10090266 CITY OF CUPERTINO BUILDING PERMIT
BUILDINVi ADDRESS: 10489 RAMPART AVE CONTRACTOR:SIMON SAYS ROOFING PERMIT NO: 10090266
OWNER'S NAME: SANDEEP PANDYA 3012 BECKLEY DR DATE ISSUED:09/29/2010
NNER'S PHONE: 4085691080 SAN JOSE,CA 95135 PHONE NO:(408)531-9700
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
License Class Lic.# RE-ROOF TEAR OFF WOOD SHAKES,INSTALL 30YR FELT
' a—2 0 PAPER CLASS A 23 SQUARES
Contractor l' 6AJDate
I hereby affirm that I a 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:$7800
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 APN Number:36926041.00 Occupancy Type:
permit is issued.
t_
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 relating 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 Issued by: Date: LG
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.
RE-ROOFS:
Signature k�_,s ✓� Date — 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: e4� Date:
I hereby affirm that I am exempt from the Contractor's License Law for one or
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I,as owner of the property,or my employees with wages as their sole compensatior,,
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code)
1,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 Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
1 have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which thisOwner or authorized agent: ti C)u Date: Z5-1-2-0
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 CONSTRUCTION LENDING AGENCY
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 mu,:t 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 relatir g
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION
nnify and keep harmless the City of Cupertino against liabilities,judgments,
s,and expenses which may accrue against said City inconsequence 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
3 ITEMS OF 3 PERMI" RECEIPT OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN 36 )26041. 00
DATE ISSUED. . . . . . . : 09 /29/2010
RECEIPT # . . . . . • . . . : BS)00011592
REFERENCE ID # . . . : 10)90266
SITE ADDRESS 10489 RAMPART AVE
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : SANDEEP PANDYA
ADDRESS 10489 RAMPART AVE
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-4524
RECEIVED FROM SIMON SAYS ROOFING
CONTRACTOR DA.RRYL SIMON LIC # 23053
COMPANY SIMON SAYS ROOFING
ADDRESS 3012 BECKLEY DR
CITY/STATE/ZIP . . . : SAN JOSE, CA 95135
TELEPHONE (408) 531-9700
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- -------------
---------- - --------- -------
1BCBSC VALUATION 7, 800 .00 1.00 0 .00 1 . 00 0 .00
1BSEISMICR VALUATION 7, 800 .00 0 . 80 0 . 00 0 . 80 0 . 00
1REROOFRES SQ FEET 23 . 00 299. 00 0 . 00 299. 00 ------0_00
- --------- ---------- ----------
TOTAL PERMIT 300 . 80 0 .00 300 . 80 0 .00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- -----------
CHECK 300. 80 1250
---------------
TOTAL RECEIPT 300 .80
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-
-------- ----------------------------
------- --------------------------- -
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
CITY OF CUPERTINO
FEE ESTIMATOR--BUILDING DIVISION
ADDRESS: I DATE: REVIEWED BY:
APN: I BP#: `VALUATION: 1$7,800
*PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY y 0,111, PENTAMATION 1 SFDWLROOF
USE: SFD or Duplex L I C�r7JZI rt� PERMIT TYPE:
WORK
SCOPE
FEE ID ROOFAREA
;..f.
1REROOFFRES 2,300
1./,-- P'w 04V4
F
lon b. Pc.wlil 1 cc�
Oiher 11 c,il. h)"r- 01)c°r Pr nb lnc,, Imp
th-t I1��7% 1`"e' Phxuh, h,q), Fc,,; Llc( Inv) 1 co.
NOTE: Theseees are based on the preliminary into rmation available and are only an estimate. Contact the De t or addn'1 info,
FEE ITEMS 09-051 Elf 74,10) FEE QTY/FEE MISC ITEMS
Plum Chcc A, Fcc:
.Bill/. PC Fee
f lrrlFzt�.:.�lcr/�.:'T�Iec Plali C hc(:A:
Permit Fee: $293.00
slfpp/1 hr y FCc
Y/trrrlh.i.11 c�It.-`Ivlcc
UM"FCC,
1'1trtlrtl.%.11<�c'1t. Tilccf's�rotill'c'c�;
F-1
C`Onsir tw[ion 7X,,:1
1(:ou lic':11 Rci-i"13,'FCC"
Work Without Permit? 0 Yes E) No $0.00
I'lrrrurftr�> f��crc'�`.
17�urc>t L)oc�rrlrrc�r7lulirltr pots.
Strom?Motion Fee: IBSEISMICR $0.78 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
SUBTOTALS: $300.78 $0.00 TOTAL FEET. $300.78
Revised: 9/29/2010
M.Indoor Air Quality and Finishes
1.Use LowMo-VOC Paint 1 IAQ/Health pts y=yes 0
2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y--yes 0
3.Use Low/No VOC Adhesives 3 IAQ/Health pts y--yes 0
4.Use Salvaged Materials for Interior Finishes 3 Resource pts y--yes 0
5.Use Engineered Sheet Goods with no added Urea
Formaldehyde 61AQ/Health pts y=yes 0
6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 0
7.Seal all Exposed f'artioleboard or MDF 4 IAQ/HealtN pts y=yes 0
B.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes 0
9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y=yes 0
10.Install Whole House Vacuum System 3 IAQ/Health pts y--yes 0
N.Flooring
1.Select FSC Certified Wood Flooring 8 Resource pts y=yes 0
2.Use Rapidly Renewable Flooring Materials 4 Resource pts y=yes 0
3.Use Recycled Content Ceramic Tiles 4 Resource pts y=yes 0
4.Install Natural Linoleum in Place of Vinyl 5 IAQ/Health pts y=yes 0
5.Use Exposed Concrete as Finished Floor 4 Resource pts y=yes 0
6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes 0
Total Points Available: I 140L 130 57
Total Points Project Received: I ot 0 0
G:data/pmgs/t reenbuildingguidelines/remodelers/greenp6intsfinal212.04protected.xis
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPAWMENT•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• )uilding(d)cupertino.org
PROJECT ADDRESS APN#
OWNER NAME t PHO JE E-MAIL
IL
STREET ADDRESS Si ATE,ZIP FAX
CONTRACTOR NAME L
LICENSE TYPE BUS.LIC.#
Y_ 1 rop
COMPANY NAME _
E-MAIL FAX
L� �u 5 b �` vt�C
CITY,ST NTE,ZIP PHONE
STREET ADDRESS
I UNDERSTAND AND AGREE TO THE FOLLOWING:
1. The re-roof project shall comply with all appliczble 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)"77-3228 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 z nd 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 obtaincd from the building in
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 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 n riling 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 understa and agree to comply with the re-roof policy bated above. ^ /
Signature of Applicant/Agent: ;Q/1 Date:
RerooJPo1icy_2010.doc revised 05/17/10
CITY OF
CITY OF (:UPERTINO
9i REROOF
CUPERTINO PERMIT APPLICATION
APN# Date:
041 2 ;
Building Address:
i ✓� ye �(/ L
Owner's Name: i }done #:
HOA: Yes ❑ No �Ifyes, provide letter from HOA
Contractor: Phone #:
�C
i,)-i F7 f (!�-�� �' - Fax#:
Cupertino Business Lice se #: Contractor License #:
Type of R)of Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ sphalt Shingles
❑ Wood Shakes ,6 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: �.�14-r o e6
Residential - Commercial
Green Building: Please complete relevant portion of the Confirmed_i4ith_Planning Dept. if
Green Building Checklist & attach it to the application or if there are any restrictions: ❑
applicable, include in plan set & the sheet index.
Valuation: d
I Have Read, Understand and Will Comply with ,'-upertino's Tear-Off Policy:
1
Signature
Revised 02/05/09