12010025 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 11776 PINE BROOK CT CONTRACTOR:CASTILLO'S ROOFING PERMIT NO:12010025
1703 CATHAY DR DATE ISSUED:01/03/2012
OWNER'S NAME: GUNASEELAN LAKSHMINARAYANAN 408
PHONE NO:(-----1-3565
SAN JOSE,CA 95122
O, 'S PHONE: 4082181139
R
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class
(%J G Lic.# MECH RESIDENTIAL COMMERCIAL
ContractorAmhat
Date
' JOB DESCRIPTION:RE-ROOF TEAR OFF WOOD SHAKE&INSTALL COMP
I hereby air I am licensed under the provisions of Chapter 9 SHINGLES CLASS A 16SQ
(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. Valuation:$8900
I have and will maintain Worker's Compensation Insurance,as provided for by Sq,Ft Floor Area:
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. APN Number:36604051.00 Occupancy Type:
APPLICANT CERTIFICATION
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 PENT EXPIRES IF WORK IS NOT STARTED
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR
indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION.
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply r
with all non-point source regulations per the Cupertino Municipal Code,Section Issued Date:
9.18. v � � /4
Signator ' Date
OF
RE-ROOFS:
L OWNER-BUILDER DECLARATION All roofs shall be inspected prior to any roofing material being installed.If a roof is
I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for
the following two reasons: inspection.
1,as owner of the property,or my employees with wages as their sole compensation, '' Date:
will do the work,and the structure is not intended or offered for sale(Sec.7044, Sign u" f p
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 o the
CaliforniaI
Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Codes Chapterp9.12 and the Health maintain
performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material.
I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air
Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
I certify that in the performance of the work for which this permit is issued,I shall
Health&Safety Code,Sections 25505,25533,and 25534.
not employ any person in any manner so as to become subject to the Worker's `
Compensation laws of California. If,after making this certificate of exemption,I O e r aut gent:
q' e 1 gDate:
become subject to the Worker's Compensation provisions of the Labor Code,I must
forthwith comply with such provisions or this pen-nit shall be deemed revoked. CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of Wrk's
I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.)
correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address
demnify and keep harmless the City of Cupertino against liabilities,judgments,
s,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION
s•anting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records.
9.18. Licensed Professional
Signature Date
CITY OF CUPERTINO
PERMIT RECEIPT OPERATOR: patg
3 ITEMS OF 3 COPY # : 1
Sec: Twp: Rng: Sub: Elk: Lot:
APN 36604051. 00
DATE ISSUED. . . . . . . : 01/03/2012
RECEIPT #. . . . . . . . . BS000015657
REFERENCE ID # . . . : 12010025
SITE ADDRESS . . . . . : 11776 PINE BROOK CT
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER GUNASEELAN LAKSHMINARAYANAN
ADDRESS . . . . . . . . . . : 11776 PINE BROOK CT
CITY/STATE/ZIP CUPERTINO, CA 95014
RECEIVED FROM • " : JOSEICASTILLOOFING
LIC # 25850
CONTRACTOR . . . . . .
COMPANY . . . . . . . . . . : CASTILLO'S ROOFING
ADDRESS . . . . . . . . . . : 1703 CATHAY DR
CITY/STATE/ZIP . . . : SAN
JOSECA 251,3565 95122
TELEPHONE
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC- --NEW-BAL-
----------
----------
----------
--------
---------- ------------- 1.00 0 .
0 .00
00
1BCBSC VALUATION 8, 900 .00 0.89 0 . 00 0 .89 0.00
1BSEISMICR VALUATION 8, 900 .00
1REROOFRES SQ FEET 16 .00 224 . 00 224 .00
---- ------0_00
TOTAL PERMIT
225.89 0. 00 ----225 .89 0. 00
METHOD OF PAYMENT AMOUNT --REFERENCE NUMBER
_ ---------------
CHECK 225. 89 #17567
---------------
TOTAL RECEIPT 225. 89
VOICE ID
DESCRIPTION VOICE ID DESCRIPTION
-------- ----------------------------
-------- ---------------------------- 311 SCRATCH COAT
309 EXTERIOR LATH
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS
605 FINAL REROOF
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO, CA 95014-3255
CUPERTINC} (408)777-3228 • FAX(408)777-3333 • buildino()cupertino.org
PROJECT ADDRESS I 1 (, �1I r �`� A/F�N#
OWNER NAME
�PHONFSee-kin l U� E-MAIL !
L MJ r� r aRls- III,
STREET ADDRESSIU CITY, FATE�
FAX
j
APPLICANT NAME 1 PHONE -MAIL
STREET ADDRESS
1-105
C ^A+tN CITY,ST (N� _J_C e QA cI51 7_.2 FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME /_ ^ST l L Lc j � LICENSE NUMBER �Il�j LICENSE TYPE � BUS.LIC.#
COMPANY NAME (-CS m �- E-MAIL �I (Q FAX
STREET ADDRESS D�
• CITY,STATE,ZIP `�t ri Tose }9512 2. "'2,S
HONE2 S� _
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC.#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF SFD or Duplex ❑ Multi-Family ROOF AREA: VALUATION
STRUCTURE: [ICommercial 1 & S&
EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ZWOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY)
REMOVE/REPLACE YES IF NO, PLYWOOD ❑ h" ❑ _ PLYWD ❑ OSB PITCH: }� ROOF
❑ NO #LAYERS: THICKNESS: ❑ 5/8" TYPE: 1:1CDX ZI `� '12 CLASS: A
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF HALT SHINGLES ❑WOOD SHADS ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT#
DESCRIPTION OF WORK FF 66
a 5 TH// �C-)
-1�I s4n (L A L OWPA 0-011 (Al
By my signature below,I certify to each of the following: I 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 provid is correct I have read the Description of Work and verify it is accurate. I a e to comply with all applicable local
ordinances and state laws r;=�uc coon. I authorize representatives of Cupertino tc enter the above-iden fie ro errs f inspectio purposes.
Signature p Ican — Date:
SUPPLEMENTAL TFORMATION REQUIRED
_If building is associated with a Home Owner's Association,provide letter .— s
of approval from HOA. F - ,
- �flt�W�EB.��._-' f� �13tE�FV -
_Provide Planning approval to verify if there any restrictions. — — -
S5— aP11II3L13�E�TEA'`.
_Provide copy of Manufacturer's Installation Specifications.
Ovide signed copy of Cupertino's Tear-Off Policy. __ -s " �❑ isi =
ReroofApp_2011.doc revised 03/02/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 11776 pine brook ct. DATE: 01/03/2012 REVIEWED BY: bobs.
APN: I BP#: "VALUATION: 1$8,900
PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY PENTAMATION 1SFDWLR00F
USE: SFD or Duplex PERMIT TYPE:
WORK tear off wood shake install comp shingles.
SCOPE
FEE ID ROOF AREA
s.f.
1 REROOFFRES 1,600
Li Li
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). Thesefees are based on therelinina information available and are only an estimate. Contact the De t or addh7 info.
FEE ITEMS (Tee Resolution 11-053..L' 1.%11) FEE QTYIFEE MISC ITEMS
Permit Fee: $224.00
Work Without Permit? Yes (D No $0.00
i
Strop Motion Fee: IBSEISMICR $0.89 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $225.89 $0.001 TOTAL FEE: $225.89
Revised: 12/04/2011
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
ELI] Telephone: 408-777-3228
.:U P E RT I N O Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: (� f ( C1}�- �' PERMIT#
OWNER'S NAME: PHONE# s—
GENERAL CONTRACTOR: ' BUSINESS LICENSE#
ADDRESS: - G CITY/ZIPCODE
*Our municipal code requires all busi sses working in the city to have a City of CupertintAusiness license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE. /I
I am not using any sub?,ontractor
Signature Date
Please check applicable subcontractors nd complete the following information:
V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring/ Carpeting
Linoleum/Wood
Glass /Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting/Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
O er/Contractor Signature Date
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-building(Wcupertino.org
PROJECT ADDRESS #
OWNER NAME )OM f6 )XU
ON E-MAIL
STREET ADDRESS J CITY, STATE,ZIP ^ \ FAX
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPr �/A BUS.LIC.#
p (s VGN , I COMPANY NAME E-MAIL FAX
STREET ADDRESS '\ CITY,STATE,Z� ` PHON J
v l
I UNDERST D AND AGREE TO E 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 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'/" 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 agree to comply with the re-roof policy stated above. I also understand that
smoke detectors and carbon monoxide detectors are required to be installed in accordance with Se tions R314 and R315 of
the 2010 California Residential ode
Signature of Ap Date:
ReroofP lice 2011.doc revised 02/16/11