14070055 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7647 RAINBOW DR CONTRACTOR:SIMON SAYS ROOFING PERMIT NO: 14070055
OWNER'S NAME: LAM RAJENDRA K AND RAJASREE 3012 BECKLEY DR DATE ISSUED:07/14/2014
OWNER'S PHONE: 4085319700 SAN JOSE,CA 95135 PHONE NO:(408)531-9700
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL ❑
0028 28 SQ-TEAR OFF(2)LAYERS WOOD SHAKES,INSTALL
License Class C t U Lic.# *?SLI f4/p 1/2 OSB,CLASS A
Contractor �� Uk l Date 7,
I hereby affirm that I am lensed 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:$10000
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:36224009 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 WITIIIN 18DAYS 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 kROM LAST CALLED 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 Issued by: AYDate: 21YI
91
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.
RE-ROOFS:
SignatureAgieDate 7—f 4-/-2 0L/ All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed without first obtaining an inspecti ,I agree to remove all new materials for
inspection.
❑ OWNER-BUILDER DECLARATION
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 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/)5533,and 25534.
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 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
918.
Signature Date
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION O
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228•FAX(408)777-3333•building(cDcupertino.org.
Culfltknko \
PROJECT ADDRESS L/ I o U-)
APN# n _/Q.061Z
OWNERNAME ( PHO �/� _ 3�/ 7D�' E-MAIL
STREET ADDRESS CITY, TATE, �f ! FAX
12
'v� RncJ -e 1
CONTACT NAME PHO E-MAIL
STREET ADDRESS. s LO
C SU TE,ZIP , w FAX
!.'J OWNER 13 OWNER-BUILD ❑.OWNERAGENTY� ❑.CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME R O I ICEN LICENSE TYPE BUS.LIC.#
Y.�
COMPANY NAME L E MAII - FAX
CITY STPHO
STREETADDRES5
Mfr 3/�7ba
ARCHITECT/ENGRMERNAME 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:
szTtucnJxE: ❑ Commercial ,,��- �f/
EXISTING ROOF TYPE: ❑BUII T-UP ROOF ❑ASPHALT SHQ IGLES WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY)
REMOVE/REPLACE ❑YES IF NO, PLYWOOD0'� ❑ PLYWD OSB FPrrCH: ROOF
❑NO I #LAYERS: THICKNESS: ❑ 5/8" TYPE: El :12 CLASS: A
ICC-FS REPORT#
PROPOSED ROOF TYPE: 13BUILT-UPROOF 13ASPHALT SHINGLES 11WOOD SHAKES 11WOOD SHINGLES ❑OTHER
DESCRIPTION OF WORK:
2 - M
L
L L rv�Q r r 6�e
By my signature below,I certiffto 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;iead 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 tructqn. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: � Date:
SUPPLEMENTAL INFORMATION REQUIRED
If building is associated with a Home Owners Association,provide letter
of approval from HOA. ��
Provide Planning approval to verify if there any restrictions. I
Provide copy of Manufacturers Installation Specifications. o
Provide signed copy of Cupertino's Tear-Off Policy.
ReroofApp_2011.doc revised 03/16/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 7647 RAINBOW DR DATE: 07/14/2014 REVIEWED BY: MENDEZ
APN: BP#: *VALUATION: $10,000
*PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY PENTAMATION 1 SFDWLROOF
USE: SFD or Duplex PERMIT TYPE: A
WORK 28 SQ- TEAR OFF 2 LAYERS WOOD SHAKES INSTALL 1/2 OSB CLASS A
SCOPE
FEE ID ROOF AREA
s.f.
1REROOFFRES 2,800
Weh, Tt`rrrt ClatccA 1'I€wh.I kln Crecl, I icc.f'ap
`l ,,h. lle,.,raa F'e!e, 1'1rtm 7. I'< mat I'e�e: Fl,.,
Other 1'Iyinb Insn. ot"wr�1..rc`.
F'7t{rrrh, tars z. 7 ue: 1.1ie:c Ir V.2, Fee::
NOTE: This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc. . These fees 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 . 7/1/13) FEE QTY/FEE MISC ITEMS
1'layl Che>c"A- ,b-,
Permit Fee: $476.00
slfjyd
ISI .il Permil 1^"ee:
('Onstrvcfioyl Tax,
Work Without Permit? 0 Yes (j) No $0.00
�t7 �7daf.'c`L��'rfLd�'€7I7zISs `C'£',5:
Trawl 1>r>£°urrcenlol on Fees:
Strong Motion.Fee: 1BSEISMICR $1.30 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
$478.30 $0.00 = a =w T(? AL FEE: $478.30
Revised: 07/10/2014
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-building0kupertino.org
PROJECT ADDRESS ,, J APN#
OWNER NAME jJ�f PHONE E-MAIL
STREET ADDRESS / CITY `STA IP FAX
CONTRACTOR NAME N
r B ! LICENSE UMBER LICENSE TY P BUS.LIC.#
COMPANY N (� E-MAIL FAX
STREET ADDRESS /eCITY,STATE ZIP PHONE /
P-1 4e(19 / 7
I I 4STAND AND AGREE TO THE FOLLOWING:
1. The re-roof project shall comply with all applicable provisions of the 2013 California Codes.
2. An inspection request can be scheduled up to one business day before the requested inspection date.
Please schedule inspections online or 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. The hours for this service are: 7:30-10:30am and 12:30-3:30 (Mon-Thurs)
and 7:30-10:30am and 12:30-2:30 (Friday). 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/"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 R314 and R315 of
the 2013 California Residential Code.
Signature of Applicant/Agent: Date:
ReroofPolicy_2014.doc revised 01/15/14
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPERTINO 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255
(408)777-3228•FAX(408)777-3333•building(Wcupertino,org
yj / Permit No. 0-7 0 0,5_
dl- Jr-
Address v 'J o L 0 Q #of Alarms Smoke: Carbon Monoxide:
La"
PURPOSE
This affidavit is a self-certification for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with 2013 CRC Section R314,2013 CBC Sections 420.6 and 907.2.11.2 where no interior access for
inspections are required.
GENERAL INFORMATION
Existing single-family and multi-family dwellings shall be provided with Smoke Alarms and Carbon
Monoxide alarms. When the valuation of additions, alterations, or repairs to exist' lin its exceeds
$1000.00, CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 require tl /or Ca bon
Monoxide Alarms be installed.in the following locations: �„} rt -9 -77
AREA SMOKE ALARM O ALARM
Outside of each separate sleeping area in the immediate vicinity of the X X
bedroom(s)
On every level of a dwelling unit including basements X X
Within each sleeping room X
Carbon Monoxide alarms are not required in dwellings which do not contain fuel-burning appliances and that
do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with
CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal.
Power Supply: In dwelling units with no commercial power supply, alarm(s) may be solely battery operated.
In existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do
not result in the removal of wall and ceiling finishes or there is no access by means of attic,basement or crawl
space. Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2. An electrical permit is required for
alarms-which must-be-connected-to-the-buil-ding-wiring.- -
As owner of the above-referenced property,I hereby certify that the alarm(s) referenced above has/have been
installed in accordance with the manufacturer's instructions and in compliance with the California Building
and California Residential Codes. The alarms have been tested and are operational, as of the date signed
below.
I have read and agree to comply with the terms and conditions of this statement
Owner(or Owner Agent's)Name:
'... .
� . ...........................Date: .!..
Contractor Name: ,�f
&?�ld...Date: r2 ZQ
Smoke and CO form.doe revised 03118114