12070215 CITY OF CU13ERTINO BUILDING PERMIT
BUILDINGADDRESS: 20662GARDENSIDECIR CONTRAC-FOR:BRADSIIAW ROOFING PERMITNO: 12070215
OWNER'S NAME: DHOLAKIA PRASHAN-AND PAYAL TRUSTEE 1821 S BASCOM AVE PNIR 160 DATE ISSUED:07272012
OWNS VS ruONE: 4087415448 CAMPBELL.CA 95008 PBONF.NO:(408)240.9930
❑ LICENSED CONfRACFOR'S DECLARATION
^� BUILDING PERMIT INFO: BLDG -- ELECT I PLUMB
License Class —3 Lic.f! /
Contmetor Date
-71Q-211
� plECll r RESIDENTIAL r, COMMERCIAL r
hereby affirm that I am licensed under the provisions of Chapter 9 •1013 1)ESCRI PTION: REMOVE EXISTING WOOD SI IAKE ROOFING AND
(cum mencing with Section 7000)of Di%ision 3 of the Business S Professions INSTALL NEW
Code and that inr license is in full force and effect. CLASS A ASPHALT SHINGLES 12 SQFT(CERTAINTEED-
AGED BARK)
hereby affirm under penalty of perjury one of the following twro 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 die stork for which this
pennit is issued. Sq.Ft Floor Area: Valuation:$6000
\I'1'LIC.t N'I'CFR'1'IFICA'I'ION
I certify that I have read this application and state that the above infomntion is ,%IiN Number:36232031.00 Occupancy TYpet
correct.I agree to comply with all city and county ordinances and state laws relating
to building construction,and hereby 0uthorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to sot
indemnify and keep harmless the City of Cupeninoagainst liabilities.judgments, PERMIT EXPIRES IF WORK IS NOT STARTED
costs,and expenses which nine accrue against said City in consequence of the
granting of this permit. Additionally,tile applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR
with all non-point source regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION.
9.18. - tt �
Signature Date�Z Issued by: ' 595;91V 1-104971-511 Date: 747/,—
❑ OWNER-BUILDER DECLARATION
1 hereby affirm that 1 ani exempt from the Contractor's License law for one of RE-ROOFS:
the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
1,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for
will do the work,and the structure is not intended or otibred for sale(Sec.7044, inspection.
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: Date:
construct the project(Sce.7044,Business S Professions Code).
1 hereby affirm under penalty or perjury one of the fallowing three ALL ROOF COVERINGS T'O BE CLASS"A"OR BF-ITER
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE
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 read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain Worker's Compensation Insurance,as provided for by California Health S Safety Code,Sections 25505,25533,and 25534. I will maintain
Section 3700 of the Labor Code,for the perforimance orthe work for which this coni Ill in nee wilb the Cu perlino Municipal Code.Chapter 9.12 and the Ilealth S
Sofeq Code,Section.553.(x)should I store or handle hazardous material.
permit is issued. Additionally,should 1 use equipment or devices which emit hazardous air
I certify that in the performance of die work forwhich this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I will
not employ any person in any manner sons to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Conmpensation laws ofCalifumia. If,atter making this certificate of exemption,I Health S Safety Code,Sections 25505,25533.and 25534.
become subject to the Worker's Compensation provisions of the Labor Code,I most
I'orthsvith comply with such provisions or this permit shall be deemed revoked f�``oar � rt r
car age :
AI'I'LIG\Nf CER'1'11'IC.VIION CONSIRIICI'ION LENDING AGENCY
I certify that I have read this application mid state that the above information is
correct. I agree to comply with all city and county ordinances and state laws relating I hereby affinn that there is a construction lending agency for the performance of%wrk's
to building construction,mid hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.)
upon the above mentioned property for inspection purposes.(We)agree to sot Lender's Namc
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the Lender's Address
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. AI3CI1ITEC I"S DGCL.U3A'I'ION
I undersand my plans shall be used as public records.
Signature Date
Licensed Professional
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
C U P E RT I N O Fax: 408-777-3333
CONTRACTOR / SUBCONTRACTOR LIST
JOB ADDRESS: /]�(� PERMIT# a0 702
OWNER'S NAM E: 1s Ci!' `� 4.n.A- PHONE #
GENERAL CONTRACTOR: i BUSINESS LICENSE #
ADDRESS: r V CITY/ZIPCODE: �l �O -25
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO 13UILDING FINAL OR FINAL OCCUPANCY INSPLCTION(S) \FILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICEENSE.
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
&/ SUBCONTRACTOR 13USINESS NANIE BUSINESS LICENSE #
Cabinets S Millwork
Cement Finishing
Electrical
Excavation
Fencing-
Flooring
encingFlooring / Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
:01 ADDRESS: 20662 Gardenside Cir DATE: 07/26/2012 REVIEWED BY: Sean
APN: BP#: 'VALUATION: 1$6,000
*PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Duplex PENTAMATION 1SFDWLROOF
USE: PERMIT TYPE:
NYORK Remove existing wood shake roofing and install new class A asphalt shingles.
SCOPE
FEE ID ROOFAREA
s.f.
1REROOFFRES 1,200
Afech. Plan Check Phmtb.Plan Check Elec.Plan Check
Afech. Permit Fee: Plumb. Permit Fee: Elec. Permit Fee:
Other,Neth.hup. Other Plumb hup. Other Elec.hup.
:Neth.Iney. Fee: Plumb.Insp.Fee: Elec.Insp.Fee:
NOTE: This estimate does not include fees due to other Departments(Le. Planning,Public "'arks, Fire,Sanitaty Sewer District,School
District, eta). Thesefees are based on the preliminan information available and are on1v an estimate Contact the De t or addn'1 info.
FEE ITEMS (Fee Resolution 11-053 Eft" 7/1/11) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Suppl. PC Fee
Plumb./Afech./Elec
Permit Fee: $180.00
Suppl. Insp Fee
Pluntb./Afech./Elec
Phunb./Mech./Elec Permit Fee:
C077SnWetiOn Tax:
Administrative Fee:
Work Without Permit? O Yes Q No SO.00
Advanced Planning Fees:
Travel Documentation Fees:
Strong Motion Fee: IBSEISA9CR $0.60 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $181.601 $0.00 TOTAL FEE: F$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•buildinD(a)cuoertino.orq
PROIECTADDRESS C`rAPN9 -03
O ER NA E \ PHONE I —SLi Lk
E-MAIL
ET ADDRESS CI STATE, IP FAx
t . c a 7
C Ct0 NA. E_ LICENSENUMBE LICENSE TYP BUS,LICA
COMPANYNAME E-M1� FAX
STREETADDRESS \ �S0.CC' CITY,STATE ZIP I HONE l�
�! qC
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 begiven 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 nail's/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: 1 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:
Reroo/Policv_201 Ldoc revised 02/16111
_ — ___.__._o..rr____._._...-...-_-_-_._�____.____.. _ — u �arnra� runnu.oru:• u�m. —
_Provide copy of Mmmfactumr's Installation Specifications. ❑ TrANDARD ❑ Fou:DE"
I
—Provide signed copy of CuNnino's Tem-Off Policy. ❑ OTHER: