12090179CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS: 20659CARDENSIDFCIR CONTRACTOR: BRADS[ IAW ROOFING INC PERMITNO:12090179
OWNER'SINAME: KUPPUSWAMYKUtIARAVrl.0 AND KUMARAVEL I82ISBASCONIAsorEPMBI60 DATE ISSUEI):09/19f-)012
OWNER'S PHONE: 4083091256 CAMPBELL, CA 95008 PlIONENO: (408) 246-9930
&r LICENSED CONTRAC'FOR'S DECLARATION'
LicenseCloss C-39 Lie. W -7 ) -;1 3 9-6
Contraicicar ate--g—L
I hereby affirin thnit I am licensed under the provisions ufChapmr9
(commencing with Section 7000) of Division 3 (of the Business & Professions
Code and flant my license is in full force and effect.
I hereby affirm tinder penalty offierjury one ofthe folloving two declarations:
I have mad voi I I maintain a ceru : ficam of co rosent to self -insure for Worker's
Compensation, us provided for by Section 3700 of the Labor Code, for the
perfornmanco: ofthe work for which this permit is issued.
I have mad will maintain Weaker's Compensation Insurrence, us provided for by
Section 3700 ofthe Labor Code, for the performance ofthe work for which this
permit is issued.
APPI,ICAN'I'Cl�'R'1'11�IC,%'I'ION
I certify that I have mad this rapplicationond suite thit the ibove information i�
correct. I agree to comply with all city and county ordinoraces; und state laws relading
to building construction, tand hereby authorize represemadives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to sas e
indemnify and keep hurnaless the City of Cupertino against liabilities, judgments,
costs, und expenses which may accrue against said City in consequence of the
gronting of this permit. Additionally, the appliciant unaersimids und will comply
with all non -point scm�pe regulations per the Cupertino Municipal Code, Section
9.18 '
Signiture Date
ONVNER-RUILDFIR DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for (me of
the following two reasons:
1, ate; owner of the property. or my employees with wages ats their sole compensation.
will do the work, mad the structure is not intended or offered for sale (Sec.7044,
Business & Professions Code)
1, ae; owner of the property, am exclusively contracting with licensed contraictrars to
constroact the project (Sce.7044, Business & Professions Code).
I herclaynfifirnn tinder penolly of perjur) one of the following three
declarations:
I have tand will maintain a Cenificate of Consent to self -insure for Worker's
Compensation, us 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, us provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
I certify that in the perforraimice of the work for which this permit is issued, I shall
not employ any person in my mainner so os; to become subject to the Worker's
Compensation laws of California. If, after making this certificate of exemption, I
become subject to die Worker's Compensution provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked.
I certify that I have read this application mad state than the above information is
correct. I agree to complywith all city and county ordinunces md state laws relating
to building construction, mad hereby authorize representutives of this city to enter
upon [lie above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City Of Cupertino agaunst litabilities, jUdgmenis,
costs, and expenses which romy accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands amod will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Signature Date
BUILDING PERINUT INFO: BLDG C ELECT r__J PLUMB 0
NIECU r- RESIDENTIAL r CONINIE'RCIAL r. -
JOB DESCRIPTION: REMOVE EXISTING WOOD SHAKE ROOF AND INSTALL
NEW
COMPOSITION SHINGLESIAGED BARK)CLASS A 12 SQFT
Sq. Ft Floni-Areat: I N'talualion: $6000
APN Number: 36232006.00 1 OccupuncyType:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: _55�-5;41V 1--14,
Drate: 90
RE -ROOFS:
All recols; shall be inspected prior to my mofing material beiig installed. If a rocif is
installed withoul first obtaining ain inspection, I agree to remove all new materials for
inspection.
Signature of Applicmat Date:
At,[, ROOF COVERINGS TO BE CLASS "A" OR BETTER
ll,%Z,%R[)Ot]S MATERIALS DISCLOSURE
I base read the hazardous materials requirements under Chapter 6.95 of the
California Health &Safety Code, Sections 25505,25533, and 25534. Iwillmatintatin
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Ileatith &
Sofety Code. Section 25532(a) should I store or handle Inizairclous material.
Addifionaliv, should I use equipment or devices which emit lavordous air
contaminants as defined by the Boy AreatAir QualityManagement District I " ill
maintain compliance vith the Cupertino Municipal Code, Chapter 9.12 and the
Ilead(h & SHfiety Code. Sections 25505, 25533, and 25534.
=6�utho�� �gnt� a
Date: Y42—A-.2—
CONSTRUC`110N LENDING AGENCV
I hereby affirma tha there is a construction lending agency for the perfiarmatrace of work's
for which this peranit is issued (Sec. 3097, Cie C.)
Lender's NARIC
Lender's
ARCIIITEC`IS DECLARATION
I understood my plansshall be used ns public records.
Licensed Professional
CUPERTINO
REROOP PERMIT APPLICATION
COMMUNITY DEVELOPIIENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAA (408) 777-3333 • buildinG..ecuoer ino.ora
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❑ owNER ❑ OWNEt•BLTLnm ❑ Ott'NERAuENT CONTR{CrOR ❑ CONTRACrOR AGENT ❑ ARQOTECr ❑ ENGINEER ❑ DEVELOPER ❑ iEC+AM
CONTRACT RNAAfE
LICENSENU_ASER
LICENSE TYPE
BUS. LIC.i • �c�
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LICENSE NU%(BER
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USE OF ❑ SFD or Duplex ' Multi -Family
ROOF AREA:
VALUAT
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STRUCTURE. CODIIrlercial
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EYISTINGROOFTYPE: ❑BUILT-UPROOF ❑.LSPHALTSHWGLES mU'OODSHAKES
WOODSHINOI-ES ❑OTHER(SPEI- Y)
RESIOVE )REPLACE S
1 IF NO .
5" 11
PLYW.D ❑
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ROOE
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PROPOSED ROOF TYPE: ❑ BUILT-UP ROOF ASPHALTSHINGLES ❑ WOOD SHAKES
❑ WOOD SHINGLES ❑ OTHER
ICC -ES REPORT a
DESCRIPTIONOF`NORK:
1
By my signswe below, I ceri y to each of the folluwinz: 1 am the property owner or authorized agent to act on die property, owncr's behalf. 1 have rrad this
application and the information 1 have provided B correct. l have read the Description of Work and verity it is accurate. I agree to comply With an applicable local
ordinances and state taus reladnc to bud/Qi/ng wns/y-�gron. I au ori/z(representatives of Cupertino to enter the above-identifFtl property for inspection purports.
Signature af.ApplicanVAgen❑ C,l�/.r L
Date. � /e.� (d / .7Pii Z—
SUPPLEMENTAL INFORIDLaTION REQUIRED
OFFICE
USE ONLY
PLANCHECKT1PE
ROLTLvGSLIP
_ If building is associated With a Home OTvneri Association, provide letter
1 OVER-THE-COUNTER
BNLDENG PLAN RENEW
of approval from HOA.
Provide Planning approval to verity if there any restrictions.
EXPRESS
❑ PL{,yNrAG PLAN RE}7ER'
_ Provide copy ofManufacnrrer's Installation Specifications.
❑ STANDARD
❑ FHtE DEPT
Provide signed copy of Cupertino': Tear -Off Policy.
❑ OTHER:
V
Reroofdpp_301 Ldoe revised 03116•71
CITY OF CUPERTINO
FEE ESTIMATOR— BUILDING DIVISION
FEE ID ROOFAREA
s.f.
1REROOFFRES 1,200
ADDRESS: 20659 Gardenside Cir.
DATE: 09/1912012
REVIEWED BY: Sean
\
APN:
BP#:
'VALUATION:
$6,000
"PERI11T TYPE: Minor Building Permit
PLAN CIIECK TYPE: Re -roof
PRIMARY SFD or Du lex
USE: p
Elec. Imp. Fee:
PENTAMATION 1SFDWLR00F
PERMITTYPE:
WORK
Remove existing wood shake roof and install new composition shingles (Aged Bark).
SCOPE
FEE ID ROOFAREA
s.f.
1REROOFFRES 1,200
NOTE: This estimate does not includejeev due to other Departments (i.e. Planning, Puhlic Works, Fire, Sanitary Sewer District, School
ni.,. ,* c erte 1 Th. ro ! ov aro 6nved .m ma nrelimh,nrr intarneatinn available and are onle an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee 1Zesnhuion 11-053 Eff 711111)
Much. Wan Check
Plumb, Plan Check
Flee. Plan Check
Alech. Permit. Fee:
Plumb. Permit Fee:
Flee. Permit Fee:
Other Mech. /nap.
Other Plumb Insu.Li
Other Elce. hup.
,L/ech. hup. Pec:
Phtmb. Lisp. Fee:
Elec. Imp. Fee:
NOTE: This estimate does not includejeev due to other Departments (i.e. Planning, Puhlic Works, Fire, Sanitary Sewer District, School
ni.,. ,* c erte 1 Th. ro ! ov aro 6nved .m ma nrelimh,nrr intarneatinn available and are onle an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee 1Zesnhuion 11-053 Eff 711111)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
SappL PC Fee
Ph an h.1111 ec1 t. /li l ee
Permit Fee:
$180.00
.S 1111111. lNBll l' L L'
Phnnh,f 11ech.R:lec
Plunlh.fhlech.flslec Nrmll Fee:
Construction Ta.v:
Administrative Fee:
Work Without Permit? O Yes Q No
$0.00
Adveniced Planning Pees:
�
Travel Documentation FBes:
Strong, Motion Fee: /BSEISMICR
$0.60
Select an Administrative Item
131du Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$181.601
$0.001
TOTAL FEE:
$181.60
Revised: 07/01/2012
By my signing below, I 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. I also understand that
smoke detectors and carbon monoxide detectors are required to be installed in accordance with Sections R314 and R315 of
CUPERTINO
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
(408) 777-3228 • FAX (408) 777-3333 • buildinana cuoertino.ora
PRQ1ECr ADORES , /O
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LICENSE LUMBER
LICENSE TYP
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I UNDERSTAND AND AGREE TO THE FOLLOWING:
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.
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.
Progress [nspection is required when approximately 50% of roof covering is installed.
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.
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, I 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. 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: Date:
RerooJPolicv_2011.doc revised 0?/16/11
Linoleum / Wood
Glass / Glazing
` CUPERTINO
/ Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
'CONTRACTOR / SUBCONTRACTOR LIST
JOB ADDRESS:
PERMIT #
OWNER'S NAME:
�1
GENERAL CONTRACTOR:
BUSINESS LICENSE #
. 1\r V/II1l,S
CITY/ZIPCODE: ff),i
` CUPERTINO
/ Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
'CONTRACTOR / SUBCONTRACTOR LIST
JOB ADDRESS:
PERMIT #
OWNER'S NAME:
PHONE #
GENERAL CONTRACTOR:
BUSINESS LICENSE #
ADDRESS: S `
CITY/ZIPCODE: ff),i
*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 BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCON"I=iLCIORS E OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.I am not using any subcontractors: as /a n/2
Signature Date
Please check applicable subcontractors and complete the following information:
Owner / Contractor Signature
Date
SUBCONTRACTOR
BUSINESS NAME
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