12090132 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 11012 CANYON VISTA DR CONTRACTOR:SORENSON& PERMIT NO: 12090132
ASSOCIATES ROOFING INC
OWNER'S NAME: VIKRAM PATEL PO BOX 786 DATE ISSULD:09/142012
OWNER'S PIIONE: 4082263300 BRENTWOOD,CA 94513 PHONE-NO:(925)626-7682
❑ LICF,NSF,D CON"FRAC'FOR'S DECLARATION JOB DF,SCRIPTION: RESIDENTIAL U COMMERCIAL,
License Class c— Lic.q Q 49131'(0 RE-ROOF 19 SQ INSTALLATION OF DURO LAST SINGLE
AA PLY
ContmctolSart4 w( Dale 9'14-12 CLASS
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000)of Division 3 of the Business&Professions
Code and that my license is in full force and effect.
hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided foray Section 3700 of the Labor Code,for the
performance of the work for which dus permit is issued. Sq.FI Floor Area: Valuation:$13300
1 have and will maintain Workers Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of tae work for which this
APN Number.35628039.00 Occupanq•'1'ype:
permit is issued.
APPLICAN I'CERTIFICATION
I certify that I have read this application mid state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correei.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS.OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments, / ' /
costs,and expenses which may accrue against said City in consequence of the �7 //�,c`J
granting of this permit. Additionally,the applicant understands and will comply Issued by: v / fff�I'A�,A///Kr( Date: / p
with all non, source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signmure Date -'14 —)7— All roofs shall be inspected prior to any roofing material bebg installed.If a roof is
- installed without first obdQTiftMinLspcction,I agree to remove all new materials for
inspection.
❑ OWNER-BUILDER DECLARATION
Signature of Applicun: Date: _1 —�Z
hereby affirm that I ora cxempl7rom the Contractor's License hew for one of
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BE;ITER
I,as owner of the property,or my eniployms with wages as their sole comfunsation,
will do the work,and the structureis not intended or offered for sale(Sec.7044,
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to ILS%ARDOUS MATERIAIS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25531 [will
hereby affirm under penalty of perjury one of the following three maintain compliance with.the.Cupertino Municipal Code,Chapter 9.12 and the
declarations: licalth&Safety Code,Section 25532(x)should 1 store or handle hazardous
I have and will maintain a Certificate of Consent to set(insure for Worker's material. Additionally,should 1 use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance wit1`1 ef�ertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Ilealth&Safet•Code,Sedl ons?.550 .(?J.19 d 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
Owner u au Ihorized ng Date:
permit is issued.
I certify that in the performance of the work far which this permit is issued,I shall
not employ any person in my manner so a to become subject to the Worker's
Compensation laws of California. If,after making this certificate of exemption,I CONSI'RUCI'ION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked w'ork's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANTCERTI FICATION Lender's Address
I certify that I have read this application mid suite that the above information is
correct.I agree to comply with all city and county ordinances mid 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 liabilities,judgments, ARCIIITECI"S DECLARATION
costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
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-building(a)-cuoertino.ora
PROIECT ADDRESS API x
OWNER NAME PHONE E-MAIL
STREETADDRESS CITY, STATE,ZIP FAX
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC.N
L
COMPAh'V NAME E-MAIL FAX
LS
REST ADDRESS CIN.STATE ZIP PHONE
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 cenify each of the following is true: I 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:
RemgiPolicv_?011.doc revised O?/16/11
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 n (11�
CUPERTINO (408)777-3228• FAX(408)777-3333•buildina(_cupertino.org ., �
PROTECT ADDRESc n�1 /�GGG r p ArN N / Q —��
ME
OWNER NA / i•/ '/ �F/` PHO;OG 'c;j
'STREET ADDRESS CITY, STATE,ZIP FAX
ASC h odd V e14 I
COtrTACT NAME PHONE EMAIL
STREET ADDRESS CITY,STATE,ZR FAX
❑OWNER ❑ OM'NFR-BIIIIDEIt ❑ OWNERAGENT J9CONTRACTOR ❑CONnUCroR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTR\CI'ORN (E LICENSE HEMMER LIC SET\TE BUS.LIC.0
COMPANY NAME E-MIAB. FAX
a -rAJ
sTREEt.ADDRFSs CITY,STATE,ZIP PHONE
ARCHITECTIENGIVEER NAME LICENSE NUM®ER BUS,LIC.0
CONTANY NMO: E-MIAIL FAX
STREET.ADDRESS CT',STATE ZIP PHONE
USE OF ❑ SFD or Duplex �Tlflulli-Family, ROOF.AREA: VALUATION:
STRUCTURE. ❑ Commercial a
EXISTING ROOF TYPE: �'�UILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY)
REMOVE/REPLACE ❑r'��YES IF NO. PLN-WOOD ❑ A- ❑ PLYWD ❑OSB PITCH: ,) ROOF
�T r1D a1.AYERc THICKNESS ❑ n." ❑ D /W .I_ CLASS t�
PROPOSED ROOF TYPE: ❑BUILT UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES z OTHER r�4y ICC-ES REPORT P
DESCRIPTION OF WORK:
By my signature below,1 certify to each of the following: I am the proper o\wter or authorized agent to act on the proper, owner's behalf. l have read this
application and die information[have provided is correct. I have read the Description of Wort:and verify it is accurate. I agree w comply\vilh all applicable local
ordinances and state laws relating tonsuuctio thorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Appl ieantl _ nt: Date: 9 -1
SUPPLEMENTAL INFO ON REQUIRED OFFICE use ONLY,, L
_If building is associated Wilh a IIonle Owners Association,provide letter -PLAXCHECKTVPEI- _ - - ' ROUTINGSLIP. -
of approval front FIOA. 19 O\•CR+T'HECOUNTER - DU ILDING PLAN RE\'ICW-
Provide Plannin roval to verify if there any restrictions. .. -
gIWP Y -❑,EXPRESS _ ❑, PLANNING PLAN REVIEW
_Provide copy cfhfanufacturer's Installation Specifications. ❑ ,STANDARu �❑ FIREoC!"r..
_Provide signed copy ofCupertino's Tear-Off Policy. Q OTHER ,
Rero f,4pp_2011.doc revised 03/16/11
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 11012 Canyon Vista DATE: 09/14/2012 REVIEWED BY: Sean
APN: BP#: 'VALUATION: $13,300
*PERI%IITTl'PE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY Building is PENTAMATION
USE: Multi-Family Dwelling >3 Stories 0 Yes 0 No PERMITTYPE: 1R2RO0F
WORK Installation of duro-last si nle ply memebrane over existing BUR roof.
SCOPE
FEE ID ROOFAREA
s.f.
1REROOFMRES 1,900
9r
Mech. flan Check /'hunk. Plan Cheek Elec. Flan Check
,tlech.Permit Fee: Plumb. Permit Fee: lilac. Permit Fee:
Other.11ec h. Insp. Other Plumb Insp. Other Eler.Insp.
.t-Lech. Insp. Fee.: Plumb. btsp.Fee: Elite. buy.Few:
NOTE: This estimate sloes not includejees due to otter Departments(i.e. Planning, Public Narks, Fire,Sanitary Server District,School
District.etc. . Thesefees are based on the prelindnan iti brnration mailable and are onh,an estimate. Contact the De t or addr;7 info.
FEE ITEMS (Fee Resolution 11-053 E0: 7/1/11/ FEE QTY/FEE MISC ITEMS
/Tenn Check Fee:
Suppl. PC Fee.
Phnnh./A•lech./Elec.
Permit Fee: $285.00
suppl, 111sp Fee
P1unnh./A4ech./Flee
PAtmh.4b!ech,/lilec Permit Fee:
Construction Tits:
Administrative Fee:
Work Without Permit?. 0 Yes Q No $0.00
Advuncecl Planning Fees:
Tro vel Documenlalion Fees: a
Strom�__Motion Pce: 1BSEISMICR $1.33 Select an Administrative Item
Ulda Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $287.33 $0.00 TOTAL FEE: $287.33
Revised: 07/01/2012