12100128 CITY OF CUPERTINO BUILDING PERMIT
BUILDING.\IIUHICSS: 10066SSTGLLING RD CON'IR,\CI'OR;1 a ' •PF,RMITNO: 12100128
OWNER'S NANIF.: AGARWAL SANJAY V AND AGRAWAL SAPNA rC L� � (� +D,CI'F ISSUED: 10/1712012
OWNER'S PHONE: 4087719934 PRONE NO:
❑ LICI.NSED CONTRACfOR'S DECLARATION BUILDING PERMIT INFO: BLDG C ELECT 0 PLUMB rJ
License Class LicA q-�Qcfo0 r C. r
`�.�I�' �,� MECH RESIDENTIALCOhIM COMMERCIAL
Contmctor?-, te. �o.t f1�lilk � tic l�)T2
I herchy affirm that 1 am licensed under the provisions of Chapter 9 306 DESCRIPTION: REMOVE EXISTING WOOD SHAKE ROOFING,INSTALL
(commencing with Section 7000)of Division 3 of the Business& Professions NEW
Code and that my license is in full force and effect. PLYWOOD(1/2"OSB),UNDERLAYMENT,AND NEW 30YR
COMPOSITION ROOFING 22 SQ CLASS A
I 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 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 perfornmce of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$10250
APPLICANT CERTIFICATION
I cenify that I have read this application and state that the above information is APN Number:35907002.00 Occupancy Type:
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 10 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 expenses which may acerae against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR
with all non-point source regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION.
9.18. J/ /
Signature �- J tela ,[.
ww
- Issued by:� /✓ / /472iI- Date: !D•I7'4?-
i
❑ ONVNFR-RUILDrR DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS:
the following two 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 wages 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 Sc Professions Code)
I,as owner of the property,am exclusively contracting with licensed cmntmetors to Signature of Applicani �/� Date: 3-
construct the project(Sec.7044,Business R Professions Code).
hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR RFI-I'ER
declarations: f
1 have and will maintain a Certificate of Consent to self-insure for Worker's IIAZARI/0I1S MATERIALS DISCLOSURE
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 read the hazardous materials requirements under Chapter 6.9.5 of the
I have and will maintain Worker's Compensation Insurance,as provided for by California Health S Safety Code.Sections 25505,25533,and 25534. 1 will maintain
Section 3700 of the Labor Code,for the performncc of the work for which this compliance with the Cupertino Nlunicipal Code,Chapter 9.12 and the HealthS
Safety Code. Section_553_(x)should I store or handle hazardous material.
permit is issued. Additimully,should I use equipment or devices which emit hazardous air
I certify that in the performance of the work forwhich this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I 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 and the
Compensation laws of California. If,after ranking this certificate of exemption,I Health&Safety Code,Sections 25505,25533,and 25534.
become subject to the Worker's Compensation provisions of the Labor Code,I must
forthwith comply with such provisions or this permit shall be deemed revoked, Own or authorized agrnC
Date: (] 7/�o,
A PI'LICANT CF,RI'I FIC\'I'ION CONSTRI ICI'ION LENDING AGENCY
BCCI'
I certify that 1 have read this application and state that the above information is
correct. I agree to comply with all city and county ordinances mid 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 Q
upon the above mentioned property 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 of the Lender's Address
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section ARCI IITECI"S DECLARATION
9.18.
I understand my plans shall be used as public records.
Signature Date
Licensed Professional
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO, CA 95014-3255
V GUPERTINO (408)777-3228• FAX(408)777-3333•buildinGCGcuoertino.oro
l./
/`V' PROJECT ADDRESS , �Ir D. APNtl �L ' O —O,`
`X OWNER NAM PIr NE J E-MAIL
STREET AOORESSDO W W rV+� CIT\', STATE,ZI 1 q F X
15-A 360
CONTACT NAME PHONE E-MAIL
STREET ADDRESS CITY,STATE,ZIP FAX
❑OW;NER - ❑ OWNER-BUILDER ❑ OWNERAGEYT ONI'RACIOR ❑CONTRACTOR AGENT ❑ ARCHTTECT ❑ENCINMR ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME ` LICENSE NUMBE LICENSE T\RE BUS.LIC.tl
I r t 1.6 - �C
COMPANYNAAIE , LG E- IL �, FA
STREET ADDRESS � 1 CITY, ' A'rE,ZIP
,� ( r q PHDNEQC
ARCHITECLENGINEER NAME / /J. LICENSE NUMBER BUS.LIC,tlJ
COMPANY NAME Y� E-AfAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF IfIkfI SFD or Duplex ❑ hlultl-FB."T ROOPAREA^ '/T1: /'w, 'VALUATION: �,-rL� I h jb
STRUCTURE: ❑ Commercial V � (�J `� ` D , a5b
EXISTING ROOF TYPE'
/❑BUILT-UP ROOF ❑ASPHALT SHINGLES r�I WOOD SHARES ❑W'OOD SHINGLES 11 OTHER(SPECIFY)
y REMOVE/REPLACE.,U' \'ES IF NO. PLYWOOD lu K" ❑ PLYWD, 0 OSB PITCH: ROOF
/1 ❑ NO 1 G LAYERS' THICKNESS. ❑ SIB" TYPE ❑COX 12 CLASS' A
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF fT��/ASPHALT SHINGLES ❑WOOD SHARES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT#
DESCRIPTION OF WORK:
/ .Z_1 /1
By my signature below,1 certify to each of the following: I am the property mvncr or authorized agent to act on the property.owner's behalf. I have read this
application and the infomnation I have provided is correct. I have read the Description of Rork and verify it is accurate. 1 agree to comply with all applicable local
ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signaturem'ApplicantlAgene Date: IO�I
,n1 SUPPLEMENTAL INFORMA'T'ION REQUIRED _ OFFICE use ONLY
�V If building is associated with a I-lome 0wrners Association,provide letter PLANCIICCK TYPE _ ROUTING SLIP
/of approval from 110A. 7 OVER-TIIF.-COW\TER I� Bm Ln('M MAN RFV lett/
/Provide Planning approval to verify if there any restrictions. ❑ FvraF:55 ❑ rl In\mC PLAN.xLV IEw'
*'"Provide copy of Manufacturer's Installation Specifications. O; ST'ANIMRD O FIxenErr
✓Provide signed copy of Cupenino's'I'ear-Off Policy. ❑ 'OTHER:
ReroojApp_2011.doc revised 03/16/11
CiTV OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 10066 South Stelling Road DATE: 10/17/2012 REVIEWED BY: Sean
97APN: BP#: 'VALUATION: 1$10,250
*PERMIT TYPE: Minor Building Per PLAN CIIECK TYPE: Re-roof
PRIMARY SFD or Duplex PENTAMATION 1SFDWLR00F
USE: PERMIT TYPE:
WORKRemove existingwood shake roofing, install new plywood 1/2" OSB underla ment and new 30 r
SCOPE composition roofing. 2.
FEEID ROOFAREA
s.f.
1REROOFFRES 2,200
Mech. Plan Check Phunh. Plan ChecA Flee.Ilan Check
,Meth. Permit Fee: Plumb. Permit Fee: Elec. Permit Fee:
Other,lfech.IrzcP. Ocher Plumb InsP. Other flee.Insp.
dle.ch.hup. Fee: Plumb. hmp.Fee: Elce.Insp.Fec:
NOTE: This evtimate doer not include jeev due to other Departments(i.e. Planning, Public Warks, Fire,Sanitary Sewer District,School
District, etc. . These eev are baser/nn the preliminan information a wilable and are only an eatirnttle. Contact the Dept for addn7 into.
FEE ITEMS (Fee•Resolmion 11-053 E/7 711112) FEE QTY/FEE MISC ITEMS
Plzen Check Fee:
Suppl. PC Fee
PltanbJMech.181ec
Permit Fee: $330.00
Supp/. lisp Fee
Phanh.lMech./Elec
Plumb.411echAlec Permit Fee:
Consn•nction Tar:
Adminisn•olive Fee:
Work Without Permit? O Yes (j) No $0.00
Advanced Planning Fees:
Travel Doctunentation Foes:
Strong Motion Fee: IBSEISMICR $1.03 Select an Administrative Item
Bldg Stds Commission Fec: IBCBSC $1.00
SUBTOTALS: 1 $332.031 $0.001 TOTAL FEE: 1 $332.03
Revised: 10101/2012
REROOF TEAR-OFF POLICY
G 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• buildina(a�ouoertino.oro
PROJECT ADDRESS APN9
• �t
OWNER N PHONE / L E-MAIL
STREET ADD S CRY,STATE,2JP I FAX
CONTRACTOR ,r�� LICENSENUMBER nq O LICENSETYP BUS.LIC.0
COATPANYN IC , AnM�j 1 E-MAIL C� rl6f FAX DI
6
STREET ADDRESS CITY,STATE,AP PHO
I UNDERSTAND AND AGREE TO THE FOLLOWING:
I. The re-roof project shall comply with all applicable provisions of the 2010 California Codes.
2. An inspection request can be scheduled up to one business day before the requested inspection date.
Please call (408) 777-3228 from 7:30-3:30pm (Mon-Thurs) or 7:30-2:30pm (Friday) to schedule
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.
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 pioposed 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. 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'W' 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.
7. 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. 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 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 de ctors are required to be installed in accordance with Sections R314 and R315 of
the 2010 California Residential C ��-
SignatureofApplicanUAgent Date: /�//�/ r�—
RerooJPo1iry_2012.doc revised 10/7/12