12070209 CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS: 20642GARDENSIDCCIR CONPRAC`fOR:BRADSHAW ROOFING PFRJIITNO: 12070209
OWNER'S NAME: NILESFI DOSHI S BHAMINI DESAI 1821 S BASCOM AVE PMB 160 DATE ISSUED:07/27R012
OWNER'S I'IIONE: 4084103037 CAMPBELL,CA 95008 PI ZONE NO:(408)246-9930
❑ LICENSED C0NI"RACI'0RS DECLARA'T'ION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
License Class_ ^..-J Lic.q I
�n� �7 6IECII r RESIDENTIAL r COMMERCIAL rContracto u'..t�✓ Date
hereby affirm That Into licensed muter the provisions of Clmpter 9 JOB DESCRIPTION: REMOVE EXISTING WOOD SHAKE ROOPING AND
(counnencing with Section 711011)of Division 3 of the Business& Professions INSTALL NEW
Code and that inr license is in full force and effect. CLASS A ASPHALT SHINGLES(CERTAINTEED-AGED BARK)
hereby affirm under penally ofperjury one of the following tno declarations:
I have and will Maintain a certificate ofconsent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
penonuance 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 perforance of the work for which this Sq.1:1 Floor Area: Valuation:$6000
permit is issued.
,\I'I'I,ICAN'I'CER'I'IF[G\"]'ION ANN Number:36232036.00 Occupancy Type:
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,mid hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting oRhls permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regufatia mer the Cupertino Municipal Code,Section
9.18. // //,�)),,
- Issued by:g��ffi/1/ 4r1r__11 Date: /a-
Signaturr `Dale 7 2
❑ OWNER-BUILDEIR DECLARATION
RF-ROOFS:
1 hereby affirm thin I an exempt from the Contractor's License Lan'for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is
the following two reasons: installed without first obtaining an inspection,I agree to remove all tic" materials for
I,as owner of the properly,or my employees with wages as their sole compensation, inspection,
Will do the Work,mid the structure is not intended or offered for sale(Sce.7044,
Business&Professions Code) Signature of Applicant: Date:
I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business& Professions Code). ALL ROOF COVERINGS TO RIS CLASS"A"OR BFATER
hereby affirm under penalty of perjury one of the following three
declarations:
I have and will maintain a Certificate of Consent Io self-insure for Worker's IIA'LARDOUS MATE RIAI S DISCLOSURE
Compensation,as provided for.by Section 3700 of the Labor Code,for the 1 have read[he hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California Il cul th&Safety Code.Sections 25505.'_5533,and 25534. I will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino\lunicipal Code,Chapter 9.12 and the Health&
Section 3700 of the Labor Code,Ibr the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material.
Additionally.should I use equipment or devices which emil hazardous air
permit is issued. contaminants as defined by the Bay Area Air Quality Management District I Will
I certify that in the performance of doe work for which this permit is issued,I shall maintain compliance with the Cupertino Alunicipal Code,Chapter 9.12 and the
not employ any person in may)tanner so as to become subject to the Worker's Health&Safety Code.Sections 25505,25533,and 25534.
Compensation laws of California. If,after making this certificate of exemption,1
become subject to the Worker's Compensation provisions of the Labor Code,I)lastwne a mrje agent:
forthwith comply with Such provisions or this permit shall be deemed revoked. ate: /.[\
CONSTRUCTION LENDING AGENCY
A IT LICANT CERTIFICATION
I certify that I have read this application mid slate that the above information is I hereby of inn that there is a construction lending agerwy for the performance of work's
correct.I agree to comply with all city and county ordinances and state lays relating for which this permit is issued(Sec.3097,Civ C.)
to building construction,mid hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless theCity of Cupertino against liabilities,judgments, Lender's Address
costs,and expenses which may accrue against said City in consequence of the
grating of this permit.Additionally,the applicant understands and will comply
With all non-point source regulations per the Cupenino Municipal Code,Section ARCA I"1'ECT'S DECLARATION
9.18. I understand my plans shall be used as public records.
Signature Date Licensed Professional
/n/,-� "
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
:91 ADDRESS: 20642 Gardenside Cir DATE: 07/26/2012 REVIEWED BY: Sean
APN: BP#: ( — / VALUATION: $6,000
*PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Duplex PENTAMATION 1SFDWLROOF
USE: PERMIT TYPE:
WORK Remove existing wood shake roofing and install new class A asphalt shingles.
SCOPE
FEE ID ROOFAREA
s.f.
1REROOFFRES 1,200
Meth.Plan Check Phmib.Plan Check Elec.Plan Check
Mach.Pemdt Fee: Plumb. Pennit Fee: Elea Permit Fee:
Other Mech.Insp. Other Plumb Lisp. Other Elec.Insp.
'Vech.Insp. Fee: Plumb.Insp.Fee: Elec.Imp.Fee:
NOTE: This estimate does not include fees due to other Departments(Le. Planning,Public Works, Fire,Sanitary Sewer District,School
District, eta). Thesefees are based on the preliminan•information available and are onhy an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 11-053 E8" 7/1/11) FEE QTYIFEE MISC ITEMS
Plan Check Fee:
SuppL PC Fee
Plmnb./A4ech./Elec
Permit Fee: S180.00
Suppl. Insp Fee
Plumb./A7ech./Elec
Plumb./A1ech./F.lec Permit Fee:
Construction Tax:
Achninistrative Fee:
Work Without Permit? O Yes Q No $0.00
Advanced Planning Fees:
Travel Documentation Fees:
Strong Motion Fee: 1BSEISMCR $0.60 Select an Administrative Item
Blde Stds Commission Fee: IBCBSC S1.00
SUBTOTALS: $181.60 $0.001 TOTAL FEE: $181.60
Revised: 07/01/2012
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•buildinaCdcupertino.ora
PROIER DES C C,�. APN0 36a
- J^� ^O /b
O .'ER NAME PHONE _ 3 E-MAIL
1
STREET AD RI C\c- CITU.STATE.Z ^ ^G�I FAX
C CTONA. E LICEN5EN'UMBER LICENSE T'P BUS.LIC.a
1 t 1
COMPANY NAME E-MAI (\L' FAX
STREET ADDRESS a , V \ `S<•lCC' CITY,STATE-ZIP 1 NONE
I UNDERSTAND AND AGREE TO THE 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. 1 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 Sections R314 and R315 of
the 2010 California Residential Code / / /
Signature of Applicant/Agent: Date:_�[_ _C-. / Q
Reroo/Poliev_201 l.doc revised 02116tlI
—
Provide copy of Marmfacturers Installation Specifications. - ❑ STANDARD 0 ETRE DEPr
I _Provide signed copy efCupertino's Teat-Off Policy. I I,':❑ OTHER: •I
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO,CA 95014-3255
CUPERTINO. (408)777-3228• FAX(408)iii-3333`buildina(o)cuoertino.orD
PROJECT ADDRESS . n _
O}vr+ NAAfE PHONE LJIJ•� E-MAI �j
L.
.AODRESs C STATE.
ZIP AX FAXL(C C p q
a)l t4
CONTACT NAME PHONE E-MAIL
STREET ADDRESS CITY,STATE. ZIP FAX
❑ OwvNER ❑ cWHER.Bun-om ❑ O%vNERAGCNT CO3,.cHOR ❑coN1RACmR AGENT ❑ ARcHrrecT ❑EaNDEt ❑ DEvELoPER ❑TENAHr
CONTRACT RNAME LICENSENU%0BER LICENSE TYPE BUS.LIC.4.2
COMPANY NAME E- L INC FAX _ Ciz
1- 2:22
STRE.11DET ADDRESeC,S CRl',TATE IP PHONE q�'5 O
r(- A
ARCHITECTIENGINEER NAME LICENSE NUMBER BUS.LIC.4
CONMANY NAME EMAIL FAX
STREET ADDRESS ^' - CT',TATE,ZIP 'PHONE..
USE OF ❑ SFD or Duplex- ❑.Ivttilti-Family. ' ROOF AREA: VALUATION:
STRUCTURE. ❑ Commercial ,-.� 'bon'
EXITMG ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES m tt'OOD SHAKES WOOD SLDNGLEs •❑OTHER(SPECIFY)
REMOVE/REPLACE tT IF NO. Y PLriY00D :5- ❑ PLrivD ❑ OSB kTCH: .12 ROOF A
❑ s VER'.
i K, c. ❑ c5- TYPE' ❑ CD% CLASS
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT I
DESCRI 011\0F WORK: 1
By my signature below,l certify to each of the fallowing: I am the property owner or authorized agent to act on the propem'owner's behalf. 1 have read this
application and the information 1 have provided is correct. 1 have read the Description of Work and verify it is accurate. 1 agree ro comply with all applicable local
ordinances and state laws relating w bubull/QQQIrI cons ion. I au ru/�re_reaerruruves ofCuperano to enter the•aabbo/ve-identifrd property for inspection purposes.
Signature ofApplicant/ /Agent:�,(//.(�L�^ 7"ri Date: �;?r/ rtan�2-
SUPPLEMENTAL[NFORAdATIONREQUIRED -• OFMCEUSE ONLY
_ [f building is associated with a Home Owners Association,provide letter PLAN CHECK TAPE ._ ROTTINGSLIP
of approval from HOA. OVER.rHE-COUNTER ❑ BUILDING PLAN REVIEW.
_Provide Planning approval t0 verify if there any restrictions. ❑ EXPRESS ❑ PLANmBG PLAN REVIEW
• _Provide copy of btanufacntrer s Installation Specifications. ❑ STANDARD ❑ FtRE DEPT
Provide signed copy efCupenino's Teal'-Off Policy. '❑ OTHER: -
Reroojdpp_201 Ldoe revised 03/16!11