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14040068
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22540 KINST CT CONTRACTOR:XTERIA CONSTRUCTION PERMIT NO: 14040068 OWNER'S NAME: BHASKAR GOPAL PO BOX 5460 DATE ISSUED:04/11/2014 OWNER'S PHONE: 4082529708 SAN JOSE,CA 95150 PHONE NO:(408)289-5353 �( LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL F] COMMERCIAL �+ 16 SQ'S-REMOVE ASPHALT SHINGLE& INSTALL NEW License Class Lic.# �(�Z-�7 ASPHALT COMP CLASS A SYSTEM Contractor r/(, — Date Lf— I — 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:$6900 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:34251003 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 DAY ST C D INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses ich m y accrue against said City in consequence of the Iss granting of this pe . A i ionally,the applicant understands andwill c with all non-point so rce la' per the Cupertino Municipa e,Section 9 18. � RE-ROOFS: Signature �— Date 11— If' Ir' j(I All roofs shall be inspected r to y roofing material being installed.If a roof is installed without first obtain n inspection,I agree to remove all new materials for inspection. u ElOWNER-BUILDERDECLARATION — )/—,I / Signature of Applicant: 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 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 equipme or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Ba rea Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cu Municipal Code,Chapter 9.12 and 1 have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 2 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date: _/NY 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 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 i RERQOF PERMIT APPLICATION (�O COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION V 10300 TQRRE AVENUE•CUPE TINO,-CA 95014-3255 (408)777-3228•FAX(408)777-3333•building0cupertino.ora O CUPERTINO PROJECT li— KOO OWNER NAME �/�^/ Cod PHONE !4 Z 17 E-MAIL STREET ADDRESS +N J C JTY,STATE ZIPS/J� ` ew q t CONTACT NAME PHO A7 (!6, E_IMA1L J STREET ADDRESS 1TY,STATE,ZIP FAX AtA e ❑OWNER ❑ OwNER-BUILDER ❑ O"AGENTCI CO ACro ❑CONTRACTOR ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME <2 (� ,yp LICENS NUMBFsR � LICENSE TYPE BUS.LIC. COMPANY NAME FAX AV L715 Z--5zt STREET ADDRESS ' ITY,STATE,ZIP PHONE S5 5 ar^s4i,tw ?3 5A4 -IZ5 f5a a� 2-93"7777 ARCHITECT/ENGINEER NAME LICENS NUMBER BUS.LIC. COMPANY NAME MAIL FAX STREET ADDRESS ,STATE,ZIP PHONE USE OF SFD or Duplex j❑ Multi-Family R F ARE .: VALUATION: STRUCTURE: ❑ Commercial EXISTING ROOF TYPE: ❑BUILT-UP ROOF ASPHALT SHINGLES 0 WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY) i REMOVE/REPLACE VYES 1F NO. PLYWOOD ❑ Vz- ❑ ...__� PLYWD ElOSB PITCH: ROOF ❑NO 9 LAYER& 1 THICKNESS: ❑S " TYPE: ❑ CDX 12 CLASS: A PROPOSED ROOF TYPE: ❑BUILT-UP ROOFt SPHALT SHINGLES 11 WOOD$HAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT# DESCRIPTION OF WORK: 3 f By my signature below,I certify to each of f owing: I am the pro owner or authorized agent to act on the property owner's behalf I have read this application and the information I have pro ' co t 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 bui o I authorize ntatjves of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: b ` SUPPLEMENTAL INRMATION REQUIRED ! pFptDy _'If building is associated with a Hglme Owner's Association,pi ovide letter TY Ci3� ` otai%tG sGrP.. of approval from HOA. OU16INc P "VIE _Provide Planning approval to verify if there any restrictions. Xt K AN REVIEW, s., Provide copy of Manufacturer's Installation Specifications. } � © FIRE DEet _Provide signed copy of Cupertino: Tear-Off Policy. arIER I ReroofApp_2011.doc revised 03/16/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 22540 KINST CT DATE: 04/11/2014 REVIEWED BY: MELISSA APN: 342 51 003 BP#: "VALUATION: 1$6,900 *PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof PRIMARY SFD or Duplex PENTAMATION 1 SFDWLROO USE: PERMIT TYPE: WORK 16 SQ'S - REMOVE ASPHALT SHINGLE & INSTALL NEW ASPHALT COMP CLASS A SYSTEM SCOPE FEE ID ROOF AREA s.f. 1REROOFFRES 1,600 r i, $IM Al 01, Lurch. Pla?l 1'111117b. I'la"Check �`/trcr. Nun Ch,"(J, Pe,-itlit Fee: Phtmb. Pe v,,n t Fee: C1i`hr r ;llc,°r h. frevl> Ut11ar 1'Irernll f�.�°P. ofhee,t C( z.nsrzLi 9-tterl /i%so. l ie: TIzu11h, h?s/). l",/o.1nsP. Vcc: NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . Theseees 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 f 7/1/13) FEE QTY/FEE MISC ITEMS Man C 7,zec/s T``AI: f'Iafrral}.;`�lc�f°h.i1'lcc Permit Fee: $256.00 Plumb,-A4ec°h.;,,,'1cc Permit Fee: (_'Ons o.11c lion 1 ax: Work Without Permit? ® Yes C) No $0.00 4(./L"t'd77t:Td PlC!nnirig 1`£.'es: Strong Motion Fee: IBSEISMICR $0.69 Select an Administrative Item BldIy,Stds Commission Fee:. 1BCBSC $1.00 $257.69 $0.00 TOTAL FEE: $257.69 Revised: 04/01/2014 i I REROC �jF TEAR-OFF POLICY COMMUNITY DEVELOPMENT D PARTMENT•BUILDING DIVISION ALBERT�ALVADOR,P.E.,C.B. .,BUILDING OFFICIAL C V PERT!NO 10300 TORE AVENUE-CUPE TINO CA 950143255 (408)777 3228•FAX(408)777-3333-building0kupertino.orp PROTECT ADDRESS - ]� G / 72APN f1 �� I L 2 OWNER NAME /`I ,F- E-MAIL r riiorl�� Z- STREET ADDRESS �.�• � 8 CITY,STATE,ZIP FAX kC CONTRACTOR NAME LICENSEN IR LICE? TYP BUS.LIC.# �a �ZZc3 q �� Zz-346 COMPANY NAME MAIL /_ __ f FAX ®� 7i5 Z-5 7-1 1 LST REET ADDRESS C ,STATE,ZIP �f�r J' PHONE itN )le Lia fS17 0,Oe8 777 1 I UNDERSTAND AGREE TO THE FOLLOWING: c 1. The re-roof project shall;comply with all applicable provisions of the 2013 California Codes. 2. An inspection request cap be scheduled up i o one business day before the recluested inspection date. Please schedule inspections online or call (4 8) 777-3228 from 7:30-3:30pm (Mon-Thurs) or 7:30- 2:30pm(Friday)to schedule inspection. Fo Tear-Off and Nailing Inspections, you must also call on the day of the inspection on:l� after that phase f the work is completed. The building inspector will be available within one hour. The hours for thi 3 service are: 7:30-10:30am and 12:30-3:30 (Mon-Thurs) and 7:30-10:30am and 12:30-2:30 (Frida)). 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 roolf sheathing is proposed throughout, all the nails/fasteners shall be either completely knocked-do*pvn or removed prior to this inspection. 4. If plywood is installed,al plywood NailingI s ection 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 al new material down to the sheathing so a proper inspection can be performed. 6. A Final Inspection and`approval shall bebtal.ned from the building inspector when the re-roofing is completed. To receive a final sign-off, the ffillowing items will be verified: a. Flat roofs shall 4ave a minimum of I/"per foot of slope and demonstrate there is no ponding. b. Listings from a0proved testing age ciesfor all pre-manufactured products used shall be available on-sit'to review at the time of the inspection. c. Proper spark a,#stor installation, v nts painted, gutter/downspouts installed, debris removed. 3 7. NOTE: If you call for a'ear-off or-plywood nailing inspection and the work is not complete, you will be charged a re-inspection fe. The re-inspection fee shall be Paid before another inspection can be scheduled. By my signing below,I certify ez ch of the following is true: I am the property owner or authorized agent to act on the property owner's behalf. I under tan d gree to comply with the re-roof policy stated above. I also understand that smoke detectors and carbon monoxi c rs are re uired'to be installed in accordance with Sections R314 and R315 of the 2013 California Residential C.I�o Signature of Applicant/Agent: ' Date: i ReroofPoticy_2014.doc revised 01115114 (JJ� r a poYG2) I I I { f { E f i i {