12110133 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRIsSS: 100590AKLCAIZ PL CONTRAC`T'OR:HAULING PROS PERMIT NO: 12110133
OWNER'S NAME: NAYAK JNANESIiWAR H AND JNANESIiWARNA PO BOX 4033 DATE ISSIIF.D: 11/262012
OWNER'S PHONE: 4089968747 NALNUTCRF.F.K.C.\ 94596 PHONE NO:(925)682-8987
❑ LICENSED CO"RACI.O9R'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT 0— PLUMB r
License Class. " Y—F. Lie.H C`7; 3 (2 2 r r r
pIECFI RESIDENTIAL COMMERCIAL
Contractor _� i Date 11-2 /9-1
I hereby nllirm that I am licensed under the provisions of Chapter 9 30B DESCRIPTION:SNIMAtING POOL DEAfOLITION
(commencing with Section 7000)of Pik inion 3 of the Business&Professions
Code and that my license is in full force and effect.
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. Sq,Ft Floor Area: Valuation:$2500
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
permit is issued. AllisNumber:32618053.00 Occupancy Type:
AI'I'LIC,\N'f CISR'1'IFIC\"PION
I cenify that I have read this application and state that the above information is
correct.l agree to comply with all city and county ordinances and state laws relating PERMIT EXPIRES IF WORK ISNOT STARTED
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR
indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM AST CALLED INSPECTION.
costs,and expenses which may accrue against said Cit in consequence of the
granting of this permit. Additionally,the applicant understands and will comply 77 f
with all non-point source regulations per the Cupertino Municipal Code,Section Issued by: Date;
--���I
9.18. {y VVV
Signature `�Date
RE-ROOFS:
❑ 'OWNER-BIJILDF.R DECLARATION All roofs shall be inspected prior many rooting material being installed.If a roof is
installed without first obtaining an inspection.I agree to remove all new materials for
1 hereby affirm that I am exempt front the Contractor's License Law for one of inspection.
the following two reasons:
I,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date:
will do the work,and 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 ALL ROOF COVERINGS TO BE CLASS"A"OR BE FER
construct the project(Sec.7D14,Business&Professions Code).
hereby affirm under penalty of perjury one of the following three HAZARDOUS NIATERIAI S DISCLOSURE
declarations: - I have read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&SafeIv Code,Sections 255115,25533,and 25534. I will mainbain
Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code.Chapter 9.12 and the Ilealth&
performance of the work for which this permit is issued. Safetv Code,Section 25532(x)should I store or handle hazardous material.
I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should 1 use equipment or devices which emit hazardous air
Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Nlanagemenl District I will
emiit is issued. p maintain compliance with the Cupertino Municipal Code.Chapter 9.12 and the
P Ilealth&Safety Code,Sections 25505,25533,and 25534.
1 certify that in the performance of the work for which this permit is issued,)shall
not employ any person in any manner so as to become subject to the Worker's Owner nuthori d attml:
Compensation laws of California. If,after making this certificate ofexemption,l
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. CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
APPLICANI'CERTI FICATION for which this permit is issued(Sec.3097,Civ C.)
I certify that I have read this application and state that the above information is Lender's Name
correct.I 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 Lender's Address
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accruc.against said City in consequence of the .\RCII I"I'ECI"S DECLARATION
granting of this permit.Additionally,the applicant understands and will comply I understand my plans shall be usedas public records.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. Licensed Professional
Signature Date
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 B.
CUPERTINO (408)777-3228• FAX(408)777-3333•building0cuoertino.oro
❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERNII'III'#
PROJECTADDRESS O 1 \ Cn C \ APNN V O
OWNERNAME ^ , `C I PHONE
I E-MAIL
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STREET ADDRESS CITY, STATE ZIP FAX
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CONTACT NAME \ c PHONE E-h1AIL
STREETADDRESSCRY,STATE ZIP FA
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❑oWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR 13 CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER 11ENANT
CONTRACTORHAME . C �µ C;o ffu \ LICEN�NUMBEERR LICENSETITE BUS.LIC0
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COMPANY NANIE E-NTAIL FAX
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STREETADDRESS C STATEZ PHONE
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ARCHITECDENGI,NEER NAME LICENSE NUMBER BUS.LIC i
COMPANY NAME E>IAIL
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STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF N'ORK _ \ q
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LJC(—fit Q '. >N d r. cA 1' r c.EXISTING USE PROPOSED USE CONSTR.Wes M STORIES �_
USE n•PE OCC. SQ.Fr. VALUATION(S)
E\TSTG NEW FLOOR DGIO TOTAL
AREA ARG AREA NET AREA
BATHROOM KITCHEN OTHER
REMODEL AREA REMODELAREA REMODEL AREA
IgRCH ARG DECK AREA TOTAL DECRIPORCH AREA GARAGEARG, DUACII
ATTACH
N DWELLING UNITS. ISASECONDUNrr ❑1'FS Sr:fo,NDSroR)' Oyu
11EI.NC.ADDED1 pso AI1DHIOSr E]NO
TOTAL VALUATION:
PRE APPLICATION ❑1'ES IF\'ES,PROVIDE COPY OF IS TIIF:01.1ffi AS ❑YES RECEIVED DY: T>
PGNNINGAPPLd E]NO PLANNING APPROVAL LLTR EICHLER IIOYIF.T ANO J22 n ��� ^�
By my signature be tow,I certify to each of the following: I am the property owner or authorized agent To act on the pro/perry owner's behal l: I have read this
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to builddiing'63manacliowauthorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicanl/Agent:_//�/%� Date:
SUPPLENIL'NTAL INFORMATION REQUIRM) PLANCHECKT1'PC ROUT INC,SLIP
_New SFD or\lultifamily dwellings: Apply for demolition permit for ❑ O\'ER=I'IIECOUNTER ❑ BUILDING PLAN REVIEW
existing building(s). Demolition pennit is required prior to issuance of building
permit for new building. ❑ F_NPRF.SS ❑ PLANNING PLAN REVIEW
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS
form if one Hazardous Materials arc being used as pan of this project. ❑ LARGE ❑ FIRE[)Err
_Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application- ❑ }L\.IOR ❑ ENVILARYSEwER HEALI If
❑ ENy1HOp'xI EN'I',A I.II F.V:1'll
Bldg,I pp_201 Ldoc revised 96121/11
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
[via ADDRESS: 10059 Oak leaf Place DATE: 11/26/2012 REVIEWED BY: jsg
APN: BPO: `VALUATION: $2,500
*PERMIT TYPE: Demolition Permit PL.d:VCHECK TYPE:
PRIMARY Swimming Pool, Res. PENTAMATION. 1SFPOOLDEM
USE: PERMIT TYPE:
WORK S a demo
SCOPE
FEE ID # POOLS
1DEMOPRES 1
Hech.Plan Check' Plumb.Plurt Check Elec. Plan Check
hlech. Permit Fee: Plumb. Pernit Fee: Elec. Permit Fee:
Other A1ech. Insp. Other Plumb Insp. Other Elco hup.
kle.ch.Insp.Fee: Plumb.btsp. Fee: Elce.Insp.Fee:
!VOTE: This avdinate does not include fees•due to other Departments(i.e. Planning, Public Works, Fire,Sanitary Server District,School
District, etc.). These feev are haled on the prelirninan information available and etre only on estiaune. Contact the De t or whin'/in a.
FEE ITEMS (Fee Fee /1-053 E//' 7/1/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Suppl. PC Fee
Phunb./A-tech./Elec
Permit Fee: $306.00
Suppl. Insp. Fee-.0 Reg. Q OT 0.0 hrs $0.00
PGtmb.lMech.lElec'
P/umh.4fech.lElee Permit Fee:
Construction Tac:
Administrative Fee:
Work Without Permit?
Advanectl Planning Fees:
Travel Documentation Fees: A
Strong Motion Fee: IBSEISAfICR $0.50 Select an Administrative Item
Bide Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $307.50 $0.00 TOTAL FEE: $307.50
Revised: 10/01/2012
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M� _CITY OF CUPERTINO
CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS: 21578ROSARIOAVE CONTRACTOR:XTERIA CONSTRUCTION PF-RMITNO: 12110132
OWNER'S NAME: MARSHALL WILLIAM J AND ELIZABE PO BOX 5460 DATE ISSUED: 11/26/2012
OWNER'S PHONE: 4082557574 SAN JOSE,CA 95150 PI IONF.NO:(408)289-5353
LICENSED CONI'RACI'OR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUPIB[I
License Class — `� l Cic.-M`-76Z��
-/f� ^ MECII C RESIDENTIAL(J CONINIERCIAL (✓
Contractor. Dale /- 2 t6 /Z)
I hereby affirm that I our licensed under the provisions of Chapter 9 JOB DESCRIPTION: RE-ROOF REMOVE CEMWOOD,REPLACE WITH COMP-
(commencing with Section 7000)of Division 3 of the Business&Professions CLASS A
Code and that my license is in full force and effect. -7 SQFI'
hereby affirm under penalty of perjury(tire 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 which this permit is issued.
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
permit is issued Sq.Ft Fluor Area: Voluation:$8600
%['['[,IGSNI'CER'1'IFICA'I'ION
I certify that I have read this application and state that the above information is APN Number:35619019.00 Occupancy'ry'pe: '
correct.I 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
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 it. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR
with all non-pat a ce regulations per the Cupertino Municipal Code.Section 180 DAYS FROM LAST CALLED INSPECTION.
9.18.
Signature Az, Dated Z Issued by:qS6—
Date:I
O OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of RF:ROOFS:
the following two reasons: All roofs shall be inapectcd prior to any roofing material beiig 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(Sec.7044, inspection.
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: Date:
construct the project(Sec.7044,.Business&Professions Code).
1 hereby affirm under penalty of perjury(tire of the following three AL1.ROOF COVERINGS TO BE CLASS"A"OR BI?TIER
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIAI S 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 6.95 of the
I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505.25533,and 25534. I will maintain
Section 3700 of the Labor Code,for theerformance of the work for which this compliance with the Cupertino Municipal Code.Chapter 9.12 and the Ilealth&
F Safety Code.Section 25532(a)should I store or handle hazardous material.
permit is issued. Additionally,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 eill
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,atter making this certificate of exemption,I Health S Safety Code,Sections 25505.25533,and 25534.
become subject to the Worker's Compensmion provisions of the Labor Code,I must ,
forthwith comply with such provisions or this permit shall be deemed revoked. Onft authorized agent: r, Z� _/�
(late: L�
A PP1.1CANT CE RTI F1CATION' CONSTRUCTION LENDING AGENCY
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 reining I hereby affirm that there is a construction lending agency for the perfonnaiice of work's
to building construction,and hereby authorize representatives of this city m enter for which this permit is issued(Sec.3097,Civ C.)
upon the.above mentioned property for inspection purposes.(We)agree to save Lender's Name
indemnify and keep hamhless the City of Cupertino against liabilities,judgments,
costs,and expenses which may acerae 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 ARCHITECT S DECLARATION
9.18.
I undersand my plans shall be used is public records.
Signature Date
Licensed Professional
�e +. I Zl ( 01 3Z
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO,CA 95014-3255
(408)777-3228• FAX(408)777-3333• buildinGCG cuoertino.om
CUPERTINO
PROTECT ADDRESS D57 oql- O A/.ti' APNM �J --/ �I�t (� 1✓1
OWNER NAME PHO'E� E--MAD, _ 1
STREET ADDRESS CIN, STATE,ZIP I FAX
CONTACT NAMEE-A1AD-
STREET ADDRESS,5 /,,I..,,, I// CIN,STATE ZIP ~— fi z FAX
❑OWNER . ❑ OWNER-BUILDER ❑ OCWNERRATGEEh_T LRO< CTOR ❑CONIRACTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME L E ER ENCS? z BUS.LIC.N
M
CONmANY NANIE / ^ ( E-MAIL FAX
J FAX !!
STREET ADDRESS 4 /V� I CIN,STATE ZIP I) Z� PHONE
ARCHITEC AINGINEER NAME (, c LICENSE NUMBER '/ BUS.LIC.M
COMPANY NAhfE E-MAIL FAX
STREET ADDRESS CITY.STATE,ZIP PHONE
USE OF SFD or Duplex ❑ Multi-Family ROOF AREA: .��� VALUATION:
❑
STRUCTURE: Commercial 2
EMSTMG ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES X� R(SPECIFY)
f0 /REPLACE IFNO. PLYWOOD ❑ W ❑ PLYWD ❑ OSB PITCH: ROOF
ONO I M R ' 1 KNESS' ElSIS" ❑ COX ')2 L A
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF PHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT
DESCRIPTION OF WORK:
By my signature below,1 cenify tbea I of the following: I am the property owner or authorized agent to act on the property owner's behalf I have read this
rm
application and the infoation 1 hat ovided is correct. I have read the Description of Work and verify it is accurate. I agree to comply With all applicable local
ordinances and state laws relating to i construction. I authorize representatives of Cupertino to enter the above-identifiedp-ropi for inspection purposes.
Signature ol'Applicant/Agene Date:
SUPPLEMENTAL INFORMATION REQUIRED _ OFFICEUSEONLY
If building is associated with a Home Owner's Association,provide letter ri.n5 cur cK Tyre, _ _ROUTING SLIP, =
i
of approval from MOA. 0 ovFR-I IF COIINTFR f❑ BUILDING PLAN,REVHEW,
Provide Planning approval to verify if there any restrictions. ❑ t:XraP_cs - ❑ rt�sNn'MG ren�'Rel•Hew
_Provide copy of Manufacturer's Installation Specifications. ❑ STANDARD ❑ FIRE DET -
Provide signed copy of Cupertino's Tear-Off Policy. ❑ OTII:R: .,
i
ReroofApp_201 l.doc revised 03116/11
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• buildincr5cupertino.oro
PROJECT ADDRESS _7,6-T9
J�/6ri -' 9 A-/ tc-�) APN 0
OwNERNAN[E k\ PHONF:
O /SV� C` I �
E-MAIL
CITY,STATE,ZIP
FAX
COYfRACLDR NAMEB C/^ LICENSE NUFIDE� 7 L
7O�r LICENSE TYPE�_ BUS.LIC,tl
CONBANY NAME E-MAD. I FAX
STREET ADDRESS Y ''`f( � li. �( � CnY,STATE,ZIP ` � /'.A yC� 7/� PHONE
l (( ` 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 one business day before the requested inspection date.
Please call (408) 777-3225 from 7:30-3:30pm (Mon-Thurs) or 7:30-2:30pn1 (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 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. 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'A" 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 are-inspection fee. The re-inspection fee shall be paid before another inspection can be
scheduled.
By my signing below, I certify eac 0 t following is true: I am the property owner or authorized agent to act on the
property owner's behalf. 1 understa d agree to comply with the re-roof policy stated above. I also understand that
smoke detectors and carbon monoxid tectors are required to be installed in accordance with Sections R314 and R315 of
the 2010 California Residential C d .
Signature of Applicant/Agent: Date:
U
RerooJPolicy_2012.doc revised 10/7/12