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11060189 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20075 NORTHWIND SQ CONTRACTOR:FOUR SEASONS ROOFING PERMIT NO: 11060189 OWNER'S NAME: BALASUBRAMANIAM SIVARAMA K PO BOX 1668 DATE ISSUED:06/22/2011 OWNER'S PHONE: 4088560196 SAN JOSE,CA 95109 PHONE NO:(408)278-0330 L LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT r PLUMB r— License Class Lic.# t'('� MECH RESIDENTIAL COMMERCIAL Contractor Date � - Z- � V� I hereby a arm hat I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REROOF,14 SQUARES,TEAR OFF EXISTING AND (commencin -with Section 7000)of Division 3 of the Business&Profession REPLACE WITH COMPOSITION SHINGLES Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declar 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 performance of the work for which this Sq.Ft Floor Area Valuation:$4400 permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is APN Number:31638008.00 Occupancy Type: 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 accrue 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. Siert,ure Date r� Issued by: �y---�— -� Date: '22— J" � OWNER-BUILDER 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 1,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 Applit`ant:_ - _ Date: construct the project(Sec.7044,Business&Professions Code). - I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS 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 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain [have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this 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 for which 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 making 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. Owner or.authorized agetc -,— l P 1 Date: APPLICANT CERTIFICATION 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 relating I hereby affirm that there is a construction lending agency for the performance of Hork's to building construction,and hereby authorize representatives of this city to 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 harmless the City of Cupertino against liabilities,judgments, C and expenses which may accrue against said City in consequence of the Lender's Address ig of this permit.Additionally,the applicant understands and will comply wm.all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION 9.18. I understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO 3 ITEMS OF 18 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 31638008 . 00 DATE ISSUED. . . . . . . : 06/22/2011 RECEIPT #. . . . . . . . . BS000013860 REFERENCE ID # . . . : 11060189 SITE ADDRESS 20075 NORTHWIND SQ SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER BALASUBRAMANIAM SIVARAMA K ADDRESS 20075 NORTHWIND SQ CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : FOUR SEASONS ROOFIN CONTRACTOR DIAZ, ALFRED LIC # 21323 COMPANY . . . . . . . . . . : FOUR SEASONS ROOFING ADDRESS PO BOX 1668 CITY/STATE/ZIP . . . : SAN JOSE, CA 95109 TELEPHONE (408) 278-0330 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ----- 1BCBSC VALUATION 4,400 . 00 1. 00 0. 00 1.00 0. 00 1BSEISMICR VALUATION 4,400 .00 0 . 50 0. 00 0 .50 0 .00 1REROOFRES SQ FEET 14 .00 182 . 00 0 . 00 182 .00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 183 . 50 0. 00 183 .50 0.00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- --------- 309 EXTERIOR LATH 311 SCRATCH COAT 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF ` N 6P CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 20075 northwind sq. DATE: 06/21/2011 REVIEWED BY: bobs. APN: �(D 32 IBP#� '"VALUATION: $4,400 'PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof PRIMARY PENTAMATION 1SFDWLROOF USE: SFD or Duplex I I PERMIT TYPE: WORK tear off replace with comp shingles SCOPE FEE ID ROOF AREA s.f. 1 REROOFFRES 1,400 NOTE. These fees are based on the preliminary in ormation available and are onlE an estimate. Contact the Dept for addn 7 info. FEE ITEMS (Fee Resolution 09-051 F,'tf. 7.-"1(?) FEE QTY/FEE MISC ITEMS F-71 Permit Fee: $182.00 Work Without Permit? 0 Yes (D No $0.00 i Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $183.50 $0.00 TOTAL FEE: $183.50 Revised: 04/29/2011 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-buildincdpoupertino.ora PROJECT ADDRESS / AM S ;260'_2,_Y_ {tttw etj f PHONE E-MAIL 'S 1 ' Q q.5 b 0`�1 i a c? (o C7 `l STREET ADDRESS CITY, STATE,ZIP FAX CONTRACTOR NAME LICENSE NUMBER L 1 Q QS TYPE EUS.LIC.S CONTRA Ot)f ` { v — �a� COMPANY NAME EMAIL D 79'�. STREET ADDRESS ` CITY,STATE,ZIP Cm �� C PHONE 279 -63-3-01 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 shall be scheduled 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. On the day of the inspection, a building inspector will be available within one hour for either a Tear-Off Inspection or Nailing Inspection if you call again on that day between the hours specified. 3. The following inspections are required: a. 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. b. If plywood is installed, a plywood Nailing Inspection is required. c. Prop-ress Inspection is required when approximately 50% of roof covering is installed. 4. New roof coverings shall not be applied without first obtaining all 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. 5. 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 1/4"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. 6. 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 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 detecto are required to be installed in accordance with Sections 14 an R315 of the 2010 California Residential Code. Signature of Applicant/Agent: Date: RerooJPoliry_2011.doc revised 02/16/11 r .�--�— MIT APPLICATION C REROOF PER COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION 10300 TORRE AVENUE-CUPERTINO, CA 95014-3255 GUPERTINO (408)777-3228- FAX(408)777-3333-building0cupertino.ora PROTECT ADDRESS 0) S "N/ K��✓Y� S "N M 3 1 to SC6, 00Z OWNER NAME J 1 (A c-( i k� 1 PHONE D �_v/ 24-- y / E-MAIL STREET ADDRESS S CITY,STATE,ZIP FAX APPLICANT NAME 12 -3 E-MAIL. STREET ADDRESSCITY.STATE, F , 50 Z �vt� .'j� e,st.—�ai-e- ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME _ (J �2�C LICENSE ER LI B TYPE BUS.LIC.N (�(p Ll o COMPANY NAME ( E-MAIL PAJ,V STREET ADDRESS 5-6 7- 3 T� C STATE ZIP / A - ARCHTTECT/ENGINEER NAME LICENSE NUMBER CXR BUS.LIC.N COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF O SFD or Duplex Wmulti-Family ROOF AREA: VALUATION: R� STRUCTURE: C] Commercial /13EXISTINO ROOF TYPE: ❑BUILT-UP ROOF 13 ASPHALT SHINGLES WOOD sHAKES ❑WOOD SHINGLES (S(SPECIFY)/�/� /0~0140d00 REMOVE/REPLACE >KXS IF NO, PLYWOOD . 13 ,4- ❑ _ PLYWD 13 OSB PrTCH :12 ROOF A 13 NO I A ❑ 13 cpx eY PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ;?(mHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT N DESCRIPTION OF WORK:ti,, l lore By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. 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 b ' Ing nstruc'on. I authorize representatives of Cupertino to enter the abov 1 'fled pro rty for inspection purposes. Signature of Applicant/Agent Date: Z6 SUPPLEMENTAL INFORMATION REQUIRED _If building is associated with a Home Owner's Association,provide letter of approval from HOA. Provide Planning approval to verify if there any restrictions. Provide copy of Manufacturer's Installation Specifications. vide signed copy of Cupertino's Tear-Off Policy. ReroofApp 20IL doc revised 03/02/11