12030055I CrrY Or CUPERTINO BUILDING PER,iMIT I
RDaDnG Auultr-SS: 10417 ANSONt AVE
OwNElt'S NAaD;: ANIU13AN K CIIANCNAL SAIIA1
CoSrR,\Cfolt: RP—"''Q filaI mrIcNIl'f No: 12030055
i t'T_T 'MII
_'rED
DATE ISSu171):03/12/2012
owNrat'S PuoNE: 4082688512 I'11O,CE NO:
❑ LICENSP:D CO.N'I'It:\CI'Olt'S DICCL,\IL\'PION
License Class 6_311 I.ic. B 929 Aff!y
Y
Contractor A RmC Ma.gecy scnc 3-(2-ZO/7
I hereby itflorin I[,:II I :un licensed under the prorisiuns of Chapter 9
(cum nnencing with Section 7000) of Division 3 ill* the Itusiness & Professions
Code:md that my license is in till] leave and effect.
I herrby al'linn under penalty of perjury otic of the lullowing nvu declarations
I have and will maintain a certificate of consent to self -insure Ibr Worker's
Compensation, as provided Ibr by Section 3700 of the Labor Code, for the
perform, ice of the work for which this permit is issued.
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 fir which this
permit is issued.
A ITIACANI' CERTI FICATIO.N
I certify that I have read this application and state thin the above inf'onnztiot is
correct. I agrcc 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. (slVe) agrcc to save
indenmify 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
with all non -paint source regulations per the Cupertino Municipal Code. Section
9.18.
Signature_ //ate` IJ:uc 3-/2"2a/Z
❑ O\\:CIi14Ml LDIiR DECL,\It:\1'IoN
I hereby affirm Thal I :tat c\crnpl from the Contractor's License L:nv for one of
the following Iwo reasons:
L as owns of the property, or in) employees with wages as their sole compensation,
will do the work, and Life structure is not intended or oll'eed for sale (S:c.7044,
Business & professions. Code)
L as owner of the property, lin exclusively contracting with licensed contractors 10
construct the project (Sec.7044, lousiness & Professions Code).
here[))affirm under penalty of perjury uric of lire falluo'ing three
declarations:
I have and will maintain a Certificate of Consent to self -insure for Worker's
Compensation, as provided Ibr by Section 3700 of the Labor Code, fur file
performance of the work for which this pcnnit is issued.
I have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, lir the performance III the srork for which this
pcnnit is issued.
I certify that in the performance of the work, for \yhich this permit is issued. I shall
not employ any person in any manner so as Io become subject to the Worker's
Compensation Lases ofCalil2unia, u; -alter making this certificate of esemplion. I
become subject to the Worker's Compensation provisions of the Labor Code. I must
Imiliovith comply with such provisions or this permit shall be deemed revoked.
,U'1'LICAN"1' CERTIFICA'f ION
I certify that I have read (his application and stat: thin the above inlr oration is
correct. I agree to comply with all city and county ordinances ad state laws relating
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property Ibr inspection purposes. (We) agree to save
indemnity 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
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Date
r r r
BUILDING PERMIT INFO: ut.DC ELECT PLUMB
r r r
31 Ecu RESIDENTIAL COMMERCIAL
3011 DESCRIPHON: Rli-ROOF 10 SQ- REMOVE EXISTING WOOD
SIIINGI.ES•INSTALL CONI' IN IM PORTION OP SFDWL
Sq. FI Flour Arca: I Valuation: $3250
APS Smaller: 32641001.00 1 occupaflcy TN pv:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF 13ERNIH ISSUANCE OR
180 DAYS FROi\1 LAST CALLED INSPECTION.
Issued by Date
ItE ROOFS:
All fours shrill be inspected prior to ally roofing material being installed. If a roof is
installed without lint ubtainit :m inspection. I.agrce to remove :dl new materials Ibr
inspection. 7
Signature of Applicant:_ _1111//_1 Date: 3 -/ L - ZOl -
A 1,1. HOOP CON, lilt(SGS'I'O hr CLASS "A" Olt It ICI"That
I IAZA LDOOS ,NIA'I' RIA :S DISCLOSURE.
I hns'c rend the tolZarduus materials requirements under Chapter 6.95 ofthe
Califurnin Ileal(h & Safely Code. Sections 25505. 25533. and 25534. 1 will
maimnin comfit i;uree with the Cupertino Municipal Code. Chapter 9.12 and the
I Iculth & S:fets' Cody. Section 25532(:) should I .dors ur handle hazardous
material. Additionally, should I use equipment or devices which calif hazardous
air nmtnntinants as defined by the Bay Arca Air Quality ?Innage mem District I
will maintain compliance frith the Cupertino Niullicipal Code. Chapter 9.12 and
the Health & Sall•IY Code, Sections?5505.25533, and' -5534.
(honer or au l horized loge til: D:ne:_3=f?-.;
CONSTIMCl'ION LESDISG AGENCI'
I hereby al7inn that there is a construction leading agency for the pertinmance of
work's Lir which this permit is issued (Sec. 3097. Civ C.)
Lender's Same
Lender's
ARClll'I'ECI" S DI,CI.ARA'I'1OS
I understand my plans shall be used ars public records.
Licensed
4 ITEMS OF 4
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 32641001.00
DATE ISSUED.......: 03/12/2012
RECEIPT 4.........: BS000016248
REFERENCE ID 4 ...: 12030055
SITE ADDRESS .....: 10417 ANSON AVE
SUBDIVISION ......:
CITY .............: CUPERTINO
IMPACT AREA .......
OWNER ............: ANUPAN & CHANCHAL SAHAI
ADDRESS ..........: 10417 ANSON AVE
CITY/STATE/ZIP ...: CUPERTINO, CA 95014
OPERATOR: SylviaM
COPY 4 : 1
RECEIVED FROM ....: A-1 ROOF MANAGEMENT
CONTRACTOR .......: TBD - TO BE DETERMINED LIC "1 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
----
3,250.00
----------
1.00
----------
0.00
--- -
1.00
0.00
1BSEISMICR
VALUATION
3,250.00
0.50
0.00
0.50
0.00
1BUSLIC
FLAT RATE
1.00
119.00
0.00
119.00
0.00
1REROOFRES
SQ FEET
10.00
140.00
0.00
140.00
0.00
TOTAL PERMIT
----------
260.50
----------
0.00
----------
260.50
----------
0.00
METHOD OF PAYMENT
-----------------
CHECK
TOTAL RECEIPT
AMOUNT
---------------
260.50
---------------
260.50
VOICE ID DESCRIPTION
-------- ----------------------------
309 EXTERIOR LATH
601 ROOF TEAR OFF
604 ROOF IN -PROGRESS
3
REFERENCE NUMBER
--------------------
12980
VOICE ID DESCRIPTION
-------- ----------------------------
311 SCRATCH COAT
602 ROOF PLYWOOD NAIL
605 FINAL REROOF
CUPERTINO
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
(408) 777-3228 • FAX (408) 777-3333 • buildino(dcupertino.org
PROTECT ORESS
APN p
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O WNEAt NAME
- PHONE
E-MAIL
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STREET ADDRESS
CITY. STATE. ZIP
FAX
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CONTRACfORNAME
LICENSE NUMB R
LICENSE TYPE
BUS. LIC.#
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E-MAIL
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CITY. STATE. ZIP
PHONE
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I UNDERSTAND AND AGREE TO THE FOLLOWING:
The re -roof project shall comply with all applicable provisions of the 2010 California Codes.
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.
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.
If plywood is installed, a plywood Nailing Inspection is required.
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.
Progress Inspection is required when approximately 50% of roof covering is installed.
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.
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 S 126.00. The re -inspection fee shall be paid before another inspection
can be scheduled.
By my signing below, 1 certify each of the following is true: 1 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. 1 also understand that
smoke detectors and carbon monoxide de)ectors are required to be installed in accordance with Sections R314 and R315 of
the 2010 California Residential Codi. .,
of
Date:
ReroofPolicv_201 Ldoc revised 02/16/11
CUPERTINO
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildingcuoetno.orc
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OWNER NAME PHONE
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❑ OW:JEA ❑ OWNER -BUR -DEA ❑ 0WI AGENT ❑ CON, CTOR Li20NiRwCTD0. AGENT ❑ ARCIo=, ❑ ENGNEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR LICENSE NUMB
I LICENSETYPE I
BUS. LICA
IAME A a«d
COMPANY NAME
E -MAB.
FAX
STREET ADDRESS I
CIPl, SCAT$ZIP
PHONE
S/O-';. 7�/`S-Cj2Z
ARCHTTECTIENGINEETI NAME LICENSENUMBER
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BUS. LICA
CO.VPANY NAME E -MAB.
FAX
STREET ADDRESS CITY, STATE, ZIP
PHONE
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USE OF FrSf5 or Duplex ❑ Multi -Family ROOF AREA:
VALUATION:
STRUCIUItE: ❑ Commercial 1Qd0
EXISTING ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES ❑ WDOD SHAKES
❑ WOOD SHNM -c ❑ OTHER (SPEC4n
REMOVEIREPLACE
IF NO. OkA -
PLYWOOD PTsr'" ❑
PLYWO OSB
P=tR
�:
ROOF
❑
ALA
S' ❑ LS"
E' ❑ X
12
A
PROPOSED ROOF TYPE: ❑ BMT -UP ROOF ASPHALT SHINGLES ❑ WOOD SHAKES
❑ WOOD SH.NGLFS ❑ OTHER I
ICC -ES REPORT A
DESCIUPTfON OF WORK:
Ecr rtj
S A,
By my siguaue below, I certify m each of the following: I am the property owner or authorind agent m act on the property owner's behalf. I have read this
application and the infomration 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 sate laws relatut m t ing wnsmrrien. I authoriu_represenarlves of Cupertino to enter the above -identified prr em for inspection purposes.
Signature of Applicant/Agenu r v�
Data:—
SUPPLEMENTAL INFORMATION REQUIRED
Ifbuilding is associated With a Home Owner's Association, provide letter
t'TyAgl - -a..RGutTNe;s
_
of approval from HOA.
_
W ���ti1IDI.CO•Rbw.l.RfiVIE.W
_ Provide Planning approval to verity if there My reStrictions.
WIN
s'�- - ss_ -" I;R- rt y�-fEw,
Provide copy ofMaDufactt>:er's Installarion Specifications.
s8'3sT'w��
�Tovide
signed copy of Cupertino's Tear -Off Policy.
ReroofApp_201 I.doc revised 03/02111