15110076 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:'10312 RICHWOOD DR CONTRACTOR:R E ROOFING& PERMIT NO: 15110076
CONSTRUCTION INC
OWNER'S NANIEN MURALIDARAN RAJAGOPAL AND KRIS1 NAMA 15230 CLYDELLE AVE DATE ISSUED: 11/12/2015
OWNER'S PHONE: 4086559376 SAN JOSE,CA 95124 PHONE NO:(408)626-9320
❑ i ?..;! LIJOB DESCRIPTION:RESIDENTIAL COMMERCIAL
. CENSED CONTRACTOR'S DECLARATION
'77 -
r REMOVE SHAKE ROOFING AND INSTALL NEW 1/2" CDX,
rI3' a ifs`e'Cl ,1 :. `;:Lic..
FELT,AND COMPOSITION ROOFING(3000 SQ FT).
Contractor _� Date
I hereby affirm�that I am.licensed under the provisions of Chapter 9
(commencing:with Sect n:7000)of Division 3 of the Business&Professions
Code'at►dithat my lieeiise:isin full force and effect. -
I hereby,affirm ii r'perialty of perjury one of the following two declarations:
I have andi.wih maintain a certificate of consent to self-insure for Worker's
Compensation;as provided foi by Section 3700 of the Labor Code,for the
performance of-the'work for,:,ihich this permit is issued. Sq.Ft Floor Area: Valuation:$19000
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:36908020.00 Occupancy Type:
permit is issued.
i, ".i i"• APPLICANT CERTIFICATION
I certify that I hake read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.I agree to cpmply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building coristruchon;and hereby authorize representatives of this city to enter
upon:the above meritioned.propeity for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION.
order P d keepiharmless the'City of Cupertino against liabilities,judgments,
casts;and'•exp "ses,which may'accrue against said City in consequence of the �J
granting 66his 'ermir.' Additionally,the applicant understands and will comply Issued by: J �f l✓'�t Date:
yvith all non• oi' eurce.re •, ions pe �e..Cupertino Municipal Code,Section
9;18.'
;., �• RE-ROOFS:
Signature. r Date !� J All roo call be inspected prior to any roofing material being installed.If a roof is
installed wi oUt-firs btaining an in ection,I agree to remove all new materials for
..•,,!,. \ inspectio l
❑ `'.•OWNER-BUILDER DECLA TION
Sianature,of li an ` %� - Date:
I hereby affirm'thaf'I am'ezempt 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'ni�employees with wages as their sole compensation,
will do the work,'an d 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.7,044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
t 1i'!', California Health&Safety Code,Sections 25505,25533,and 25534. I will
I hereby'iffirm`6nder penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: „i;``• Health&Safety Code,Section 25532(a)should I store or handle hazardous
I have and'will maintairt a Certificate of Consent to self-insure for Worker'sn aterial. itionally,should I use equipment or devices which emit hazardous
Compensation,I as provided for by Section 3700 of the Labor Code,for the air contaminan as defined by the Bay Area Air Quality Management District I
performance of the work fmwhich this permit is issued. will maintain co liajia with th -uperti o Mit icipal Code,Chapter 9 12 and
I have and1will maintain Worker's Compensation Insurance,as provided for by the Health&Safe i dp Sectio s"5,,"225�53,3, d 25534.
p ,Section 3700 of the Labor,Code,;for the erformance of the work for which thisOwnerorauthorrz dages l: Date: "'
permit is issued.'i;.:, ;-
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
1.1 :. t. . .,. ,. •.. .
become subject to the Workers 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; the harmless' 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- pint source re mations per the Cupertino Municipal Code,Section
P g P P P Licensed Professional
9.18.
Signature Date
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUlPERTIhEQ (408)777-3228• FAX(408)777-3333•building cDcupertino.org
PROJECT ADDRESS /� I I/0, In (/� �}� 7APN#
OWNERNAME TAT M(�RA,
L j I)kRVJ PHONE
STREET ADDRESS 0y CITY, STATE,ZIP D T;A;
CONTACT NAME I / PHONE
J\�-62] 'W O E-MAIL
STREET ADDRESS ( .� V��M ! CITY,STATE,ZIP / �I FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT elsoNTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TE ANT
CONTRACTOR NAMEf{r ,j n_(j LICENSE NUMBER �J�I�G CI LICENSE TYPE /J BUS.LIC.# 7& O
COMPANY NAMEJ 'I`// E-MAIL /� `�- Ib q 4
f �Q�'
STREET ADDRESS 1,� C1lJVV� I) CITY,STATE,ZIP �V lCJ I/1/
ARCHITECT/ENGINEERNAME LICENSE NUMBER [ BUS.LIC.#W L
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OFSFD or Duplex El Multi-Family ROOF AREA:
VALUATI
0"
STRUCTURE: ❑ Commercial �V V0 1 g I "
EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES El'OTHER(SPECIFY)
[R&M�)/REPLACE YES IF NO, i PLYWOOD h" ❑ PLYWD ❑ OSB PITCH: 1 ROOF
O #LAYERS: THICKNESS: ❑ 5/8" TYPE: CDX 12 CLASS: A
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES &WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT#
DESCRIPTION OF WORK: ,A / ! \n r
M RkAKV-;
lJ 0 l 1 << </b �✓\ n.�V
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 in at'.
ave p ided is correct. I have read the - iption of Work and verify it is accurate. I a ee to comply with all applicable local
ordinances and state laws o buildi uthoriz , prese atives of Cupertino to enter the above-ident fled prop rty for inspection purposes.
Signature of Applicant/AgDate:
SUPPLEMENTAL INFO TION INQUIRED
v.,r : .Y OFFICE USE ONLY;
_If building is associated with a Home Owner's Association,provide letter PLAN CHECKT,,YPE xouinv`G sL>p
of approval from HOA. ovER TrcouNTER BUILDnvcPLAN,REVIER
_Provide Planning approval to verify if there any restrictions. EXPREss ", PLANNING PLAN REVIEW
_Provide copy of Manufacturer's Installation Specifications. ❑ sTANDARD �' FD2E'DEPT `i £'
Provide signed copy of Cupertino's Tear-Off Policy. 0 OTHER
iter. p dt�i
ReroofApp_2011.doc revised 03/16/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 10312 Richwood Dr DATE: 11/12/2015 REVIEWED BY: Sean
APN: BP#: 'EVALUATION: 1$19,000
*PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Duplex PENTAMATION 1 SFDWLROOF
USE: PERMIT TYPE:
WORK Remove shake roofing and install new 1/2" CDX 30#felt and composition roofing 3000 sq ft).
SCOPE
FEE ID ROOF AREA
s.f.
1REROOFFRES 3,000
'N"Pli?i. 111 an("he k 1.ieC. 1';hv. t(,heck
1£'c11
2../sG1"YYdI . ,e: l'luiw?, i'r.'i'ni f 1'r:1i': /_leC. Pent"if Fee:
oihei�4k4eoh.:1;qui. L1f;re, .1'irrr>>'Z?t7'ts; El I
other Oc'c.
$f{:r:lr. Ir<sr?. 1•t'e': . I'?tr�azt..Crt,t�f,z:>c: l;r`t'c:. Ir;.r�?. '"2c':
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District;etc. . Thesefees are based on the reliminar information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (Tee Resolution 11-053 E . 7/1/13) FEE QTY/FEE MISC ITEMS
Plan ("heck
x1'7{ppL PC.Fe'e,' _F
Permit Fee: ' 5 0
'lr4rra .-'<I.&c:lr:;'1�`lc�c.l'£�r�rtit.1���c;:
�;onsiruc lion 711x:
.f thninisircaiive l'ee:
Work Without Permit? 0 Yes (E) No $0.00
F(Ivel Docunlie iatir P'er.,s:
Strong Motion Fee: 1BSEISMICR $2.47 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00 y,93.g7
SUBTOTALS: $ 47 $0.00 TOTAL FEE. .47
L1�j3. Revised: 10/01/2015
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
CUPE=RTINO 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228• FAX(408)777-3333•building(a.cupertino.org
PROJECT ADDRESS \ V�I T 1(U W b n2 ` T—APN#
PHONE � - MOWNERNAME 1 )D 7
STREET ADDRESS ,I I\ I I Ja/U I / {I CITY, STATE,ZIP n j I FAX o( l
CONTRACTOR NAME � �1ZLICENSENUMBER�,2� CA LICENSETYPE�2� BUS.LIC.#
COMPANY NAME1!. T�." �o _ �. // E-MAIL
STREET ADDRESS I��i/ ,\ /u� �^�� � I CITY,STATE,ZIP - p�/(�' � PHONE
I UNDERSTAND 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 un 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/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 un d and agree to comply with the re-roof policy stated above. I also understand that
smoke detectors and carb monoxietect requ' to installed in accordance with Sections R3 4 and R315 of
the 2013 California Resi ential Code.
Signature of Applicant/Agent: Date:
ReroojPolicy_2014.doc revised 01/15/14