13040171 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10906 NORTHRIDGE SQ CONTRACTOR:FOUR.SEASONS PERMIT NO:13040171
ROOFING
OWNER'S NAME:"SUBACINI BALAKRISHNAN PO BOX 1668 DATE ISSUED:04/23/2013
OWNER'S PHONE: 4089963717 SAN JOSE,CA 95109 PHONE NO:(408)278-0330
16
❑ LICENSED CONTRACTOOR'S�,,/CLARATION DE JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
IJ
License Class —3 �Jy JLica:# � RE-ROOF 12 SQ-REMOVE EXISTING AND INSTALL NEW
GRAND SEQUOIA SHINGLE ROOF SYSTEM OVER
Contractor.tbodA,_)P, V\1 Date 4 -;;e :::-a EXISTING
I-hereby affirm that I am licensed un he provisions of Chapter 9 PLYWOOD DECK CLASS A
(commencing With Section 7000)'of Division 31 of the Business&Professions
Code and that my license is in full force and effect.
I hereby affirui 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:$5200
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:31636020.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the.above information isPERMIT XPIRES IF WORK IS NOT STARTED
correct;,I agree to comply with all cityand county ordinances and state laws relating WIT 80 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 D OM LAST CALLED INSP CTION.
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 b Date:
u
with all'no t sorce'regulatio er Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Sign r Dat All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed withoutgn,
an inspection,I agree to remove all new materials for
inspection.
❑ OWNER-BUILDER DECLARATION 4/1 12
3
Signature of AppDate: 4I hereby affirmthatI am exempt from the Contractor's License Law for one of
the following two reasons: ALL an
TO BE CLASS"A"OR BETTER
I,as owner of the property,or my employees with,wages as their sole compensation,
will do thei work,.and;the!structure:is,not intended or offered for sale(Sec.7044,
Business&s Professions Code)
I,asowner 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 upertino Muni ' al ode,Chapter 9.12 and
I have and will maintain YVorkey's,Compensation Insurance,as provided for by the Health&Safety Code,Sec' s 255 33
Section 3700 ofthe'Labor:Code for the performance of the work for which this Owner or authorized age ! Date
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 must I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with,such provisionior 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)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 anon-point source'regulations:per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
i
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION �
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10300 TORRE AVENUE-CUPERTINO,CA 95014-3255 R1�Iil/
CUPERTINO (408)777-3228•FAX(408)777-3333•buildinciftcuaertino.org 0
PROV ADDR APN# L;5) r p 3 / ZE)
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STREET ADDRESS `rrry,STAT$,ZIP FAX
CONTACT NAME PHONE E-MAIL
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❑OWNER ❑ Owmm-BUILDER ❑OWNERAma COMUICrOR. OCONTRACTORAGENT ❑ ARc=cr ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACT RNAMELICENSENUMBER
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COMPANY NAME E-MAIL -
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ARCHTTECT/ENGINEER NAME LICENSE NUMBER BUS.LIC.#
COMPANY NAME EMAIL 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 SHARES ❑WOOD SHINGLES #OTHER(SPECIFY)aWe.,C0W
s �
REMOVE/REPLACE91WO
ES WNO, PLYWOOD ❑_ PLYWD ❑OSB PITCH: ROOF
#LAYERS: 5/R" TYPE: CD t:12 CLASS: A
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ASPHALT SHINGLES ❑WOOD SHADS ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT#
DESCRIPTION OF WORK:
� �DI,'�l�/ Ciirtti+�� r'ae ..S Sew►- .�.�� �� iGt.�•�/ t,.
/ ��.c� �CGs�. �h.� lea a....-�.. ��.us.�e•--� ,,. Coe-•-
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 construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: ���s�vl Date
SUPPLEMENTAL INFORMATION REQUIRED �otcEsE-cru
If building is associated with a Home Owner's Association,provide letter " ?ctl�cxTVPs ROUIBVG"
of approval from HOA. '.Cl 'aR collnrrR, svunn�IGw
Provide Planning approval to verify if there any restrictions. 1 ❑ pymGpy,N ,
Provide copy of Manufacturer's Installation Specifications. jp 'sTArinnRn p r-FM
Provide signed copy of Cupertino s Tear-Off Policy. ❑ oTtt
ReroofApp 2011.doc revised 03/16111
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: DATE: 04/23/2013 REVIEWED BY: Mendez
APN: BP#: "VALUATION: 1$5,200
*PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY PENTAMATION
USE: SFD or Duplex PERMIT TYPE: 1SFDWLR00
woRK RE-ROOF 12 SQ- REMOVE EXISTING AND INSTALL NEW GRAND SEQUOIA SHINGLE ROOF
SCOPE SYSTEM OVER EXISTING PLYWOOD DECK CLASS A
FEE ID ROOF AREA
s.f.
1REROOFFRES 1,200
WE;Leech.Plan Check, Plwnbr Plan Check Elec.Plan Check
;L1e11.Permit Feet Plumb.Permit Fee: Elec. Permit Fee.:
t>ther,L9ech.Ins'p. Other Plumb Imp. 01herElec.Insp.
Rech:Insp.Fee: Plumb.hap.Fee: Glee,Insp.Fee:
NOTE:This estimate does not include fees due to other Departments(La Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.). Thesefees are based on the prellmina information available and are only an estimate. Contact the De t or addn'l info,
FEE ITEMS (Fee Resolution 11-053 E . 7/1/12) FEE QTY/FEE MISC ITEMS
Plan Cheek Fee:
.Suppl. PC Fee
Plumb.lAfech./Elec
Permit Fee: $180.00
.Suppl. Insp Fee..
Plumb.i lfech.lElec
Plumh.IiWech.,Elec Permit Fee.:
Conso-tiction::Tax:
A.dministrative.Fee:
Work Without Permit?' Yes
O:. ® No $0.00
Advanced Planning Fees
Travel Doeiunentation Fees: �
Strong Motion Feer 1BSEISMICR $0.52 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
$181.52 $0.00 , $181.52
Revised: 04/01/2013
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O.,BUILDING OFFICIAL
GUPERTINO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•buildincp -cupertino.org
PROJECT DDS S
APN#
P NE /�l 71 E-MAIL
STREET ADDRESS CITY,STATE,ZIP ` FAX
CON4CTOR NAM LICENSE NUMBER LIC" BUS.LIC.#
NY NA E-MAIL FAX
REF ITY,STAT IP PH N
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 can be scheduled up to 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.
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. Progress
and 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. Progress Inspection is required when approximately 50% of roof covering is installed.
7. 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/"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.
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 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.doe revised 02/16/11