13080003 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19726 WHEATON DR CONTRACTOR:RUFF'S ENTERPRISES PERMIT NO:13080003
OWNER'S NAME: SHANTANU PATWARDHAN 3643 EASTRIDGE DR DATE ISSUED:08/01/2013
OWNER'S PHONE: 4088292813 SAN JOSE,CA 95148 PHONE NO:(408)528-6227
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL El COMMERCIALE]
License Class C`3 5 Lic.# 7 7 70 (24 SQ'S)TEAR OFF(E)COMP OVER WOOD SHINGLES
AND
Contractor 1 y`�� S ✓rf Date a t" I •3 INSTALL OSB,30 LBS FELT,COMP ROOF SYSTEM
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:$11000
7 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:31628005.00 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 180 DAYS OF 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 DAYSYIWW, AST LED 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 / 3
granting of this permit. Additionally,the applicant understands and will comply lr ed b Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature Date _(3 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: 7w f 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
I,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. 1 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(x)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. c�
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: 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
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
0�
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION �v
10300 TOR RE AVENUE•CUPERTINO, CA 95014-3255 n^�
{408)777-3228•FAX(408)777-3333•buildinga-cupertino.org • '/
CupER'1''IN6.
PROJECT ADDRESS ' Ll D V n /) APN# �' 2 8 —v a-
PH 1� 17 � E-MA�J 193Zy 1-5
OWNER NAME S . a
OLA, CL+ W a Ct a, �L , L• vV
STREET ADDRESS �t w� CITY,STATE,ZIP FAX
5 -e
CONTACT NAMEe� PHONE o _
STREET ADDRESS CITY,STATE,ZIP FAX
❑OWNER ❑ OWNE^R-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME I J GJ ( LICENSE NUMBER LICE TYPE Q BUS.LIC.#
COMPANY NAME S \ Gt 1 `� r r s� � E MAII.I/J Gt S e l l FAX I I I
STREET ADDRESS oA CITY,ST/A�TE,ZIP �� 1 G PH g' 7
ARCHITECT/ENGINEERNAME LICENSE NUMBER BUS.LIC.#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF '1 SFD or Duplex ❑ Multi-Family ROOF AREA: It VALUATION:
STRUCTURE: - ❑ Commercial
EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES WOOD SHINGLES ❑OTHER(SPECIFY)
REMOVE/REPLACE' YES IFNO, PLYWOOD ❑ '/� ❑ PLYWD SB PTTCH: ROOF
❑NO #LAYERS: THICKNESS: ❑ 5/8" TYPE: ❑CDX :12 CLASS:
ICC-ES REPORT# .
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF �XSPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES O OTHER
DESCRIPTION OF WORK: I �
�e w,,v V� O (:Qlrt alter �ti
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 tob ing onstruction. authorize rep/rese tatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: 6F±j Date:
SUPPLEMENTAL INFORMATION REQUIREDIf building is associated with a Home Owner's Association,provide letter
of.approval from HOA.
Provide Planning approval to verify If there any restrictions. i
"ExrxEs r ,
Provide copy of.Manufacturer's Installation.Specifications.
Provide signed copy of Cupertino's Tear-Off Policy. a
ReroofApp_2011.doc revised 03/16/11
CITY OF CUPERTINO
itsFEE ESTIMATOR—BUILDING DIVISION
ADDRESS: -19726WHEATON DR DATE: 08/01/2013 REVIEWED BY: MELISSA
APN: BP#: *VALUATION: j$11,000
*PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Duplex PENTAMATION 1SFDWLROOF
USE: P PERMIT TYPE: i
WORK 24 SQ'S TEAR OFF E COMP OVER WOOD SHINGLES AND INSTALL N OSB 30 LBS FELT
SCOPE COMP ROOF SYSTEM
FEE ID ROOF AREA
s.f.
1 REROOFFRES 2,400
7 tfech.flan Check. Plumb.flan Check Elec.Plan Check
:Lleclr.Permit Fee: FPFermat Fee: Elec.Permit Fee:
CJtTzcrr!l9ech.Insp> Other Plumb Insp. CatTrer 'lec.Insp.
rl3ech.Imp.Fee: Plumb.Inslz.Fee: Elec.Ind.I°ee,:
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). 77tese
ftex are based on the relimina
information available and are only an estimate. Contact the Det fi7r addn7 info,
FEE ITEMS (Fee Resolution 11-053 E . 711112) FEE QTY/FEE MISC ITEMS
Pleat Check Fee:
Suppl. PC:.Fee
Plum b.Il1lech.IElec
Permit Fee: $384.00
.SuppL Insp Fee
PlumbAl fechlElec
Plurnb.11fech.lElec Permit Pee:
Construction Tax:
Admintstr ative.Fee:
Work Without Permit? ®Yes (E) No $0.00
Advawced Planning=Fees:
Travel Documentation Fees.-
Strong
ees Strong Motion Fee: 1BSEISMICR $1.10 Select an Administrative Item
Bldg Stds Commission Fee: 1BCSSC $1.00
$386.10 $0.00 $386.10
Revised: 0761/2013
s 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 cDcugertino.org
PROJECT ADDRESS 7 Z�N V' e �l"\ � '` APN
OWNER NAME l I� f(!` O� -` E-MAIL
5�.�� n Iia 6t a
CITY,STATE,ZIP _ /� FAX
STREET ADDRESS
aw( e�+i�no Ca,
CONTRACTOR NAME / 1 ( I LICENSE BER d LICENSE TYPE BUS.LIC.#
YG , ZC
COMPANY NAME e.1 I. 1 1 E-MAIL (� ( t FAX
STREET ADDRESS �)7 CITY,ST E�LZIP (r V PHO
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 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 8314 and 8315 of
the 2010 California Residential Cod .
eg
Signature of Applicant/Agent: Date: F
ReroofPolicy_2012.doc revised 10/7/12