12070212 CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRI:SS: 20658GARDENSIDECIR CO\TRACfOR:13RADSHAW ROOFING PERMITNO: 12070212
OWNER'S NAME: VELUSWANIY THIRUMA V AND THIRUMAVALA 1821 S RASCOM AVE P\IB 160 DATE ISSUED:07272012
OWNER'S PHONE: 4085284980 CAMPBELL.CA 95008 PRONE NO:(408)246-9930
❑ LICENSlill CONI'RAC OR'S DECLARATION
BUILDING PE12iNI1T INFO: 131,DC r ELECT r PLUMB
License Class Lie.k
DIECII r RESIDENTIAL r COMMERCIAL r
Contractor l..J VOcf—Date .Z)b
hereby al firm that I am licensed under the provisions of Chapter 9 3013 DESCRIPTION:REMOVE EXISTING WOOD SHAKE ROOFING AND
(commencing with Section 7000)of Division 3 of the Business&Professions INS' NEW
Code and that my license is in full force and effect. CLASSSS A A ASPHALT SHINGLES 12 SQI•'f(CBRTAINFEED-
AGED BARK)
hereby affirm under penalty of perjury one of the follaving fico declarations:
1 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 perfommnce of die work for which this
permit is issued. Sq. Ft Floor Aren: Valuation:$6000
A 1'I'I,IC\NI'f.I?R'1'IPIC,\'1'1(1\
I certify that I have read this application acid state that the above information is APN Number:36232032.00 Occupancy Type:
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
indemnify and keep harmless the City of Cupertino against liabilities,judgments, PERMIT EXPIRES IF WORK IS NOT STARTED
costs,and espenses which may accrue against said City in consequence of the
grunting of this permit. Additionally,theapplicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR
with all non-point sou cc regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION.
9.18.
Signator Date J2— Issued by': /�/�Al o 197-4/ Date: 7--77-19-
M
- 19-
❑ OWNER-BIIILDER DECLARA'T'ION
1 hereby affirm(lint I am exempt from the Contractor's License Law for one of RF-ROOFS:
the f Lilo ting aro reasons: All roofs shall be inspected prior to any roofing material being installed If a roof is
I,as owner of the property,or my employees with mages 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 offered for sale(Scc.7044, inspection.
Business R Prolcssions Code)
I,as owner 01'111C property,am exclusively contracting with licensed contractors to Signature of Applimin: Dale:
construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three ALI,ROOF COVERINGSTO BE CLASS"A"OR BETTER
declarations:
I have and will maintain a Certificate of Consent to self insure for Worker's IL\%ARDOIIS MATERIALS DISCLOSURE
Compensation,its provided for by Section 3700 of the Labor Code,for the
performance ofthe 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 Ilealth&Safety Code,Sections 25505,25533,and 25534. I it ill maintain
Section 3700 ofthe Labor Code,for theerfommnce of the work for which this compliance with the Cupertino Municipal Code.Chapter 9.12 and the Braids&
F Safety Code,Section 25532(a)should I store or handle hazardous material.
permit is issued. Additionally,should I use equipment or devices which emit hazardous air
I certify that in the performance of the work for which this permit is issued,l shall contaminants as defined by the Buy Area Air Quality Management District T will
not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 unit the
Compensation Imus of California. If,after making this cenilicate of esemplion,I Ilealth&Safety Code.Sections 25505.25533,and 25534.
become subject to the Worker's Compensmion provisions of the Labor Code,I must
forthwith comply with such provisions or this permit shall be deemed revoked. f1�irAL�,�f I1mri'rQigrnl: / �7/
APPLICANT CE RTI FI CATI ON CONS'1RUC11ON LENDING AGENCY
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 I hereby affirm that there is a construction lending agency for the performance of work's
to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.)
upon the above mentioned proper for inspection purposes.(We)agree to save Lender's Name
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence ofthe Lender's Address
gninting of this pernit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section ARCII ITECI"S DECLARATION
9.18.
1 understand 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: bL I PERA,11T# /a o7aal
O%VNER'S NAME: S Gc PRONE# 3(4 (,
GENERALCONTRACTOR: ( BUSINESS LICENSE #
ADDRESS: t {ert V CITY/ZIPCODE:
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL 13E SCHEDULED UNTIL TI4E
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR 1USINESS NAiiME 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
Owner/Contractor Signature Date
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 20658 Gardenside Cir DATE: 07/26/2012 REVIEWED BY: Sean
17214 APN: BP#: 'VALUATION: IS6,000
*PERMIT T1'PE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY PENTAMATION
USE: SFD or Duplex PERMIT TYPE: 1SFDWLROOF
WORK Remove existing wood shake roofing and install new class A asphalt shingles.
SCOPE
FEE ID ROOF AREA
s.f.
1REROOFFRES 1,200
Afech.Plan Check Plumb. Plan Check Elec.Plan Check
Afech.Pennit Fee: [Plumb. Pernnit Fee: Elec.Perntit Fee:
Other Mech.Iup. Other Plumb Insp. Other Elec.Insp.
Afech.Insp. Fee: Phnnb.Insp.Fee: Elec.Insp.Fee:
NOTE: This estimate does not include fees due to other Departments(Le. Planning, Public Works, Fire,Sanitap•Sewer District,School
District, etc). Thesefees are based on the pretiminan information available and are only an estimate Contact the Dept for addn 7 info.
FEE ITEMS (Fee Resolution 11-053 E . 7/1/111 FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Suppl. PC Fee
Phanb./Alech./Elec
Permit Fee: $180.00
Suppl. Insp Fee
Plumb./Mech./Elec
PlumbJMech./Flec Permit Fee:
Construction Tax:
Administrative Fee:
Work Without Permit? 0 Yes Q No $0.00
Advanced Planning Fees:
Travel Documentation Fees:
Strong Motion Fee: IBSEISA17CR $0.60 Select an Administrative Item
Blde Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $181.601 $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•buildingCa)cupertino.org
PROIECi ADDRES �� rC APN0
OWNERNAME PHONE q E-MAIL
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STREET ADDRESS C`Ty STATE,ZI FAX
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CM NA, E LICENSE NUMBS LICENSE TYP BUS.LIC.0
1 1 I1
COMPANY NAME E A1A1 IY rAx -
STREETADDRFSS CITY.STATE.ZIP ONE
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 S 126.00. The re-inspection fee shall be paid before another inspection
can be scheduled.
By my signing below, 1 certify each of the following is true: 1 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. 1 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:___7_1a L-1 -(�
RerooJPohc.v_201/aloe revised 02116/11
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