12080161 CITY OF CUPFIRTIN'O RUILDIt\'C PERN91T
BUILDING mmul:SS: 21070 RED rut Cr CON'l KAcf0R: POUR SEASONS PERMITNO: 12030161
ROOFING
O\\':NEWS NAMEI: LAU DIANE L PO 130\ 1663 D,\TE ISS(Wit:03/20/2012
OWNF IVS 141OX :: 4082109747 SAN JOSE. CA 95109 PUOSI'NO:(408)278-0330
I.ICEN'SI'.1),C:OSTRACfOR'S DECL,UL\'IION
tiRIMMINGrhltIN '1'u1N'Fu: MAW et.ecr r rt.u>m r
License Class Lic.k q y1 0`101 r F �—
`^ MECII RF.SIDKN'I'L\I. COMMERCI.\I.
Contractor Asa�4 IJL D:vr��''L
.IOB DESCR11''IION: 13 SQRSTFAR Olq:1:XISI ING WO(1D SIIAKI.ROOF,
I hereby allirm that I :un liccnsrd under the prnvisiu to of Chapter'1 INSTALL
(Hort nu`acine"'inti Section 7000)of Division 3 of the Itusincse S Professions I/2"CDX PL1"\1'OOD'I'I Ili\lOd Plil:r 11NDIiRLU'\11iN'I'.
Code anti than nnlicense is in full forcc;md effce(. INS'PAI.1.CHR'1'A]\'[ITI)PRESIDENl'Al1.COME'Sl I1N(i 1,liS.
I her'chy allirm under pendty of perjury tine o1'the follmeimg l,vo declarations:
I have and will maintain a certificate of consent b,self-insure for\\'orkcr's
Compensation,as provided for by Section 3700 N'the[:Thor Code,for the
performance orthe work for which Ellis perntil is issued. Sq. Ft Flour Arca: \':du:niun:S4500
I have and will maintain Worker's Compcnsatinn II15laranee',as provided fir by
Section 3700 of the Labor Code,for the perlimnanec orthe work fir which this
permit is issued AI•,\'Numher:350)051150.00 Ocnlpanev'1\'pe:
AITLIC\NT CERTIFICATION
Ice'rinfy that l have read this application and stale that lheabove ntlnrlanl;otl is PERAUT EXPIRES IF WORK IS NOT STARTED
correct.l agree to comply with all city and counry ordinances and state laws relating BVI-I-MIN 180 DAYS OF PI Rfl1 EI- ISSUANCE OR
to building construction,and hereby authorize npmsentatives ol'this city to enter
upon the above mentioned property for inspection purposes. (We.)agree to save 180 DAY� 'RON'1 LAST CA LL.ED 1N'SI'1: T[ON,
indcnniFy End keep harmless the City of Cupertino against liabilities.judgments,
costs,and expenses,vhich nrw accrue against said City in consequenec of the 2
Z
granting nllhis permit. Additionally,the applicant understands and will comply Issued bp:
with all non-point source regulations per the Cupertino Municipal Code.Section
9.18.
p .nom rr\ n h:ROOFS:
[)life ale_D'µr IS/ All roofs shall be inspected prior m am routing material being installed. II'a ruinis
installed without first obm,i ting an inspection.I agree to remove all new mato ials li,r
inspection.
❑ O\\':\'ISR-Illi ,UI?It UIiCI„\It,\'PION' 6-C.GJ
W-IZ
Signnlurc of Applicant:_ Dale:
I her rb)'allirm that I nm esrngn tram the Con t'arlrr's License L:nr lin'one til'
the fullowine oro reasons: ALL ROOF CU\'1':1 'O BE CLASS"A”Olt til I'1'6,It
h its Quango of the property.or my employees with,cages as their sole compensation.
will do the"ark,and Elie structure is not intended or ol)ced lir sale(See.70,14.
Business tC Professions Code)
I.as owner orlhe propery.;till cxcluskeh.contracting wills licensed contractors to IL\%AIIDOUS 3LYITRIALS DISCLOSURE
construct the project(Sec.7044.Business S Professions Code.). I have read the hazardou,material,requirement,under Chapter 6.95 ill the
California Ilcalth l Sarm.Cade,Sections 25505,25533,unit'_5534. 1 will
I hereby affirm under penally of perjury one of the folluwine do cc maintain compliance with the Cupertino,Municipal Code.Chapler9.12 and the
declarations: licul,h&Safety Code.Section 25532(a)should I Blore or handle hazardon,
I have and will maintain a Certificate of Consent W self-insure for Worker's material. Additionally,should I use cquipmctn(or devices which emit hazardous
Compcnsatinn,as provided Ion by Section 3700 orthe Labor Code,lir the ;lir contaminants as dclined by the tiny Area,Mir Quality Manaeeoent District I
perlbnnaaec oflhe work I-or which this permit is issued. "'ill maintain compliance with the Cupcnino.\l unicipal Code.Chapter 9.122 olid
I have and will maintain Workers Compensation Insurance,as provided liar by the Ileallh S S:felc Ca&.Sections 255115,21533,and 25534.
Section 3700 ol'the Ichor Code,for the performance nflhe%%ork fir which this
0,act-urudbm9zed agent: ,t•; C
permit is issued —
I ccnif�.that in the perlonnantce of the work for ohich this pcnnit is issued I shall
nal employ any person in any manner:so as to become subject to the Worker's
Compensation laws of California. If,alter making this cer ilicanc orewraption,I CONS I'12li CITU.\ LFSDING AGENCY
become subject to Elie Worker's Compensation provisions orlhe Labor Code I must I hereby affirm that there is it construction lending agency for the perlbntance or
forthwith comply with such provisions or this pcnnit shall be deemed revoked. work's for which This permit is issued(Sec 3097-Civ C.)
Lender's Name
A PPLICA:N'I'CP:ICI'IFIC\'IION I.t'odcn''s Address
I certify that I have read this application:tall state that the above inlbunation is
correct.I agree to comply with all city mud county ordinances and slue laws relating
to building construction,:and hereby:uthuri/c reproQutaliv"orchis city t,enter
upon the above mentioned properly Ibr inspection purposes.(WO aerec la save ,\HCI I I'1'FCI"S DISC LAI;,\Ill)N
indenmiN and keep harmless the City or Cuperinn against liabilities,Judgments,
costs,and expenses which nay accrue against.said CRY in consequence orlhc I understand my plans shall he used:E public records.
granting orchis permit.Additionally.the applicant understands and will comply
ss'ith all non-point source rc_gulalions per the Cupertino Municipal Code.Section Licensed Professional
9.18.
Signature One
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
:91 ADDRESS: 21070 Red Fir Ct DATE: 0 8/1 512 01 2 REVIEWED BY: Sean
APN: BP#: 8V/40 'VALUATION: $4,500
*PERDIIT TYPE: Minor Building Permit PLAIN CHECK TYPE: Re-roof
PRIMARY Multi-Family Dwelling Buildina is PENTADIATION 1R2RO0F
USE: 3 Stories O Yes 0 No PER,111T TYPE:
1voRK Tear off existing wood 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.L)
1REROOFMRES 1,300
Afech.Plan Check- Man&Plan Check- £lee.Plan Check
Hach. Permit Fee: North.Permil Few: Ele.c.Penang Fee:
Other 3tech./ntp. Other Phrmb lisp. Other Ele c.Insp. Ll I
Hwh.Insp. Fee: Plumb.btsp.Fen' Elec.. hnep.Fee:
NOTE: This estimate does not include fees due to other Departments(Le. Planning, Public I Porks. Fire.Sanitary Server District.School
District,etc.). These fees are based on the prelfininarl information available and are onrr an estimate. Contact the De t or addn 7 in o.
FEE FI'EMS (Fee Resolution 11-053 E2 7/1/11) FEE QTY/FEE N11SC ITEDIS
Plmt Chick Fee:
.Supp!. PC Fee
Plunlh.iAyech./Elec
Permit Fee: $195.00
SuppL lisp Fee
Plumb.:Uech.;Elec
Phunb.:Afech./Slee Permit Fee:
Construction Tax:
Acdntinictrative Fee:
Work Without Permit? O Yes (F) No $0.00
Advanced Planning Fees:
Travel Documentation Fees: A
Strong Motion Fee: IBS£ISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $196.50 $0.0.01 TOTAL FEE: $196.50
Revised: 07/01/2012
"Y- -
• f ,
REROOF PERMIT APPLICATION
COMMUN17 DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO.CA'95014-3255
CUPERTINO (408)777-3228• FAX(408)777-3333-buildinOCdcupertino.oro
PROJECT ADDRESS ka C _ApN. 1 ry O
OWNERNAME Deo a 6 -Z 0 PHOS -/ E-MAIL V
-
STREET.AUDRESS 0� CITY.ST.{ P
FAX
CONTACT NAME PHONE E-NI.{IL
-Q
STRE17ADDRESS Sot S CITY.STATE.ZIP FAX
❑OWNFR ❑ OWNER-FILILDER ❑ OWNER AGENT Jf CONTRA TOR ❑COITRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NNAME LICENSE NUMBER LICENSE PE BUS.CIC.
17,1 OR
COMPANY NAME E-MAIL FAX
SAME
STREET ADDRESS CIT'.STATE.ZIP PHONE
Set ea o5e C 8'0
ARCHrrECTrENIJINEER N'A?IE LICENSE NUMBER BUS,LIC.6
COMPANY NAME E-MAIL FAN
STREET ADDRESS CITY,ST.ATE.%IP PHONE
/
USE OF ❑ SFD or Duplex ` Multi-Family ROOFAREA: VALUATION:
STRUCTURE: ❑ Commercial 13 S 5-00
EXISTING ROOF TYPE: []BUILT-CPROOF ❑ASPI(ALT SHINGLES ;CXVOODSHAKES ❑WOODSHINGLES ❑01 HER ISPECIFY)
RE.VIOVF.:REPLACE YES IF NO. PLYWOOD' ❑ PLYWD ❑OSB PITCH: ROOF
❑ N LAVER dd ICKN ❑ 5!1- TYPE- f -12 LA A
PROPOSED ROOF TYPE: ❑BUILT-UPROOF 1/`ASPHALT SHINGLES 13 WOOD SHAKES ❑W'OOD SHINGLES ❑OTHE0. ICC-ES REPORT
DESCRIPTION OF WORK:
t� c
Hy mjsignature below.1 certify to each of the follmcingt 1 am the property owner or authorized agent to act on the property 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 accurate. I agree to comply with all applicable local
ordinances and state laws relating to building cons cion. I allIhorize represmliativu of Cupertino to enter the above-identified property for inspection purposes.
Signature of ApplicanUAgem Dale: 3 0
SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY
_ If building is associated With a Home Ooner's Association.provide letter PLAN CH ECH TYPE ROUTING SLIP
of approval from HOA. ❑ OVER-THE-COUNTER ❑ BUILDINC PLAN REVIEW
Provide Planning approval to verify if there any restrictions. ❑ E,XpgpSg ❑ puNNlNc eun'REv1EW
_ Provide copy of Manufacturer's Installation Specifications. ❑ STANDARD ❑ FIRE DEPT
Provide signed copy of Cupertino's Tear-OCT Policy. O'OTHER:
Reroof4pp_2011.doc revised 03/16/11