13080057 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10668 FLORA VISTA AVE CONTRACTOR:DADDARIO ROOFING PERMIT NO:13080057
OWNER'S NAME: SRINIVASA CHAPPIDI 716 CAPITOLA AVE STE E2 DATE ISSUED:08/07/2013
OWNER'S PHONE: 4082095792 CAPITOLA,CA 95010 PHONE NO:(831)476-9109
ItsNELICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL El COMMERCIALU
License Class G _ Lic.# Gr Flo?"7 _ (31 SQ'S)TEAR OFF(E)COMP&INSTALL(N)40 YR
CLASS A COMP
Contractor Date
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:$10250
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:32608041.00 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 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 L ED 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
Y/7 1-3
granting of this permit. Additionally,the applicant understands and will comply Issu Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature Date O/,j 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: "VVDate: d�
1 hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: ALL ROOF COVERIN 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 is not 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 25505,2553 ay 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Dater
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
�b
10300 TORRE AVENUE CUPERTINO, CA 95014-3255 (�
(408)777-3228•FAX(408)777-3333•building Dcupertino.org
CUPERTFNO: \�
PROJECT ADDRESS .U+'S � APN# � — 09 -0 '11:D ' .
OWNER N y, t • PHONE . n9 EMAIL
r, vt� ua5,q Cha 7Q
STREET ADDRESS CITY, ST E,ZI
95 F0 FAX
(a 66� :far v� cam » c ra
CONTACT NAME P O E-MAIL
(Trl - 5- L
STREET AD CITY,STATE,ZIP FAX
i Wit—. /
❑OWNER ❑ OWNER-BUIIAER 13OWNERAGENT lu�yCONTRACTOR ❑CONTRACTOR AGENT 13ARcmECT ❑ENGINEER [3 DEVELOPER 1:3 TENANT
4=0
R LICENSE LICENS BUS.LIC.#
AME
a :0 led ✓I
COMPANYNAMEE-MAIL FAX
CLa.I *%0
STRE T.ADDRESS lQ wt�e� J C. O PHOIt"f -76
°` (7(0
` !(0
ARCHffECT/ENGI EERNAME LICENSE NUMBER BUS.LIC.#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE.OF ❑ SED or Duplex . ❑ Multi-Family ROOF AREA: VALUATION:
STRUCTURE: ❑ Commercial N v
EXISTING ROOF TYPE: ❑BUILT-UP ROOF ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY)
REMOVE/REPLACF, IFNO,- PLYWOOD ❑ '/:" ❑ PLYWD ❑ OSB PITCH: ROOF
13NO #LAYERS: THICKNESS: 135/8" TYPE: 11 CDX I Z CLASS:
ICC-ES REPORT# .
PROPOSED RO.OF TYPE: ❑BUILT-UP ROOFSPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER
DESCRIPTION OF WORK:(3 M4
o 4 I. e
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 co i . I authorize representatives of Cupertino to enter the above-id tified pr erty for inspection purposes.
Signature of Applicant/Agent: Date: 0
SUPPLE NTAL INFORMATION REQUIREDcr�° .�o
If building is associated with aHome Owners Association,provide letter
of approval from HOA. ME
Provide Planning approval to verify if there any restrictions. s xr
Provide copy of Manufacturer's Installation Specifications. K, T D
Provide signed copy of Cupertino's Tear-Off Policy.
S
�R,,oqf�4pp �.doc revised 03/16/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10668 FLORA VISTA AVE DATE: 08/07/2013 REVIEWED BY: MELISSA
APN: 326 08041 BP#: "VALUATION: 1$10,250
*PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Duplex PENTAMATION 1 SFDWLROOF
USE: P PERMIT TYPE: A
WORK 31 SQ'S TEAR OFF E COMP & INSTALL N 40 YR CLASS A COMP
SCOPE
FEE ID ROOF AREA
s.f.
1 REROOFFRES 3,100
X&ch.Plan Check Plumb,Plan Cheek Elec.Plan Check
rbfech. Permit Feet: Plumb.Permit Fee: Elec. Permit Fee:
FC)iher Xlech.Insp Other Plumb Insp. Other Eke.Insp,11ech.Insp.Fee: Plurnb. Insp.Fee: Elec.Insp.Fee:
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). These fim are based on the prelimina information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 E . 7�f 11/12) FEE QTY/FEE MISC ITEMS
Plan Cheek Fee:
Stipp/. PC"Fee
Plumb.111fech.IElec
Permit Fee: $496.00
Suppl. Insp Fee
Plumb.;Mech./Elec
Plumb./Mech.iElee Permit Fee:
Construction Tax.,
Administrative Fee:
Work Without Permit? ® Yes Q No $0.00
,advanced Planning Fees:
Travel Documentation Fees: �
Strops Motion Fee: IBSEISMICR $1.03 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
$498.03 $0.00immm $498.03
Revised: 07/01/2013
�`.N
RE ROOF 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•buildingCaD-cupertino.org
PROJECT ADDRESS,46q d v Q VIS APN# /I 27 � O`Q � 011 11
o � .j„7 �G E-MAIL
I
OWNER NAME�'✓,�` Sa � ' ; HO
P
FAX
STREET ADD Qa ' `t,� OL� Chu IP r it'
CO CTO ME � !V LICENSE N Q F LICENEYP BUS.LIC.#
CO N E-MAIL FAX
a air; s l2vcr
S. S ' CIT STAT IP C 5c) [0 PGI
AV
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-roofmg 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 thel
property owner's behalf. .1 understand and agree to comply with the re-roof policy stated above. I also understand that
smokedetectors and carbon.monoxide detectors ar re ired to be installed in accordance with Sections R314 d R315 of
the 2010 California Residential Co
Signature of Applicant/Agent: Date: Q O
ReroofPolicy_2012.doc revised 10/7/12