11030101 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 11455 CHARSAN LN CONTRACTOR:MARCO ROOFING PERMIT NO: 11030101
OWNER'S NAME: SATHYANARAYAN MANDLI AND KRIPA P O BOX 1691 DATE ISSUED:03/22/2011
O`-'VER'S PHONE: 4089739726 FREMONT,CA 94538 PHONE NO:(510)656-6400
I LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT f— PLUMB
License Class C 'S / Lic.# t402-'W
3 MECH RESIDENTIAL� COMMERCIAL r
Contractor.�4izco ��C Date ZZ 1 )
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:RE-ROOF TEAR OFF EXISTING SHAKE.INSTALL COMP
(commencing with Section 7000)of Division 3 of the Business&Professions SHINGLES,CLASS A,33SQUARES
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.
I have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Valuation:$10000
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
APN Number:36210050.00 Occupancy Type:
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 PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION.
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. Issued hr. Date: Z Z�
Signature Date 3 �"
f
O ER-BUILDER DECLARATION RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed.If a roof is
I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for
the following two reasons: inspection.
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, Signature of Applicant: Date: /ZZ/
Business&Professions Code) i
1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I hereby affirm under penalty of perjury one of the following three
declarations` HAZARDOUS MATERIALS DISCLOSURE
I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the
Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
1 have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material.
Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air
permit is issued. 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
I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534.
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 fl
wner or au d agent: 2
111
become subject to the Worker's Compensation provisions of the Labor Code,I must Date: Z
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION ereby affirm that there is a construction lending agency for the performance of"wrk's
I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.)
correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
and expenses which may accrue against said City in consequence of the
mg of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
�.... all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records.
9.18.
Licensed Professional
Signature Date
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36210050 . 00
DATE ISSUED. . . . . . . : 03/22/2011
RECEIPT #. . . . . . . . . : BS000012955
REFERENCE ID # . . . : 11030101
SITE ADDRESS . . . . . : 11455 CHARSAN LN
SUBDIVISION . . . . . . :
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : SATHYANARAYAN MANDLI AND KRIPA
ADDRESS . . . . . . . . . . : 11455 CHARSAN LN
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-4981
RECEIVED FROM . . . . : JEFF RAINEY
CONTRACTOR . . . . . . . : CREEDEN, MIKE LIC # 21317
COMPANY . . . . . . . . . . : MARCO ROOFING
ADDRESS . . . . . . . . . . : P O BOX 1691
CITY/STATE/ZIP . . . : FREMONT, CA 94538
TELEPHONE . . . . . . . . : (510) 656-6400
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 10, 000.00 1. 00 0. 00 1 .00 0. 00
1BSEISMICR VALUATION 10, 000. 00 1. 00 0. 00 1 .00 0. 00
1REROOFRES SQ FEET 33 . 00 429. 00 0. 00 429 .00 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 431. 00 0. 00 431. 00 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 431. 00 VISA
---------------
TOTAL RECEIPT 431. 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
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 11455 charsan lane DATE: 03/22/2011 REVIEWED BY: bobs.
APN: BP#: 'VALUATION: j$10,000
y'PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Duplex PENTAMATION 1SFDWLROOF
USE: PERMIT TYPE:
WORK tear off existing shake install comp shingles class A.
SCOPE
FEE ID ROOF AREA
s.f.
1REROOFFRES 3,300
F7
NOTE: Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addn'1 info,
FEE ITEMS (]r'ee.Resolution 09-051 Efff 711,"10) FEE QTY/FEE MISC ITEMS
Permit Fee: $429.00
Work Without Permit? Q Yes (D No $0.00
Stroniz Motion Fee: IBSEISMICR $1.00 Select an Administrative Item
Bldg, Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $431.00 $0.00 TOTAL FEE: 1 $431.00
Revised: 01/15/2011
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-buildinaacupertino.org
PROJECT ADDRESS 'I 4 r ?,- A J Z—A +C_ 7PN#
OWNER NAME '5 401 A �� e 1A� PHONE E-MAIL
STREET ADDRESS /II�� /�T'�� CIZ�STATE,?dPCA 5O / FAX
CONTRACTOR NAME ,�/�� /J I LICENSEE NUMBER LICENSE TYPE BUS LIC #
COMPANY NAME MA 2C�% 1`�`� (� � .•1J1J E-MAIL , pp
C/�/`C' �to 4S6 .30 1
STREET ADDRESS 3X '/b 1' CITY,STATE,ZIP PHONE
//ll eA O d 7 CA 3,4 5 3 -65,6 ` ,f tv
I UNDERSTAND AND AGREE TO THE FOLLOWING:
1. The re-roof project shall comply with all applicable provisions of the 2007 California Building Code.
2. You must schedule all needed inspections a minimum of one day before the requested inspection date.
Please schedule inspections online or call (408)777-3228 between 7:30-3:30 (Mon-Fri).
3. Tear-off roof inspection is required. Please call for tear-off inspection after the roof is torn off and all
the nails/fasteners have been removed. Any and all dry-rotted wood shall be replaced prior to this
inspection. A building inspector will be available within one hour.
There are special hours for this service: 7:30 — 10:30am and 1:00—3:30pm(Mon—Thurs);
7:30 — 10:30am and 1:00—2:30pm(Friday).
4. If plywood is installed, a plywood nailing inspection is required.
5. In-Progress roof inspection is required. Call for an in-progress roof inspection to verify building is
weather tight after installation of approximately 25% of the roofing material.
6. New roof coverings shall not be applied without first obtaining all inspections 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.
7. A final inspection and approval shall be obtained from the building inspector when the re-roofing is
complete. 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 must 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.
8. 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 un d agree to comply with the re-roof policy stated above.
Signature of Applicant/Agent: Date: 2 Z I
RerooJPolicy_2010.doc revised 05/17/10
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
C O P E RT I N O Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: tI `f 5 5 �� 2 Si4,.7 L.J PERMIT# g�? G
OWNER'S NAME: 5A- H ' AJ Z A) PHONE# LfOr 7 9 7L6
GENERAL CONTRACTOR: f4AZ c ,� BUSINESS LICENSE#
ADDRESS: PO &X 169/ CITY/ZIPCODE: ' -wto,J? 9`FS 3
*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:
Signa Date
Please check applicable subcontractors and comple a the following information:
V 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/Cont or Signature Date