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11050149CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 10380 IMPERIAL AVE I CONTRACTOR: M & S ROOFING CO. I PERMIT NO: 11050149 OWNER'S NAME: NARAYAN VENKATARAMANI& RAMAN 1208 COPCO LN DATE ISSUED: 05/19/2011 I OWNER'S PHONE: L LICENSED CONTRACTOR'S DECLARATION License Class l Lic. # ContractorDate I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 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: 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. 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 permit is issued. APPLICANT CERTIFICATION 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 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, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -points rce regulations per the Cupertino Municipal Code, Section 9.18. Signature Date OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1, as owner of the property, or my employees with wages as their sole compensation, 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 construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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 performance of the work for which this permit is issued. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's 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 forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 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 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, cr--, and expenses which may accrue against said City in consequence of the i ig of this permit. Additionally, the applicant understands and will comply w.:_. dll non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date SAN JOSE, CA 95123 1 PHONE NO: (408)314-0870 BUILDING PERMIT INFO: BLDG r— ELECT f— PLUMB F MECH I— RESIDENTIAL f— COMMERCIAL f— JOB DESCRIPTION: RE -ROOF REMOVE ORIG ROOF & REPLACE WITH COMP SHINGLES 32SQFT CLASS A Sq. Ft Floor Area: I Valuation: $15800 APN Number: 35719096.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Date: RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE 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 compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Owner,w7authorized agent: Date:_( CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional 3 ITEMS OF 3 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 35719096.00 DATE ISSUED.......: 05/19/2011 RECEIPT #.........: BS000013496 REFERENCE ID # ...: 11050149 SITE ADDRESS .....: 10380 IMPERIAL AVE SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ...... OPERATOR: patg COPY # : 1 OWNER ............: NARAYAN VENKATARAMANI& RAMAN ADDRESS ..........: 10380 IMPERIAL AVE CITY/STATE/ZIP ...: CUPERTINO, CA 95014 RECEIVED FROM ....: M & S ROOFING CO CONTRACTOR .......: MIRSAD KRAJWIC LIC # 28360 COMPANY ..........: M & S ROOFING CO. ADDRESS ..........: 208 COPCO LN CITY/STATE/ZIP ...: SAN JOSE, CA 95123 TELEPHONE ........: (408)314-0870 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL ---------- ----------------------- 1BCBSC VALUATION ---------- 15,800.00 ---------- 1.00 ---------- 0.00 ---------- 1.00 0.00 1BSEISMICR VALUATION 15,800.00 1.58 0.00 1.58 0.00 1REROOFRES SQ FEET 32.00 416.00 0.00 416.00 0.00 TOTAL PERMIT ---------- 418.58 ---------- 0.00 ---------- 418.58 ---------- 0.00 METHOD OF PAYMENT ----------------- CHECK TOTAL RECEIPT : AMOUNT --------------- 418.58 --------------- 418.58 VOICE ID DESCRIPTION -------- ---------------------------- 309 EXTERIOR LATH 601 ROOF TEAR OFF REFERENCE NUMBER -------------------- #2646 VOICE ID DESCRIPTION -------- ---------------------------- 311 SCRATCH COAT 602 ROOF PLYWOOD NAIL 604 ROOF IN -PROGRESS 605 FINAL REROOF -- CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION FEE ID ROOF AREA s.L 1 REROOFFRES 3,200 [vv[ C: [ nese tees are basea on the Preuminary information available ana are onlv an estimate. Contact the Dent for aa!an 7 into. FEE ITEMS (Fee Resolution 09-05I J 7.-"10) FEE QTY/FEE MISC ITEMS Permit Fee: $416.00 Work Without Permit? 0 Yes E) No $0.00 Strom Motion Fee: IBSEISMICR $1.58 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $418.58 $0.00 TOTAL FEE: $418.58 Revised: 04/29/2011 ADDRESS: 10380 imperial avenue. DATE: 05/19/2011 REVIEWED BY: bob s. APN: BP#: "VALUATION: 1$15,800 "PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re -roof PRIMARY SFD or Duplex USE: PENTAMATION 1SFDWLR00F PERMIT TYPE: WORK remove existing roof replace with comp shingles SCOPE FEE ID ROOF AREA s.L 1 REROOFFRES 3,200 [vv[ C: [ nese tees are basea on the Preuminary information available ana are onlv an estimate. Contact the Dent for aa!an 7 into. FEE ITEMS (Fee Resolution 09-05I J 7.-"10) FEE QTY/FEE MISC ITEMS Permit Fee: $416.00 Work Without Permit? 0 Yes E) No $0.00 Strom Motion Fee: IBSEISMICR $1.58 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $418.58 $0.00 TOTAL FEE: $418.58 Revised: 04/29/2011 CUPERTINO REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 - building ancupertino.org PROJECT ADDRESSj APN # � � �% / 096e�l OWNER E-MAIL i D p �✓� Z- C6"STATE, ZIl',� C,001 FAX = V APPLICANT NAME PHONE rG� �j 6 / E-MAIL STREET A2DDRESS 0 U � STATE, ZIP p FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME _ NSE ER LICENSE TYPE BUS. LIC. # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEERNAME LICENSE NUMBER BUS. LIC. # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF SFD or Duplex ❑ Multi -Family ROOF AREA: VALUATION: STRUCTURE: ❑ Commercial EXISTING ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER (SPECIFY) REMOVE /REPLACE YES IF NO, PLYWOOD W. ❑ PLYWD ❑ OSB PITCH ROOF ❑ NO # LAYERS: THICKNESS: ❑ 5/8" TYPE: ❑ CDX ' 12 CLASS: A PROPOSED ROOF TYPE: ❑ BUILT-UP ROOF ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER ICC -ES REPORT # DESCRIPTION OF WORK: 16 - 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 building c nstruction. I authorize representatives of Cupertino tc enter the above- identified prope:T for inspection purposes. Signature of Applicant/AgentDate: S , t SUPPLEMENTAL INFORMATION REQUIRED.' MORMONISM = 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. }'jam—- ��Y, _ V T Provide copy of Manufacturer's Installation Specifications. Policy. Provide signed copy of Cupertino's Tear -Off ReroofApp_2011.doc revised 03/02/11 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 - buildingi�i)cupertino.org PROJECT ADDRESS �t # OWNER NAME PHONE E-MAIL STREET ADDRESS I- CITY, STATE, ZIP FAX CONTRACTOR NAMELISE NUMBE , (( �� LICENSE TYPE �' f5 BUS. LIC. # COMPANY NAME 7 f.0 �r K E-MAIL FAX STREE�ADDRESS ^ �D C?� CITY, STATE,ZIP; ' Z PHONE 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. 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. Progress 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 I/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 detectors are required to be installed in accordance with Sections R314 and R315 of the 2010 California Residential Code. Signature of Applicant/Agent: Date: ReroofPolicy_2011.doc revised 02/16/11 :UPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: PERMIT # OWNER'S NAME: A PHONE # GENERAL CONTRACTOR: BUSINESS LICENSE # ADDRESS: Z 4cp Z--e� CITY/ZIPCODE: S ? .f/? -? *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 SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: Owner / Contractor Signature '-! f -// 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 '-! f -// Date