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13120109 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21647 RAINBOW DR CONTRACTOR:THD AT-HOME SERVICES, PERMIT NO: 13120109 INC. OWNER'S NAME: PATIL SUHAS S AND JAYASHREE S 2690 CUMBERLAND PKWY STE 300 DATE ISSUED: 12/13/2013 OWNER'S PHONE: 4083072312 ATLANTA,GA 30339-3913 PHONE NO:(510)731-1004 6� LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB License Class G Lie.# 3 66-z-- )r MECH r RESIDENTIAL r COMMERCIAL r Contractor 17/I'1 6 SU'��Date 1'2'1(3 If;, JOB DESCRIPTION:REMOVE&REPLACE ROOF(76SQ),WOOD SHAKES OFF, I hereby affirm that I am licensed under the provisions of Chapter 9 LIFETIME COMP ON,NO PLYWOOD (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 erfor ance of the work for which this permit is issued. and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Valuation:$39866 cti n 3700 of the Labor Code,for the performance of the work for which this per it is issued. APN Number:36637002.00 Occupancy Type: APPLICANT CERTIFICATION 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 PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the 180 DAYS FRO ST CALLED INSPECTION. granting of this permit. Additionally,the applicant understand will comply with all non-point source regulations per the Cupertino icipal Code,Section 9.18. Issge�l by: Date: Signature Date I 1 t ❑ OWNE ER DECLARATION RE-ROOFS: All roofs shall be inspected prior to any roofing material installed.If a roof is I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agr o remove all new materials for the following two reasons: inspection. 1,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, Signature of Applicant: Date: I z f t 13 Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code;Sections 25505,25533,a 5534. not employ any person in any manner so as to become subject to the Worker's Compensation laws of Califomia. If,after making this certificate of exemption,I Owner or aur n ' Date: 12, become subject to the Worker's Compensation provisions of the Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. ONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereby affi at there is a construction lending agency for the performance of work's I certify that 1 have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.) correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. Licensed Professional Signature Date D�) 1 2 C-�>i 09 REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228•FAX(408)777-3333•building0cupertino.org CUPERTINO PROJECT ADDRESS I APN# 0 7 I`• 5 V OWNER NAME ?1 P O O • E-MAIL STREET DRESS 1 CITY,STATE,ZIP FAX 2-1 �� DiZ . �Z�t,�v ch o 9 soil CONTACT NAME Eileen Cook PHONE 707-527-7727 E-MAIL - sTREETADDREss 2456 VERNA COURT CITY,STATE,ZIP FAX 510-357-3750 SAN LEANDRO CA 94577 1 ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME LICENSE NUMBER 836021 LICENSE TYPE C39 BUS.LIC.# COMPANY NAME THD AT HOME SERVICES E-MAB, FAX 510-357-3750 sTRFFTADDRFss 2456 VERNA COURT CITY,STATE,ZIP SAN LEANDRO,CA 94577 PHoNE510-877-4550 ARCHTTECT/ENGINEERNAME LICENSE NUMBER BUS.LIC.# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF SFD or Duplex ❑ Multi-Family ROOF AREA: VALUATION: n / STRUCTURE: ❑ Commercial �OVv � 5 ZS�tJ EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES WOOD SHINGLES ❑OTHER(SPECIFY) REMOVE/REPLACE KYES IF NO, PLYWOOD ❑ w, ❑ PLYWD ❑OSB PITCH: tt- ROOF ❑NO I #LAYERS THICKNESS: 115/8" TYPE: 11COX +'12 CLASS: PROPOSED ROOF TYPE: ❑BUILT-UP ROOF XASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT# DESCRIPTION OF WORK: I 7 0 1 L��L-T n� �• AJ '` �I 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 Descriptionc-end verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction. I an Ives of Cupertino to enter the abovje-iidenjtified property for inspection purposes. Signature of Applicant/Agent: Date: I �:j k3 SUPPL INFO :ON RE D OFFICE USE ONLY _If building is associated with a me s Association,provide letter PLAN CHECK TYPE ROUTING SLIP of approval from HOA. ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW Provide Planning approval to verify if there any restrictions. ❑ EXPRESS ❑ PLANNING PLAN REVIEW Provide copy of Manufacturer's Installation Specifications. ❑ STANDARD ❑ FIRE DEPT Provide signed copy of Cupertino's Tear-Off Policy. ❑ OTHER: ReroofApp_2011.doc revised 03/16/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 21647 rainbow drive DATE: 12/13/2013 REVIEWED BY: larrys APN: BP#: *VALUATION: 1$39,866 *PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof PRIMARY SFD or Duplex PENTAMATION 1SFDWLROOF USE: PERMIT TYPE: WORK remove and replace roof. wood shakes off, lifetime comp on. no plywood SCOPE FEE ID ROOF AREA s.f. 1REROOFFRES 7,600 Alech.Pleur Check. Plumb.Plan Check Elec.Plan Check A-fecf�.Permit Fee: Plmnb.Permit Fee: Elec. Permit Fee: Otfaer&tech.Insp. EIF-L- Otlx:r Plfernb Insp. E17-- Other fs'Ic'C.Inslr. LL1 I-] bli c lr. hrsp. Fee: I Plumb. Insp.Fee: I 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 preliminar information available and are only an estimate. Contact the De t or addn'l info, FEE ITEMS (Fee Resolution 11-053 E . 7/1/13, FEE QTY/FEE MISC ITEMS Platz Check Fee: Suppl. PC Fee Plum b./A1ech./flee Permit Fee: $1,216.00 Suppl. Insp Fee Plum h./1L1ech.IF_l ec .Plltt)zb.%llech.il'lec.Permit Fee: Construction Tax: Administrative Fee: Work Without Permit? ® Yes (E) No $0.00 Advanced Planning.Fees: Travel Documentation Fees: A StronizMotion Fee: IBSEISMICR $3.99 Select an Administrative Item Bldiz Stds Commission Fee: IBCBSC $2.00 SUBTOTALS: , $1,221.99 $0.00 TOTAL FEE: $1,221.99 Revised: 10/01/2013 REROOF TEAR-OFF POLICY COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION ALBERT SALVADOR, P.E.,C.B.O., BUILDING OFFICIAL CUPERTINO 10300 TORRE AVENUE-CUPERTINO, CA 95014-3255 (408)777-3228-FAX(408)777-3333-building .cupertino.org PROJECT ADDRESS f LL,7 �AlI APN# OVk �Q -1 ��( PHONE,,,,,, - I E-MAIL J STREET.ADDRESS CITY,STATE,ZIP FAX 21 o Lt R-A ,J J 1 GU 2-MAIC) CA . Ol� CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC.# 836021 C39 COMPANY NAME E-MAIL FAX THD AT HOME SERVICES 510-357-3750 STREET ADDRESS 2456 VERNA CT. CITY,STATE,ZIP SAN LEANDRO, CA 94577 PHONE 510-887-4565 I UNDERSTAND AND AGREE TO THE FOLLOWING: 1. The re-roof project shall comply with all applicable provisions of the 2007 California Building Code. 2. You must schedule all needed inspections a minimum of one day before the requested inspection date. Please schedule inspections online or call (408)777-3228 between 7:30-3:30 (Mon-Fri). 3. Tear-off roof inspection is required. Please call for tear-off inspection after the roof is torn off and all the nails/fasteners have been removed. Any and all dry-rotted wood shall be replaced prior to this inspection. A building inspector will be available within one hour. There are special hours for this service: 7:30 — 10:30am and 1:00—3:30pm (Mon—Thurs); 7:30 — 10:30am and 1:00—2:30pm(Friday). 4. If plywood is installed,a plywood nailing inspection is required. 5. In-Progress roof inspection is required. Call for an in-progress roof inspection to verify building is weather tight after installation of approximately 25%of the roofing material. 6. New roof coverings shall not be applied without first obtaining all inspections 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. 7. A final inspection and approval shall be obtained from the building inspector when the re-roofing is complete. To receive a final sign-off,the following items will be verified: a. Flat roofs shall have a minimum of 1/4"per foot of slope and must 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. 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 compl the re-roof policy stated above. Signature of Applicant/Agent: Date: 13— k3/ I zl_� ReroofPo1iQ_2010.doc revised 05/17/10