12070169CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10450 BAYWOOD DR CONI'RACI'OR: ABOVE ALL ROOFING PERMIT NO: 12070169
OWNER'S NAME: NAIR RAMESIi G AND USDA R TRUSTEE 1550 S WINCHESTER BIND STE 223 DATE ISSUED: 07Q3/2012
OWNER'S NIONE: 4086368635 CAMPRRLL. CA 95008 NIONE NO: (4081370.1056
❑ LICENSED CO,VI'R,\CI'O�Rt'S DECLARATION
License Class � O q Lie.
Contractor /-C��
ctor �j .R`I 3
I hereby affirm that Iam licensed under the provlsions of 'haple ')
(commencing with Section 700) of Division 3 of the Business & Professions
Code and that my license is in fall force and effect.
herehy affirm under penalty of perjury one of the following twodeclarations
I have and will maintain a cenilicate 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
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.
,u'rl.lc\Nr cl:Irrrnla\TION
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
indemnify and keep harmless the City of Cupertino against liabilhiesJudements,
costs, and expenses which may accrue against said City in consequence of the
gaming of this permit. Additionally, the applicant understands and will comply
with all non-p0hlLSourc4JC8ulali0u per the Cupertino Municipal Code, Section
9.18. l f l
❑ OWNEIc-B(IILDER DIiCLARA„ON
heretic alTirn than I am esanpi from the Contractor's License Lar fur ane of
the following two reasons:
I, 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 R Professions Code)
I, es owner of property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
hereby allirn under pemdtr of perjury one of the following three
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 performance of the work for which this
permit is issued.
I certify that in the performance of dnc work for which this permit is issued, I shall
not employ any person in any manner so as to become subject to the p'orker's
Compensation Imes of California. If, alter making this certificate of exemption, (-
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.
A PPLICAN1' 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 Imus 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.
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
BUILDING PERMIT INFO: BLDG 1- ELECT 1— PLUMB r
NIECF1 r RESIDENTIAL r COMMERCIAL r
JOB DESCRI PTION:;PSQFT-RE-ROOF REh10VE EXISTING "'ODD SHAKE AND
INSTALL 7/16" OSB, 2 LAYERS OF W15LB FELT AND
LICH'I' W EIGHT TILE CLASS A
Sy. Ft Floor -Area: I Valuation: $11000
APN Number: 31630019.00 1 Occupaney'I'ype:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAY -SS FROM LAST CALLED INSPECTION.
Issued by: �An/ i�%li� Date: 7-c;1-3 -lot
RF -ROOFS:
All roofs shall be inspected prior to any roofing material being installed If a roof is
installed without first obtaining an inspection, 1 agree to remove all new materials for
inspection.
Signature of Applicae Date:
ALL ROOF COVERINGSTO HE CLASS "A" OR BF;ITER
IIA'LARDOUS MATERIA --S DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Ileallh & Safety Code. Section., M505, 25533, and 25534. 1 will maintain
compliance with lie Cupertino Municipal Code, Chapter 9.12 and the Ilcalth &
Safely Code. Section 25532(8) should I store or handle hazardous material.
Additionally, should I,use equipment or devices which emit hazardous air
cunlaminants as defined by the Bay Area Air Quality Mara gement District I will
maintain compliance wills the Cupertino Municipal Code. Chapter 9.12 and the
Ileallh & Safely Code, Sections 25505. 25533, and 25534.
On tier or nal 't'=2
(�
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AGENCY
1 hereby amort that there is a construction lending agency for the performance of work's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's
ARCIIFFECI"S DECLARATION
I understand my plans shall be used as public records.
Licensed
CUPERTINO
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
(408) 777-3228 • FAX (408) 777-3333 • buildine(dcuoertino.oro
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I UNDERSTAND AND AGREE TO THE FOLLOWING:
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.
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.
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 S 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:
property owner's behalf. I understand and agree to complr
smoke detectors and carbon monoxide detectors are quirec
the 2010 California Residential,Code.
rill
I am the property owner or authorized agent to act on the
tth\the re -roof policy stated above. 1 also understand that
to lic iR<a—fled in accordance with Sections R314 and R315 of
Date: ✓ 7
RernnfPolie.v_201 l.doc revis6rl 02116111
REROOF PERMIT APPLICATION
C COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION I�
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
CUPERTINO (408) 777-3228 • FAX (408) 777-3333 • buildinG(cDcuoertino.om
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❑ OWNER ❑ Ot4'NFAbUiIDER ❑ OANERAGENT ❑ CONTRACTOR .fir CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTORNAME Jit t //1rI
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USE OF �SFD or Duplex ❑ Multi-Fmnily, ROOF
STRUCTURE. ❑ Commercial
AREA
%PHONE
VALUATION:
EXISTING ROOF TYPE 11 RUILT-UP ROOF ❑ ASPHALT SHINGLES > WOODSHAKES ❑ WOOD SHIONGLES ❑ OTHE�R{�(S1PiEC- UFYJ
REPLACE
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PRCN: '
ROOFSB
aREMOVE
CLASSRS•
PROPOSED ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPH.M-T SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES
IMES REPORT 0
DESCRIPTION OF WORK:
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By wry signature below, I certify to each of the bllowing: 1 am the operly owner or authorized agent to act on the property owner's behalf. [ have read this
application and the information 1 have provided E correct. l ha cad the Description of Work and verify it is accurate. I agree to comply With all applicable local
ordinances and state laws relating to bui g c ssmction. udtorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicarn/Agenl: Date: 2
SUPPLEMENTAL [NFORDL4T(NRE IRED
_ If building is associated with a Home Owners Association, provide letter
of approval from HOA.
Provide Planning approval to verify if there any restrictions.
_ Provide copy of Manufacturers Installation Specifications.
Provide Signed copy of Cupertino's Tear -Off Policy.
OFFICE
USE ONLY
PLAN CHECK' TYPE.
R0n1NGSLIP
j/ ,OVER-TH&COUNTER.
❑ EXPRESS
❑ 'TNDARD
,0 -BUILDING PLANREVIEW
❑ PLANNING PLAN REVIEW
❑ FIRE DEPT
❑ ,OTHER:
Reraojipp_201 Ldoc revised 03116/11
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