
9,13.
�_+ ��ZO� Irl:-HOOFS:
Signature \ Dan: I All tool's shall be inspected prior loan roofing material being installed.Ifo roof is
installed without first obtaining an inspection.I agree to remove all newmaterials 1'or
inspection.
❑ ONN'SER-TrUILDER ULCLARA'IION
Signature ofApplicant: 'le: C=
I hereby affirm thatI:un ru•nn pl from the Cuntracmr's Lice ase I:ae'(or unr Ill'
the follu..ing too reasons: ALL HOOF CO\I'.RIN ;' fU ISF,CL,\SS \"OR BE 171"k
I,as owner of the property,or lip•employees with%%ages as their Sole compensation.
will do the work,and the structure is not intended or ollired far sale(Sce.7044,
Business R Professions Code)
1,as owner of the property,am esClusively contracting I,ilh licensed contractors to IL\Z,\It U(l1IS 31:YI'lilt L\LS DISCLOSIII F
construct the project(Sec.70-1.1.Business.l''Professions Code). I lia,v read the hazardous Vanier requirements under Chapter(.95 of the
California l Icadth A'Safely Colic.Sections 255115.'-5531 and 25.,34. 1 will
I hrreby air rni under penalty of perjury one ofthe full....ing three maintain compliance with the Cupertino.Municipal Code.Chapter9.12 and the
decd:u aliens: Ilealth&Salety'Code.Section 25532(:q should I s(mre or handle hazardous
I Ila\c and\1111 maintain a Cenilicaw of Consent to sell-111sorl'lin Worker's material. Additionally,should I nue equipment or device,which emit hazardous
Compens:tion,as provided Im by Sectio13700 ofthc labor Code.Ilarlhe air can nuainantx:t,defined by the Bit y Area Air Ouality?lanagenu•nl DWriclI
performance ofthe work for which this permit is issued. will muinnin cum III is lice with the Cupertino Jlumicip:d Cudc,Chaplet 9.12 and
I have land will maintain Worker's Compensation Insurance,as provided fior by the I lealth&Safety Cade.Sections 25.,15,25533,xnd 25534.
Section 3700 ofthc labor Code,for the perlimnancc nllhe work Int which this g`7-Q
llwne'mr uulhurizrd:agent:_ Date.
permit i5 issued.
I certify thin in the perlimnancc of jhc work lin which this pcnnil is issued.I shall
not employ any person in any manner so as to become subject ill the Worker's
Compensation laws of Calilnnlia. If.alter making this certificate orexemption.I (:UNs I'It11Cl'ION LIiNDING AG FNCI'
become subject In the Worker's Compensation provision,ofthe labor Code I must I herchy allir n that there is a construction lending agency liir the perlium:uce(It'
Ibnhwith comply with such provisions lir this pcnnil shall he deemed revoked. ..ark's lin which this pcnnil is issued(Sec.3097,Civ C.)
Lender's N:ane
APPLICANT CERTIFIC,\'IION Lender's Address
I certify that I have read thisapplication and sone Jam the above imlornlanion is
correct. I agree to comply with all cityandcounty ordinances and state laws relating
to building construction,and hereby authorize repmsentaii%es orthis city to enter
upon the above mentioned property for inspection purposes.(\Vel agree to save
indcmnify:std keep harmless the City of Cupertino against l inhilinics,judgments, ARCIIITICCI"S UFCLARATION
costs,and expenses which nay accrue against said City in consequence 0f the I understand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and.till comply
with all non-point source regtdalions per the Cupertino Municipal Code.Section Licensed Professional
9.18.
Signature Dale
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 21068 Red Fir Ct DATE: 08/15/2012 REVIEWED BY: Sean
APN: BP#: c; U1_5-C -VALUATION: $4,500
*PERINUT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY Buildina is PENTAMATION
USE: Multi-Family Dwelling >3 Stories O Yes E) No PERDIITTYPE: 1R2R00F
WORK Tear off existingwood shake roof. Install 1/2" CDX plywood then 30#felt underla ment. Install
SCOPE Certainteed Presidential composition shingles. Color: Country Gray
FEE ID ROOFAREA
(S.f.)
1RER00FMRES 1,300
Mech.Plan Check Plumb.Plan Check Flee,Plun Clack
;Heck Permit Fee: Ph;mh. Permit Fee: Ele.c.Permit Fee:
Other Mech.Insp. Other Plumb Insp. Ll I Other Elec.Insp.
Afech. Insp.Fee: Phanb.Jusp.Fee: £lee. Insp.Fee:
NOTE: This estimate docs not include fees due to other Departments(i.e. Planning. Public ll'orks, Fire,Sanitary Server District,School
District, etc.). Thesefees are based on the preffininari information available and are on11•an echinate. Contact the Dept for adds 7 info.
FEE ITEDIS (Fee Ravoltion ll-053 Ell. 7/1/11) FEE QTY/FEE MISC ITED1S
Hun Check Fee:
Suppl. PC Fee
Plumh.%d1ech.!Elec
Permit Fee: $195.00
Suppl. lisp Fee
Plumb.,i14¢ch.iElec
Phunba'5Vech.lElec Permit Fee:
Con witeiion.Tax:
.441minicuatire Fee,.-
Work
ee:Work Without Permit? O Yes (F) No $0.00
_Ichvancetl Planning Fees:
Travel Dueumentenion Fees:
Strome Motion Fee: IBS£ISMICR $0.50 Select an Administrative Item
Bide Sids Commission Fee: IBCBSC 1 $1.00
SUBTOTALS: 1 $196.501 $0.001 TOTAL FEE: $196.50
Revised: 07/01/2012
REROOF PERMIT APPLICATION
COMMUN17 DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA'95014-3255
CUPERTINO (408)777-3228 •FAX(408)777-3333• buildinO(.cuperlino.orO
PROJECT ADDRESS Z104
Q C AP, � �i O O (oD
OWNERN'AAIE `V Tea su I PHONE — E-MAIL
STREEI'.ADDRESS ��bp CITY, STA P I FAX
CONTACT NAME PHONE EJIAIL
.Q
STREETADDRESS5,02— S CIT\'.STATE.ZIP FA.x
❑Ou NF.R ❑ OWNER-RUILDER ❑ OWNER AGENT . COM1TRACTOR ❑CON'TRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENAM1T
CONTRACTOR NAMELICF.NSENL:NIBER LICENSET'PE BUS.CIC-.•
17,j
COMPANY VAMC E-MAIL FAX
SAME
STREET ADDRESS CITY.STATE.ZIP PHONE
Sot w oS¢ C 8'0
ARCHITECT•ENGIVEER NAME LICENSE NUMBER BUS.LIC.
CONIPA.NYNAME I E-MAIL FAX
STREET ADORFSS CITY.STATE ZIP PHONE
USE OF ❑ SFD or Duplex Jf Multi-Family ROOF AREA: r VALUATION:
$TRUCTl1RE: ❑ Commercial 13 S S'DO
If
EMSTING ROOF TYPE: 11 BUILT-CP ROOF ❑ASPI[ALT SHINGLES rs'OODSHAKES ❑WOODSHINGLES ❑OTHER(SPECIFY)
RCNIOYF.:REPLACE VYES IFNO. PLYR'OpD .-' ❑ PLYWD ❑OSB PITCH: ROOF
13NO .LAYERS� 'NE ❑ "p C x :17 A A
PROPOSED ROOF TYPE: ❑BCILT-UPROOF XASPHALT SHINGLES 1:1 WOOD SHAKES ❑R'OOD SHINGLES CI OTHER IMES REPORT.
DESCRIPTION OF WORK: Y� 'A"
dl
Cox
t0I- b
By,my signature below.I certify to each of the following: I am the property owner or authorized agent to as on the property owner's behalf. have read this
application and the information I have provided is coned. I 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 onze repress [jvu of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Dote: -3O
SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY
If building is associated with a Home Owner's Association,provide letter PLAN CHECK TYPE ROUTING SLIP
of approval from HOA. ❑ OVEIRTHE.COONTER ❑ 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 Cupertino's Tear-01T Policy. ❑ OTHER:
ReroojApp_201 Ldoc revised 03116111