13040112 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10425 IMPERIAL AVE CONTRACTOR:M&S ROOFING CO. PERMIT NO:13040112
OWNER'S NAME:.CHEXAL V K AND MANJU 208 COPCO LN DATE ISSUED:04/15/2013
OWNER'S PHONE: 4087181957 SAN JOSE,CA 95123 PHONE NO:(408)314-087.0
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIALS
License Class Lic..# RE-ROOF 33 SQ,REMOVE SHAKE ROOF INSTALL OSB
e 50YR
Contractor 6& Date COMP,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:$1800
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:35719101.00 Occupancy Type:
permit is issued.
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 IPO DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property.forinspection:purposes. (We)agree to save 180 DA OM LAST CALLED INSPECT 0,
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 source regulations per the Cupertino Municipal Code,Section 117
9.18.
RE-ROOFS:
SignatureDate. 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.thaf.I.am exempt from the Contractor's License Law for one of
the following two reasons: ALL ROOF COVERING 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 isnot 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 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
I 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 theerformance of the work for which this < E Date:) 13
p Owner or authorized agent:
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 CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must 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 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 ARCHITECT'S DECLARATION
indemnify 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
REROOF PERMIT APPLICATION rJ/
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10.300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(40.8)777 •FAX(408)777-3333•buildin WD-cupertino.ora
CUPERTINO
PROJECT ADDRESS ! i 7NAL_
# 1
OWNERNAME ny� PHONE / E-MAIL
`
11�r LA L! At
STREET ADDRESS CITY,STATE,ZIP FAX
CONTACT.NAME PHO
STREET ADDRESS CITY,STATE,ZIP
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❑OWNER ❑ OWNER BUILDER ❑OWNER AGENT ACONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAMEF t LICENSE NUMBETt�C LICENSE�YP BUS.LIC.#
IU �f G+
COMPANY NAME E-MAIL FAX ` . `
STREET ADDRESS20R epr ,Y J>rCITY,STATE,ZII'� ^� PHO n' ^
ARCHITECT/ENGIN EER NAME LICENSE NUMBER BUS.LIC.#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑ SFD or Duple$ Mlllti-Family ROOF AREA 2 VALUATION: `
STRUCTURE: . ❑ Commercial {p�� 3 "� w�
EXISTING ROOF.TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES $WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY)
REMOVE/REPLACE; 9YES IFNO, PLYWOOD ❑ /a" ❑ PLYWD ❑OSB PITCH: FFS7�NO #LA THICKNESS: 115/8" TYPE: 11 CDX 12
ICC-ES REPORT#
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑!OTHER
DESCRIPTION OF WORK \
�..
<__0 If oe
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 nstruction. 1tauthorize representatives of Cupertino to enter the above-identified property for inspection purposes..,
Signature of Applicant/Agent: C==hX Date: L
SUPPLEMENTAL INFORMATICP 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.
Provide signed copy of Cupertino's Tear-Off Policy. "
ReroofApp_2011.doc revised 03/16/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 10425 Imperial Ave DATE: 04/15/2013 REVIEWED BY: mendez
APN: BP#: *VALUATION: 1$18,000
*PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY PENTAMATION
USE: SFD or Duplex PERMIT TYPE: 1 SFDWLROO i
WORK re-roof 33 sq, remove shake roof install osb 50 r comp, class a
SCOPE
FEE ID ROOF AREA
s.f.
1REROOFFRES 3,300
.a
.Tech.Plan Check Plumb.Plan Check Elec.Plan Check
tilech.Permit Pee: Plumb.Permit T c:e: Elec.Permit Fee:
LI,",h.
.tlech.Insp. Other Plumb Insp. Other Elec.Insp.
Insp.Fee: Plumb. Insp.Fee: Elec.Insp.Fee:
NOTE:This estimate does not include fees due to other Departments(Le,Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). These ees are based on the preffinWdna information available and are only an estimate. Contact the Dept for addn'1 info,
FEE ITEMS (Fee Resolution 11-053 Ef.. 711112) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Suppl. PC Fee
Pl uin b.i1l1lech./Elee
Permit Fee: $495.00
Suppl. Insp Fee
Plumb.lMech:/Elec
Plumb,lyVech.%Elec Permit`F'ee:
Construction Tczx:
Administrative Fee:
Work Without Permit? 0 Yes E) No $0.00
Advanced Planning Fees.-
Travel
ees:Travel Documentation Fees:
Strong;Motion.Fee: IBSEISMICR $1.80 Select an Administrative Item
Bldg-Stds Commission Fee: IBCBSC $1.00
$497.80 $0.00 $497.80
Revised: 04/01/2013
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•building aacupertino.org
PROJECT ADDRESS APN#
owNERNAME PHONE46f /\ E-MAIL
STREET ADDRESS CITY,STATE,ZIP 6 FAX
CONTRACTORNAMEt LICENSENUMBE LICENSEM BUS.LIC.#
z
COMPANY NAME t_ /� E-Mp II FAX
un
STREET ADDRES M J CITY,STATE,ZIP/I PHONE
I UNDERSTAND AND AGREE TO HE FOLLOWING:
1. The re-roof project shall comply with all applicable provisions of the 2010 California Codes.
2. An inspection request can be scheduled up to one business day before the requested inspection date.
Please call (408) 777-3228 from 7:30-3:30pm(Mon-Thurs) or 7:30-2:30pm(Friday)to schedule
inspection. For Tear-Off and Nailing Inspections,you must also call on the day of the inspection only.
after that phase of the work is completed. The building inspector will be available within one hour.
Final Inspections will be given a two hour window.
3. 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.
4. If plywood is installed, a plywood Nailing Inspection is required.
5. Roofing.shall not be applied without first obtaining all prior 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.
6. 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,vents painted, gutter/downspouts installed, debris removed.'
.7. 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. 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_2012.doc revised 10/7/12