10090019 CITY OF CUPERT'INO BUILDING PERMIT
BUILDING ADDRESS: 922 BROOKGROVE LN CONTRACTOR^ Tn 1F PERMIT NO: 10090019
E
$�tIiNED
VNER'S NAME: KAVITA MAHTANEY DATE ISSUED:09/03/2010
OWNER'S PHONE: 4083662003 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
License Class C ' 3� Li,.# � RE-ROOF 30 SQ REMOVE TAR AND GRAVEL AND
INSTALL
Contractor /�o�T�t; �JsPs1iP ° MINERAL CAP CLASS A
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:
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:$13450
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 is APN Number:37539035.00 Occupancy Type:
permit is issued.
C/ .
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relati ig WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION.
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 Issued by: Date:
with all non-point sour regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
nature Date T-0 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.
❑ OWNER-BUILDER DECLARATION
Signature of Applicant: Date: /
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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 HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. I will
I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Are Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the Cuper` o Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 5,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this c. d
permit is issued. Owner or authorized agent: Date: 01
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 CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I mi ist I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lender's Address
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 relati ig
*^building construction,and hereby authorize representatives of this city to enter
n the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION
...,iemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
CITY OF' CUPERTINO
4 ITEMS OF 4 PERM=:T RECEIPT OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: B=.k: Lot:
APN . . . . . . . . : 3"539035. 00
DATE ISSUED. . . . . . . : 09/03/2010
RECEIPT # . . . . . . . . . : B:;000011376
REFERENCE ID # . . . : 10090019
SITE ADDRESS . . . . . : 922 BROOKGROVE LN
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : KlXITA MAHTANEY
ADDRESS . . . . . . . . . . : 9::2 BROOKGROVE LN
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-4668
RECEIVED FROM . . . . : ROOFING RESPONSIBLY
CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096
COMPANY . . . . . . . . . . : TBD - TO BE DETERMINED
ADDRESS . . . . . . . . . .
CITY/STATE/ZIP . . . : ,
TELEPHONE . . . . . . . . :
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- - --------- ---------- ---------- ----------
1BCBSC VALUATION 13,450 . 00 1. 00 0 .00 1 . 00 0. 00
1BSEISMICR VALUATION 13, 450 . 00 1.40 0 .00 1 .40 0. 00
1BUSLIC FLAT RATE 1 . 00 114 . 00 0 .00 114 . 00 0. 00
1REROOFRES SQ FEET 30 . 00 390. 00 0 . 00 390 . 00 0. 00
- --------- ---------- ---------- ----------
TOTAL PERMIT 506 .40 0 . 00 506 .40 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 506 .40 986
---------------
TOTAL RECEIPT 506 .40
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
REROOF TEAR-OFF PC LICY
COMMUNITY DEVELOPMENT DEPAPTMENT•BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BLILDING OFFICIAL
CUPERTINO 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228• FAX(408)777-3333•building .cupertino.org
PROJECT ADDRESS 7APN
OWNER NAME t4 � _ PH(NE!/-�Q e4r 262Q� E-MAIL
STREET ADDRESS V '1 CITY, S ATE,,ZIPJ FAX
CONTRACTOR NAME/D�� �IJLICENSE NUMBER r/ / LICENSE TYPE/' jQ BUS.LIC.#
COMPANY NAME /( ,( r E-MAIL 1 L G J/ FAX
STREET ADDRESS /7T7 /t� )O� / CITY,S7 ATE,ZIP�i rp
xl
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 min mum of one day before the requested inspection date.
Please schedule inspections online or call (408),77-3228 between 7:30-3:30 (Mon-Fri).
3. Tear-off roof inspection is required. Please cz 11 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 availab e 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 inspf ction is required.
5. In-Progress roof inspection is required. Call or 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 follow ing items will be verified:
a. Flat roofs shall have a minimum of/4"per loot 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 I e-inspection fee shall be paid before another
inspection can be scheduled.
By my signing below, I certify each of the fo wing i� true: I am the property owner or authorized agent to act
on the property owner's behalf. I and d and agree., to comply with the re-roof policy astated above.
Signature of Applicant/Agent: Date: /— Tr
ReroofPolicy_2010.doc revised 05/17/10
CITY OI' CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: DATE: REVIEWED BY:
APN: BP#: *VALUATION: 1$13,450
PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Duplexlt�l"�l PENTAMATION 1SFDWLR00F
USE: f 1<X�i`l �E_ : PERMIT TYPE:
WORK
SCOPE
FEE ID ROOF AREA
's.f.
1REROOFFRES 3,000
a,k,, tb Phaj,t,I,!" '�ts;th. 7";,n{'l 1'7
�"lr Ir_ Pyr;rot°t�c�: Prrr•�h. Pi rrni.T�'e: titer- P�rrtii7 T�t��
L—i 0o, V, Li
)�`hrr;if"t rr iy�p C),l�,°r P t-r ,,Ir<`P
NOTE. Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addn'l info,
FEE ITEMS (Fee Resolution 09-051 Ef FEE QTY/FEE MISC ITEMS
Plan Clwc:k
szlppl. PC.'t'G '
Phanh.;'_11er -h.i'Flec flail Check:
Permit Fee: $390.00
5upp/. 111 p FCC,
P/t�lrzh.:'alc�c�l1""Elec t_'17rr
PhI/-tIh.;aIlc'cPermit V C.
C.'on.I71'11('tio17 7-�ff
;Icouslical Rovic'li;
Work Without Permit? 0 Yes E) No $0.00
1'f�:rrtrtitr,�>f'cat's:
1r<ivel1)ot'ltlJ't t.'ttltll7t)I'f 1'E.'f'.4.
Strona,Motion Fee: IBSEISMICR $1.35 0 # Revision
Bldg Stds Commission Fee: IBCBSC $1.00 $0.00 IREVSFDWL SFDWL
SUBTOTALS: $392.35 $0.00 TOTAL FEE: $392.35
Revised: 9/01/2010
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
CUPERTINO Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: p ,_e I aPERMIT#
OWNER'S NAME: V/ er 71 PHONE#
GENERAL CONTRACTOR d�,, wg stpd. 1',Qc �' BUSINESS LICENSE #
ADDRESS: LrL Liv L.� /Ja --j � CITY/ZIPCODE:
*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 SUBC kACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE. �2_'7`/ 0
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
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
wner/Contractor Signature Date
CITY OF
CITY OF CUPERTINO
REROOF
CUPERTINO PERMIT APPLICATION
APN# 3-15 3 -7 035 .6 O Date:
Building Address: �I /S3e60ir,2U✓C- 0V
Owner's Name: Phone #:
HOA: Yes ❑ No ❑'If yes, provide letter from HOA °� Z
Contractor: Phone #:
001;:51,✓ L Fax#:
Cupertino Business License #: Contractor License #:
Type of Roof Covering:
Existing: Proposed:
eY Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other (Specify) ❑ Other (Specify)
Number of existing coverings ❑ Provide I.C.C.E.S. Report #
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description: Awlo
Residential Commercial ❑
Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if
Green Building Checklist & attach it to the application or if there are any restrictions: ❑
applicable, include in plan set & the sheet ind ex.
Valuation: 1-7 J,�f
I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
Si a re
Revised 02/05/09