12090016 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20663 GARDENSIDE CIR CONTRACTOR:BRA DSHAW ROOFING INC PERMITNO: 12090016
OWNER'S NAME: DANDAPANI RAMESH AND RAMAKRISf1NAN K 1821 S BASCOM AVE PMIS 160 DATE ISSUED:09/102012
OWNER'S PBONF.: 4082469930 CAMPBELL,CA 95008 PHONE NO:(408)2149930
CY LICENSED CONTRACT'OR'S DECCLARATIONBUILDINC.PERMIT INFO: BLDG r ELECT r IJ
PLUMB
License Class C_39 Lic.# � l�l'39G
MECII rRESIDENTIAL r COMMERCIAL
I_'
Contactor At.j R( bCd Uate�p �� lZ
1 hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REMOVE EXISTING WOOD SHAKE ROOFINGINSTALL
(commencing with Section 7000)of Division 3 of the Business&Professions NEW
Cade and that my license is in full force and effect. CLASS A COMPOSITION SHINGLES(AGED BARK)1200 SQFT
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.
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 Sq.Ft Floor Area: Valuation:$6000
permit is issued.
APPLICANT'CERT'IFICATION ANN Number:36232005.00 Occupancy Type:
1 certify that 1 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 PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep hamdess the City of Cupertino against Iiabilities,judgmenls,
costs,and expenses which may accrue against said City inconsequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,the applicant undcrstmhdsand will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulations per the Cupertino Municipal Cade,Section `V 17-1 D_)Z
9:18. 171110
�rY1Ff
Signature (/ Date r0 �2 Issued by: Date:
❑ OWNER-RUILDF.R DECLARATION
RF-ROOFS:
hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material beitg installed.If a roof is
the following two reasons: installed without first obtaining an rnspec ton,I agree to remove all new materials for
1,as owner of the property,or my employees with wages as their sole compensation, inspection.
will do the work,and the structure is not intended or offered for sale(Sec.7044, // 17//O//
Business&Professions Code) Signature of ApplicmCLDate:
I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). AI.I.ROOF COVERINGS TO RE CLASS"A"OR BETTER
I hereby allirm under penalty of perjury one of the following three
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's IIAZARDOUS 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 pemrit is issued. California Health&Safely Code.Sections 25505,25533,and 25534. 1 will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Ilealth&
Secdom3700 of the Labor Code,Ibr the performance of the work for which this Safety Code,Section 25532(n)should I store or handle hazardous material.
Additionally,should I use equipment or devices which emit hazardous air
permit is issued. contaminants as defrnrd by the Rav Area Air Quality Management District I will
I certify that in the performance of the work forwhich this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's Ilealth&Safety Coda Sections 25505,25533,and 25534.
Compensation laws ofCalifomia. If,after making this cerificate of exemption,I
become subject to the Worker's Compensation provisions of the Labor Code,I must owner r Char' d agent: '
forthwith comply with such provisions or this permit shall be deemed revoked.
Date: �.• •�,"
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of murk's
correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.)
to building construction,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned property for inspection purposes.(We)agree to save -
indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
costs,and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply ARCII ITECf'S DECLARATION
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. 1 understand my plans shall be used as public records.
Signature Date Licensed Professional
iZo
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
' '10300 TORRE AVENUE •CUPERTINO,CA 95014-3255
CUPERTINO (408)iii-3228• FAX(408)iii-3333•building6cuoertino.orG
OWNER NA PHONE bOC E`MA-bIL�
C b
STRCEr ADDRESSC Y', STATE,Z�14%43 Ci Sol
O FAX
pe
CONTACT NAME PHONE E-MAIL
SritEET ADDRESS Crrt',STATE,.ZIP FAX
❑ OWNER ❑ OWNEII-BUTLOFA ❑ O%VNERAGEIfr CONTa{MR ❑CONIRACrORAGEM ❑ ARCHT ❑ENGMEER ❑ DEVELOPER ❑TENANT
CONTRACT RNAAIE LICENSE.'MBER LICENSE TYPE BUS.LIC.4 3oG
rlk�j
COMPANYNAM E EAU bC OcIt FAX
STREET ADDRESS _ C[1Y.STA IP PHONE
t Cl
ARCHITECTIENGINEER NAME LICENSE NUMBER BUS.LIC.i
COM1mANY NAME E-MAIL FAX
STREET ADDRFSS Crrl',STATE.ZIP PHONE
USE OF ❑ SFD or Duplex Multi-Family. ROOF AREA: VALG TION:
as
STRUCTURE. C] Conunercial 1-Acc n �,0
EXISTMO ROOF TYPE,//❑BUILT-UP ROOF ❑ASPHALT SHINGLES w'OOD SHAKES ❑wOOD smNGLES ❑OTHER(SPECrFYI
REMOVE!REPLACE IF,
❑ n IF /1 N :iC3 PLriYD ❑OSB RC : RWF
❑f. ]S• DX I2
PROPOSED ROOF TYPE: ❑BUILT-0P ROOF 2 ASPHALT SHINGLES Cl WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICCES REPORT C
DESCRIPTION OF WORK: I
By my signature below,I certify W each of the followin=-: 1 am the property owner or authorized agent to act an We properly owners behalf. [have read this
application and the information I have provided is correct. 1 have read de Description of%VorA and verity it is actuate. [agree w comply with all applimble local
ordinances and slate laws relating to buillo�i//ngg coon. I arud�n/zyfrepresenmtives of Cupertino to enter the+albove-idendry:d property for inspection purposes.
Signature of.ApplicandAgent:(A�l rii..i�e� G✓h�J'�� Date: //o�
SUPPLEMENTAL[NFORNLATION REQUIRED OMCE USE ONLY
_
if building is associated with a Home Owners Association,provide letter PL-N CHECK WPE ROUTCIGSLIP
of approval from HOA. ❑ OVER.THE-COUNTER ❑ BUB.DIN'G PLAN REVIEW
—Provide Planning approval to verify if there any restrictions. C1 EXPRESS ❑ PU.WFNG PLAY REv1EW
_Provide copy of Niattufacturer s Installation Specifications. ❑ srANDA" ❑ "RE DEPT
Provide signed copy of Cupettino's Tey-Off Policy. ❑ OTHER:
Reroojipp 20!l.doc revised 03!16!11
o•�
j 2_'Oc [
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 20663 Gardenside Cir DATE: 09/04/2012 REVIEWED BY: Sean
APN: BPH: I 'VALUATION: $6,000
*PERNIIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY Buildina is PENTANUITION 1R2ROOF
USE: Multi-Family Dwelling >3 Stories O Yes O No PERNIIT TYPE:
WORK Remove existing wood shake roofing. Install new Class A composition shingles (Aged Bark
SCOPE
FEE ID ROOFAREA
s.f.
1REROOFMRES 1,200
Aleclr. Plan Check Plumb. Plan Check Flee.Plan Check
,Weclr.Perurlt Fee: Plumb.Pcrnr(I Fee
F(ec•.Permit Gee:
Ocher,Hoch.Insp. Ocher•Plumb Insp. Other F.lce. lnsp.
,Hoch.Imp.[,cc: Phanb. hup. Gee: rice.Imp.Fee:
NOTE: This estimate does not includejees clue to other Departments(i.e. Planning, Puhlic Works, Fire,Sanirapy Sewer District,School
District,etc.). These fees are baser/on the prelintittarl,information available and are adv an estimate. Contact the Dept for addn'I info.
FEE ITEMS (Fee Resolution 11-053 Elf. 7/1/11) FEE QTY/FEE MISC ITEMS
Plan Check Pec:
Supp/. PC Fcc
Phitn b./Aleclr./lace
Permit Fee: $180.00
Supp/. lnsp Fee - T7771
Plumb./11ech./Blee ?
PlumbAl,le(AlElec/'ernlir F'ee:
Construction Tax:
Administrative Fee:
Work Without Permit? Yes Q No $0.00
Advanced Planning FeeS:
Travel Docnnentation Fees:
Strong Motion Fee: IRSEISAtCR $0.60 Select an Administrative Item
Bldg Stds Commission Fee: IRCRSC $1.00
SUBTOTALS: $181.60 $0.00 TOTAL FEE: 1 $181.60
Revised: 07/01/2012
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O.. BUILDING OFFICIAL
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
CUPERTINO (408)777-3228• FAX(408)777-3333•building(Dcupertino.ow
PROJECT ADDRFSS^1 O 3
OWNER NAM ON ^ E-MAIL
STREET ADDRESS CSTATE,ZIP �Q FAX
�p'-
C TRACTO NA. E LICI _ NUMBER UCENSETYP BUS.
`1C t 1 (o -
COMPANYNAME Ji ADDRE-MAI � FAX
STREEr ESS CIro
TY.STATE.ZIP ONE )-1
\/ l C C CEe Ct S241, 99 Q
I UNDERSTAND AND AGREE TO THE FOLLOWING:
1. The re-roof project shall comply with all applicable provisions of the 2010 California Codes.
2. An inspection request can be scheduled up to the day before the inspection date. Please call (408)777-
3228 from 7:30 - 3:30pm,(Mon-Thurs) or 7:30 - 2:30pm (Friday) to schedule the next day 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. Progress
and 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. Progress Inspection is required when approximately 50% of roof covering is installed.
7. 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.
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 S 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: 1 am the property owner or authorized agent to act on the
property owner's behalf. 1 understand and agree to comply with the re-roof policy stated above. 1 also understand that
smoke detectors and carbon monoxide detectors are required to be installed in accordance with Sections R314 and R315 of
the 2010 California Residential Code /
Signatureof Applicant/Agent: Date:_2
RePwDJPo1icv_2011.doc revised 02116111
Building Department
City Of Cupertino
f� I030((0 Torre.Avenue
C'UPERTffYO 1.111\t\Y'IBA. Lt� 11llll_I_�1��
4-08-7-7,76333
CONTRACTOR
CONTRACTOR I SUBCONTRACTOR LIST
JOBADDRI-SS: ' .(- PERMIT#
OWNER'S NAME: PHONE #
GENERAL CONTRACTOR: BUSINESS LICENSE#
ADDRESS. CITY/ZIPCODE: CC, n\)t0k(
*Our municipal code requires all businesses working in the city to have a City of Cupertino. usiness license.
NO BUILDING' FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.•am m' �
not using asubcontractors: 1 R( '�,,� r
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring/Carpeting
Linoleum /Wood
Glass/Glazing
Heating
Insulation
Landscaping
'Lathing
Masonry
Painting/Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date