B-2016-1452 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1452
821 BETLIN AVE CUPERTINO,CA 95014-4546(369 27 019) (A-1 ROOF
MANAGEMENTAND
CONSTRUCTION INC)
SAN LEANDRO,CA
94577
OWNER'S NAME: Anand And Jain Deepali Trustee Bagga DATE ISSUED:03/01/2016
OWNER'S PHONE:408-398-6360 PHONE NO:510-347-5400
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B C-39 C-33 Lic.#929384
Contractor(A-1 ROOF MANAGEMENT AND CONSTRUCTION INC)Date XBLDG _ELECT —PLUMB
03/01/2016 _MECH X RESIDENTIAL_COMMERCIAL
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 JOB DESCRIPTION:
license is in full force and effect. REMOVE(E)CLAY TILE IN FRONT,LEFT SECTION(6 SQ'S),
INSTALL(N)30#FELT,(N)CLASS A COMP SHINGLE(PREPARE FOR
I hereby affirm under penalty of perjury one of the following two declarations: PV SYSTEM)
1. 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
K�� performance of the work for which this permit is issued.
z: %`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 Sq.Ft Floor Area: Valuation;$3800.00
this permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above APN Number: Occupancy Type:,
information is correct.I agree to comply with all city and county 369 27 019
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 indemnify and keep PERMIT EXPIRES IF WORK IS NOT STARTED
harmless the City of Cupertino against liabilities,judgments,costs,and WITHIN 180 DAYS OF PER T ISSUANCE OR
expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will 180 DAYS FRO T C INSPECTION.
comply with all non-point source regulations per the Cupertino Municipal
Code,Section 9.18.
Issued by:MELISSA NAME
Date:03/01/2016
Signature//' _ I Date 03/01/2016
RE-ROOFS:
OWNER-BUILDER DECLARATION All roofs shall be inspected prior to any roofing material being installed.If a roof is
I hereby affirm that I am exempt from the Contractor's License Law for one of the installed without first obtaining an inspection,I agree to remove all new materials for
following two reasons: inspection.
t. 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 Signature of Applicant/,
for sale(Sec.7044,Business&Professions Code) Date:03/01/2016 U
2. 1,as owner of the property,am exclusively contracting with licensed
contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE GLASS"A"OR BETTER
I hereby affirm under penalty of perjury one of the following three declarations:
t. I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE
Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will
2. I have and will maintain Worker's Compensation Insurance,as provided for maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
by Section 3700 of the Labor Code,for the performance of the work for which Health&Safety Code,Section 25532(a)Should I store or handle hazardous
material. Additionally,should I use equipment or devices which emit hazardous
this permit is issued.
3. 1 certify that in the performance of the work for which this permit is issued,I air contaminants as defined by the Bay Area Air Quality Management District I
shall not employ an person in an manner so as to become subject to the will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
p Y y p Y the Health&Safety Code,Sections 25505,25533,and 25534.
Worker's Compensation laws of California. If,after making this certificate of
/7
exemption,I,become subject to the Worker's Compensation provisions of the Owner or authorized agent"/, -��
Labor Code,I must forthwith comply with such provisions or this permit shall Date:03/01/2016 `
be deemed revoked. CONSTRUCTION LENDING AGENCY
I hereby affirm.that there is a construction!lending agency for the performance
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is of work's for which this permit is issued(Sec.3097,Civ C.)
correct.I agree to comply with all city and county ordinances and state laws Lender's Name
relating to building construction,and hereby authorize representatives of this city Lender's Address
to enter upon the above mentioned property for inspection purposes. (We)agree
to save indemnify and keep harmless the City of Cupertino against liabilities, ARCHITECT'S DECLARATION
judgments,costs,and expenses which may accrue against said City in I understand my plans shall be used as public records.
consequence of the 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. Licensed
1
x REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
C P. ' (408)777-3228• FAX(408)777-3333•building(kupertino.org
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PROJECT ADDRESS e /n A J� APN#
OWNERNAME (�,,., /� PHONE _7E-MAIL [ /
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STREET ADDRESS CITY, STATE,ZIP FAX
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CONTACT NAME PHONE E-MAIL
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❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME LICF NUMBER LICENSE TYPE BUS.LIC,# �J 2 6
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COMPANYNAME �a Y�a-sp a!,� E-MAIL ':.FAX
STREET ADDRESS CITY,STATE,ZIP PHO
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ARCHITECT/ENGINEER N.�ME Q LICENSE NUMBER BUS.LIC.#
COMPANY NAME y^`/ E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF SFD or Duplex ❑ Multi-Family ROOF AREA: VALUATION:
STRUCTURE: ❑ Commercial (�,LS 3/ p
EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES 'OTHER(SPECIFY)R®-u--1 -X
REMOVE/REPLACE OYES IF NO, PLYWOOD ❑ %/ ❑ PLYWD ❑OSB PITCH: ROOF
❑.NO #LAYERS: THICKNESS: ❑ 5/8" TYPE: 11CDX :12 CLASS: A
PROPOSED ROOF TYPE: ElBUILT-UPROOF 45ASPHALT SHINGLES ElWOOD SHAKES 11WOOD SHINGLES ❑OTHER ICC-ES REPORT#
DESCRIPTION OF WORK: -H ` Q
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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'is 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 construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: F — Date: 34111(12
i.,x1 s. ,OFFICiISCJIaiI,Y' ,"$„= r,5+k� r .:,.
SUPPLEMENTAL INFORMATION REQUIRED _ . _
_If building is associated with a Home Owner's Association,provide letter �� �� �BOZ7IINGSi IP
w' s s
of approval from HOA.
o r CoTI ztvu1LLTiIr1G rr AN
_Provide Planning approval to verify ifthere any restrictions. NA
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Provide copy of Manufacturer's Installation Specifications. ❑ sTiRM
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_Provide signed copy of Cupertino's Tear-Off Policy. C3 orl�rErr"`
ReroofApp_2011.docrevised 03/16/11
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B4O., BUILDING OFFICIAL
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
Ct p'tIt I Nt3t
Z
(408)777-3228• FAX(408)777-3333•building-) /�
PROJECT ADDRESS C� j� 1 pf\/�✓1 v� APN# v ' J(/�� t `
OWNERNAME /�_ _ — _n PHONE E-MAIL
STREET ADDRESS C , STATE,ZIP C ��t FAX
CONTRACTOR NA7�� p+ _ , ,,.�- LIC ENSE4N 5!EER,>�, LICENSE3T�EBUS.LIC.#
COMPANY NAME E-MAILFAx
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STREET ADDRESS CITY,STATE,ZIP by 3`�� s cram
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 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/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 anotherinspection 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.11 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: _16
ReroofPolicy_2014.doe revised 01/15/14