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11010158 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20127 APPLE TREE LN CONTRACTOR:CD ROOFING PERMIT NO: 11010158 OWNER'S NAME: DEVEND MATHUR 2909 WILBUR AVE DATE ISSUED:01/31/2011 OWNER'S PHONE: 4084801404 SAN JOSE,CA 95127 PHONE NO:(408)898-6605 I LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL IJ COMMERCIAL License Class Lic.# 23�Z I q(::� RE-ROOF 25 SQ,TEAR OFF OSB TO COMP CLASS A Contractor�t o Date 0 t ^,1 -- I hereby affirm that I am lice un r the provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. I 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 for which this permit is issued. Sq.Ft Floor Area: Valuation:$10500 1 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 APN Number:31633092.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHINS O PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DA M LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the Issued by: Date: 1 granting of this permit. Additionally,the applicant understands and will comply with all non-point sourc eg tions per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature Date_421 3 l t All roofs shall be inspected prior to any roofing material being installed.If a roof is installed without first obtaini7aninsectio ,I agree to remove all new materials for inspection. OWNER-BUILDER DECLARATION Signature of Applicant: Date: /Of — SX t i hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL R06 COVER TO BE CLASS"A"OR BETTER 1,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area ality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cuperti icipal Code,Chapter 9.12 and 1 have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25 . ;25 334. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent, / Date:,O\ permit is issued. I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the Worker's CONSTRUCTION LENDING AGENCY Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 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 to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities,judgments, -osts,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. -ting of this permit.Additionally,the applicant understands and will comply .,h all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date REROOF TEAR-OFF POLICY COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION ALBERT SALVADOR,P.E., C.B.O., BUILDING OFFICIAL CUPERTINO 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408)777-3228•FAX(408)777-3333•building(cDcupertino.org PROJECT ADDRESS APN# OWNULNAME ` HOS E-MAIL STREET ADDRESS CITY, STATE,ZIP FAX Rp )_� r- c c. Uo aLA CONTRACTOR NAME` LICENSE NUMBER LICENSE TYPE BUS.LIC.# J 3,CR COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP 1 PHONE �� 11�2 .p►`1 C' J �ZT I UNDERSTAND AND AGREE TO THE FOLLOWING: 1. The re-roof project shall comply with all applicable provisions of the 2007 California Building Code. 2. You must schedule all needed inspections a minimum of one day before the requested inspection date. Please schedule inspections online or call (408)777-3228 between 7:30-3:30 (Mon-Fri). 3. Tear-off roof inspection is required. Please call for tear-off inspection after the roof is torn off and all the nails/fasteners have been removed. Any and all dry-rotted wood shall be replaced prior to this inspection. A building inspector will be available within one hour. There are special hours for this service: 7:30 — 10:30am and 1:00—3:30pm (Mon—Thurs); 7:30 — 10:30am and 1:00—2:30pm (Friday). 4. If plywood is installed, a plywood nailing inspection is required. 5. In-Progress roof inspection is required. Call for an in-progress roof inspection to verify building is weather tight after installation of approximately 25% of the roofing material. 6. New roof coverings shall not be applied without first obtaining all inspections 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. 7. A final inspection and approval shall be obtained from the building inspector when the re-roofing is complete. To receive a final sign-off, the following items will be verified: a. Flat roofs shall have a minimum of 1/4"per foot of slope and must 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. 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 under a e to comply with the re-roof policy stated above. Signature of Applicant/Agent: Date: 01 - 8 1 -20H RerooJPo1icy_2010.doc revised 05/17/10 CITY OF CITY OF CUPERTINO REROOF CUPERTINO PERMIT APPLICATION 14 Ofw APN# t a� 7,.,n ate: t i _ c _ If residential, is house an Eichler? Yes ❑ No If yes, needs planning approval. Building Address: -*- — Owner's Name: 4E f_o V ? -C P one #: ito6' /+ � 0 ) ucV �+ HOA: Yes No esprovide letter from HOA Contractor: Phone #: A vl;� - &q E - 6(oo S- e_p Fax#: L,S�- i 2-0 Cupertino Busine s License #: Contractor License #: Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles ❑ Asphalt Shingles V- Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles spy ❑ Other (Specify) ❑ Other (Specify) "-c ori Number of existing coverings ❑ Provide I.C.C.E.S. Repolt # ❑ To be Removed ❑ Provide Mfgr. Installation Specs. Job Description: c=Imo©� fi CA a e_1CA)_t Pe--S Residential Commercial ❑ Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if Green Building Checklist & attach it to the application or if there are any restrictions: ❑ applicable, include in plan set & the sheet index. Valuation: Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy: / _7_7