12090115 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20660 GARDENSIDE CIR CO\fRACFOR:BRADSHAW ROOFING PERMIT NO: 12090115
INC
OWNER'S NAME: RAVINDRA&SUJATA TADWALKER 1821 S BASCOM AVE PMB 160 DATE ISSUED:09/132012
OWNER'S PIIONE: 4082471453 CAMPBELL,CA 95008 PHONE NO:(408)246-9930
[IY LICENSED COKIRACfOR'S DFCLARATION JOB DESCRIPTION: RESIDENTIAL Ll COMMERCIAL.
11
License CI s C 3 Lic.q 3RE-ROOF 12 SQ-TEAR OFF EXISTING, INSTALL NEW
Contmcto
�<,\ l AtJ • 'C ole ASPHALT SHINGLES CLASS A
1 hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000)of Division 3 of the Business&Professions
Cade and that my license is in full force and effect.
1 hereby affirm under penalty of perjury one of the following two 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 whichthis permit is issued. Sq.Ft Floor Area: Valuation:$6000
1 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 ,APN Number:36232016.00 Occupancy Type:
pernit is issued.
APPLICAN`F CERTIFICATION
I cenify that I have read this application and state dial the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.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-1 AST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments, .
costs,and expenses which may aceme against said City in consequence of die Issued by: Date: r• I I
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.
^7 RM:ROOFS:
Signature — Date �` All roofs shall be inspected prior to any roofing material being installed.if roof is
installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
❑ ON'NFR-BUILDER DECLARA'T'ION /
Signature o(Applipnl ale:
1 hereby affirm that Iam exempt from the Contractor's License Law far one of
the following two reasons: ALL ROOF COVERINGS TO RE CLASS"A"OR BF,TTER
1,as owner of the property,or my employees with wages as their sole conhp:nsation,
will do the work,aid the structure is not intended or offered for sale(Sec.7044,
Business& Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUSMATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Ilealth&Safety Code,Sections 25505,25533,and 25534. 1 will
1 hereby affirmunder penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code.Chapter 9.12 and the
declarations: Health&Safety Code.Section 25532(a)should 1 store or handle hazardous
I have and will maintain aCertificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District
performance of the work for whichthis permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Ilealth&Safety Code,Sections 255 5533, nd'--55}/�
c U /
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized ager: / ((�'�� Date:
permit is issued.
1 certify that in the performance of the work for which this permit is issued,l shall
not employ any person inany marmer so as to become subject to the Worker's CONSTRUCTION LENDING AGENCY
Compensation laws of California. If,after making this certificate of exemption,I
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, work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANTCERTIFICATION Lender's Address
I certify that I have read this application and state that the above information is
correct.1 agree to comply with all city and county ordinances and 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 ARCIIITECT'S DECLARATION
indemnify and keep hamnless the City of Cupertino against liabilities,judgments.
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 PERMIT APPLICATION
�.
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO•CA 95014-3255
GUPERTlNO (408)777-3228 •FAA(408)777-3333•buildinGfacuoertinO.orG 20�
PRO=ADDRESS / APN e — 1
O ER NAAn: (� PHONE EdLVL
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STREET ADDttEss r Q Crtf. STATE, FAX
CONTACT NAhIE lJ PHONE E.NQIL
STREET ADDRESS I CITY.STATE ZIP FAX
❑O%VhTR ❑ OWNTA-BUMDER ❑ OVVNERAGErrr CONTRAROR ❑CON-iRAROR AGEYr ❑ ARCHITECT ErCA1EER ❑ DE'/ELOPER ❑TENANr
CONi1tACT RNANt'c LICENSENUMBER LICENSE TYPE BUS.LIC,d '
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COMPANYNAafE bC n� F.Ax _
STREET ADDRESS CITY.STATE IP PHONE
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ARCHITELTIENOWEER NAME LICF ME NMMER BUS LIC..
CONVANl'NAME -• E-NUa. FAX
STREET ADDRESS CITY.STATE ZIP PHONE
USE OF ❑ SFD or Duplex ❑ Nluld-Family ROOF AREA: vµu,�TION:
STRUCTURE. ❑ Convnercial ,�yrl �U
EA7S7WOROOFTYPE,::^/OSUD.T-UPROOF ❑ASPHALTSHWGLES 2,1'00DSHAKES ❑WOODSHWGLES ❑OTHER(SPECIFY)
REMOVE,REPLACE `LttT3 IF NV. PLY:`.'OOD CKV ❑ PLViWD ❑ OSB PITCH: (L ROOF
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ASPH.ALTSHINGLES ❑WOOD SHAKES '❑WOOD SHWOLES ❑OTHER ICC-ES REPORT:
DESCRIPTION OF RK: .� I
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By my,signature below,I certify to each of the following: I am the propem•owner or authorized agent to act on the property owners behalf. I have rcad this
application and the information I have provided is correct. I have read die Description of Work and verify itis accurate. I agree m comply withall applicable loci
ordinances and state laws relating to builging conar}+gion. f au riz epresenatives of Cuperdno to enter the—ablove-identifKd property for inspection purposes.
SigtatureofApplicand.•1gent: `(,(� //.-yS Date: /�e�. r.1 on 2—
SUPPLEMENTAL INFOPMATION REQUIRED OFFICE USE ONt.Y
_If building is associated with a Home Owners Association.provide letter P"NCHECK nPE -�ROtmNG SLIP
of approval from HOA. �.ovER-Tt�:CouN'rER BL.1 W.DING PLAN REVTEW
Provide Planning approval to verify if there any restrictions. ❑ EXPRESS ❑ PLANNING PLAS RMEW
_Provide copy of Manufacturer's Installation Specifications. ❑ STANDARD ❑ =DEPT
r+�P ovide signed copy of Cupertino',Tear-Off Policy. ❑ OTHER:
Rerooj4pp_201 Ldoe revised 03!767 1
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
{' ADDRESS:Jp 6(0 gardens ide circle DATE: 09/12/2012 REVIEWED BY: bob s.
APN: BP#: 'VALUATION: $6,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex PENTAMATION 1SFDWLROOF
USE: PERMITTYPE:
WORK remove existing roof. Install new asphalt shingles 1200 s.f.
SCOPE
&tech. Plan Check Plumb. Plan Check Flec. Plan Check
Atech. Permit Fee: Plumh. Permit pee: Elee. Permit Fee:
Orher Meeh. Insp. Other Plumb Insp. L1 I Other Eler.Insp.
,Meeh. Imp. Fee: Plumb. hup. Fee: Dec.Insp.Fee:
NOTE: This estinmte does not include jeer due to other Departments(i.e. Planning,Public Warks, Fire,Sanitary Sewer District,School
District,etc.). These feev are based ai tie prelitninarr information available and are only an estimate. Contact the De t or addn 7 info.
FEE ITEMS(Fee Resolution 11-053 EIL 7/1/11) FEE QTY/FEE I MISC ITEMS
Plan Check Fee: $0.00 1,200 s.f. Re-roof
Suppl. PC Fee: (j) Reg. O OT 0.0 hrs S0.00 $180.00 IREROOFRES
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee:Q Reg. Q OT 0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: 50.00
Consnvcrion Tax:
Admiuisirarive Fee: O
Work Without Permit? O Yes Q No $0.00 E)
Advanced Planning Fee: $0.00 Select a Non-Residential 0
Travel Doctarrenlation Fees: Building or Structure 0
Strong Motion Fee: IBSEISAIICR $0.60 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
4i 'SUBTOTALS:i 1 $1.60 $180.00 " TOT1LtFEE.': $181.60
Revised: 07/01L2042�
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•buildinglMcupertino.org
PROJECT ADDRESS APNu
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Of RNAME ` PHONE l EMAIL
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STREET ADDRES ` 51 I CITY,S -ZI-ZP G �/t FAx
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C TRACTOR,NA,fE LICENSENTiMBER LICE\SE TYP BUS. .N
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COMPANYNAME EMAI Fdo
STREET ADDRESS ` ' \J
\ CG CM.STATEZH` J 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 are-inspection fee of S126.00. 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: 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:
RerooJPo1icv_2011.doc revised 02/16111