12080239 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20665 GARDENSIDL'CIR CONTRAC'T'OR:BRADSHAW ROOFING INC PERMIT NO: 12080239
OWNI,R'S NAME: MAKARAND CH[TALE 1821 S BASCOAI AVE 1'AIB 160 DATE ISSUED:08/)32012
OWNER'S 1'II0NF.: 4083071997 CAAI I'BELL,CA 950118 PHONE NO:(408)2469930
LICENSED CONTRACTOR'S DECfL�A/RATION BUILDING PERMIT INFO: BLDG r ELECT F- PLUMB r
License Class Lie.N�l- �- K�V� �^�,.�
i� is �i�f3la—c12 11ECF1 r RESIDENTIAL r COMMERCIAL r
Contractor Dale
Thereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: RFMOVF EXISTING WOOD SHAKE ROOF.INSTALL 12SQ
(commencing with Section 7111111)of Division 3 of the Business S Professions NI7W
Code and that my license is in full force and effect. CLASS A ASPHALT SHINGLES:AGED BARK
1 hereby affirm under penalty of perjury one of the following bra declarations:
Ihave and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided lar 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 work for which this Sq. Ft Floor Area: Valuation:$6000
permit is issued.
\I'I'LIG\N'I'CI?RTI EIC,\9'ION MRN Number:36232022.00 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
m building construction,and hereby authorize representatives of this city to enter
upon the above mentioned properly f'or inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED
indemnilj•and keep harmless the City ol'Cupenino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of'the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
- gmnling of this permit. Additionally,the applicant understands and will comply ,
with all non-point source regulation Ns per the Cupertino Municipal Code,Section
180 DAYS FROM ST CALLED INSPECTION.
9.18. � —• ' y �t �r,l/
Issued by: 2,5DaSignature �%/'/✓Y!.'J—
Signature _
❑ OWNER-BUILDER DECLARATION
RF.-ROOFS:
I hereby aflirnm that I:rn exempt from the Contractor's License Law 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 new materials for
I,as owner of the property,or my employees with wages as their sole compensation, inspection.
will do the work,and the structure is not intended or offered for sale(Sec.7044, q h2Business R Professions Code) Signature of Applicant: Date: xV
I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business R Professions Code), ALL ROOF CO\'P:RINCS'I'O RE CLASS'SV'OR RE'l-11'.11
hereby affirm under penalty of perjury One of the following three
declarations:
I have and will maintain a Certificate m'Consra to self-insure for Worker's TIM%,\ItDOIIS AIM I Is12LU.S DISCLOSURE:
Compensation,as provided for by Section 3700 of the Labor Code,for the I hn%c read the hazardous material requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California I Iealth S Safety Code.Sections 25505,25533.and 25534. 1 will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by complinnee with the Cupertino Mumici pal Code,Chapter 9.12 and the Health S
Section 3700 of the Labor Code,.for the performance of the work for which this Safety Code.Section 25532(0)should I store or handle hazardous material.
Additionally,should I use equipment or devices which emit hazardous air
permit is issued. contaminants as defined by the Ila)Area Air Quality Management District 1 will
I certify that in the performance of die 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 any manner so as to become subject to the Worker's Health S Safety Code,Sections 25505.25533,and 25534.
Compensation laws of Cul ifamia. If,alter making this certificate of exemption,I
become subject to the Worker's Compensation provisions of the Labor Code,I must 0, ier .a horiz naent�/
Ionhwith comply with such provisions or this permit shall be deemed revoked (�'� &=Dater /12
AI'I'LICAN'I'CEIt'1'IPICA'I'ION CONSTRHC'fION LENDING AGENCY
I ccrii(v that I have read this application and stale that the above inforrmatlmn is I hereby affirm thin there is a construction lending agency for the.performance Of work's
correct.I agree to comply with all city and county ordinances mid state laws relating for which this permit is issued(Sec.3097,Cie Q
to building construction,and 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 the City of Cupertino against liabilities,judgments, Lender's Address
costs,and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands turd will comply ARCHITE:C'I"S DECLARATION
with all non-point source regulations per the Cupertino Municipal Cade,Section
9.18. 1 understand my plans shall be used as public records.
Signature Dale Licensed Professional
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE -CUPERTINO.CA 95014-3255
CUPER T INO (408)777-3228• FAA(408)777-3333•buildinq?@cupertino.org
PROIER ADDRESS '� O / C S( 1� APN• 1
b d r
OWNER At•Q� e- o Y P ONE 30--) E-hNLL
kct le
STREET.aDDRES , CITY STATE•'IP A � �1 1 . I FAX
CONTACT NAME PHON E-MAIL t-�
STREET ADDRESS CITY,STATE. ZIP FAX
❑ OWNER ❑ OWHFR-BUILDER ❑ O%VNERAGENrCONIRACrOR ❑CONTRACmRAriENT ❑ ARCHnECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACT RNAME LICENSENUN(BER LICENSETYPE BUS.LIC.d 305
COMPANY NAME E-AIA FA% _ _ C13 .
STREET DRESS CM',STATE IP PNONE
�ijC5a n
ARCHITECT1ENGINEER NAME LICENSE NUMBER BUS.LIC.d
COMPANY NAME E-MAIL FAX
STREET ADDRESSfi�tt'' CI Y•STATF,ZIP PHONE
USE OF ❑ SFD or Duplex Ly�vlulti-Family. ROOF AREA: VALUATION: '�T
STRUCTURE. ❑ Commercial \AQ0 (+ 6- OOV ,
EXISTING ROOF TYPE: ❑BUILT-UPROOF ❑ASPHALT SHINGLES ae R'OOD SHAKES ❑WOODSHINGLES ,❑OTHER(SPECIFY)
REAIDVT'/REPLACE tl'YEs IF NO. PLriYOOD w' ❑ PLriVD ❑OSB PRCH: ROOF
PROPOSE DROOFTYPE: ❑BUILT-UPROOF 62.ASPHALT SHINGLES ❑WOOD SHAKES C3 WOOD SHINGLES ❑OTHER [CC-FS REPORT
DESCRIPTIONOFWOR1:
By my signature below,[certify to each of the follonning: 1 am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information 1 have provided is correct. I have read the Description of Work and verify it is accurate. 1 agree to comply With ell applicable local
ordinances and state Imvs relnting to Uil/Qm//S tons/r}-t��wn. I a�r/tly�n/z�re�presenmtives of Cupertino to enter the abover--i�dentifwd property for inspection purposes.
Signature of ApplicmtlAgenC LA/-(,(/tom-/yLn4�L/�T-r _ _ Date: ?(,?C-1/ QCW-1
SUPPLEMENTAL INFORMATION REQUIRED OFFICE(ISE ONLY
_If building is associated with a Home Owners Association,provide letter Pt sr CHECK TYPE ROIrTINGSLIP
of approval from HOA. OVER-THE-Co6NrER BUILDING PLAN NEVTEw
_Provide Planning approval to verify if there any resV'cuons. E�REBS - _ ❑ PLANNING PLAN REVIEW'
_Provide copy of Manufacturers Installation Specifications. ❑ STANDARD _ ❑ TvtE oEvr
Provide signed copy of Cupe vno's Tear-Off Policy. ❑ OTHER:
Reroojdpp_)011.due revised 03/1611
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
:12 ADDRESS: 20665 Gardenside Cir. DATE: 0 812 212 01 2 REVIEWED BY: Sean
ANN: BP#: 'VALUATION: $6,000
*PERMIT TYPE: Minor Building Permit PLAN CIIECK TYPE: Re-roof
PRIMARY Buildina is PENTANIATION
Multi-Family Dwelling , 1R2ROOF
USE: 3 Stories 0 Yes � No PERMITTYPE:
WORK Remove existing wood shake roof. Install new Class A asphalt shingles: Aged Bark.
SCOPE
FEE ID ROOF AREA
(s.f.)
iREROOFMRES 1,200
Afech. Plan Chuck Plumb. Plan Cheek Dec.Plan Check
Mech, Permit Fee: Plumb.Permit Fee: Flec•.Permit rea:
Other Afech. Insp. Other Plumb Insp. Other F,lec.Imp.
.11e.ch.Insp. Pec: Plumb. hasp. ree: Flee.Insp.Pec:
NOTE: This ewitnate does not include jets due to other Departments(i.e. Planning. Public Works. Fire,Sanitary Sewer District,School
District,etc.). These ees are baser/on the prelitninan information available andare only an estimate. Contact the De t or adcln'I info.
FEE ITEMS (Fee Resohuirm 11-053 li/L 7/1/11) FEE QTY/FEF MISC ITEMS
Plan Check Fee:
SappL PC Rec
Plumb./ddech./Flec.
Permit Fee: $180.00
Suppl. bnsp Fee
Plum b./.d tech./F.lec
Plumb.4lech./Flec Permit Fee:
Consnvction Tau':
Administrative Fee:
Work Without Permit? 0 Yes (D No $0.00
Advanced Planning Fees:
Travel Documentation Fces•:
Stione Mohon Fee: IBSEISMICR $0.60 Select an Administrative Item
131de 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
CUPERTINO 10300 TORRE AVENUE • CUPERTINO. CA 95014-3255
(408)777-3228• FAX(408)777-3333•building(akuoertino.oro
PROJECT ADDRESS All
NE NAME P LONE b E-MAIL
STREET \\ CIN. ATE.ZIP S� FAX
C_)(n C Y1
C 'TRACTO NA, E LICE\SE RUMBE LICENSE TYP BUS.LIC.
1L ( 1 t
COMPANYNAMEJj E-MAI
& ) 1 l�
STREETADDRFSS ; CG CITY.STATI ZIP 1 HONE
1 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 authnrized 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 Sections R314 and R315 of
the 2010 California ResidentialCode
Signature of Applicant/Agent: Date: _LA_-
RerooJPolicv_201 Ldoc revised 02/16/11