12080165 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20661 GARDENSIDE CIR CONTRACUOR:BRADSIiAW IZOO17ING 11IiRMIITNO: 12080165
INC
OWNER'S NAME: ASIS K S ROMA 13ASU 1821 S 13ASCONI AVE PMB 160 DATE ISSUED:08/l7/2012
OWNER'S I'IIONE: 4088630053 CAMPBELL,CA 95008 PHONE.NO:(408)246-9930
❑ LICENSED CflY1R.\CI'OR'S DECLARATION
.IOB DFSC.RIPPION: RESIDEN HAL❑ COMIMIERCIAI.
License Clas. TEAR OFF EXISTING SHAKE AND INSTALL 12 S RS
' Lie.q F.J Q
, CLASS
Contractor Gf�S NCi.✓ Date
A ASPHALT COMP SHINGLES, COLOR ACED BARK
1 herehr allirm that 1 am licensed under the procisions 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 alfrm under penalty of perjuy one of the following two declarations:
I have and will maintain a cenifcate 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 whichlhis permit is issued. Sy.Ft Floor Area: Valuation:$6000
1 have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for Cie performance of the work for which this
AI'V Number:36232023.00 OccupancyType:
permit is issued.
A I'I'LICANI"CERTIFICATION
I certify that I have read This application yid state Oma the above infomhationis PERMIT EXPIRES IF WORK IS NOT STARTED
correct.I agree to complywith all city and county ordinances and stace 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 1$0 CiDAV OM LAST CALLED CALLED INSP t CTWN.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the /
grinning of this permit. Additionally,the applicant understands mad will comply Issued by: Date:
with all non-point sourc regulations per the Cupertino Municipal Code,Sectio
9.18.
RE-ROOFS:
Signatur Date g l 7k12 All roofs shall be inspected prior to any roofing material being installed If a roof is
installed withohu first obtaining an hasp•-tion,I agree to remove all new materials for
inspection.
ClO\\'VIS It-I3IIILUISK DGCL.Ut,\'PION
herehr affirm that 1 am exemptfrom the Contractor's LicenseLaw Formic of Signature of Applicata Date: & /
the following two reasons: ALL ROOF COVERINGS TO 13E CLASS"A"Olt BFITER
I,as owner of the property,or my enployees with wages as their sole conhM1nsation,
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business 8•Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIA1 S DISCLOSURE
construct the project(See.7044,Business R Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Ilealth S Satiety Codc.Sections 25505.'_5533,and 25534. 1 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&Salety Code,Section 25532(x)should 1 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 hanmdous
Compensation,as provided for by Section3700 of the Labor Code,for the air comanihmnts as defined by the Bay Area Air Quality Management District
performance of the work for tyhichlhis permit is issued. will maintain compliance with the CupertinoMunicipal Code.Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Ilealth&Safety Code,Sections 2 50 ,25533,and 2553
Section 3700 of the Labor Code,for Che performance of Che work Ibr which this U1
Owner or authorized agent: _ Datr.
pemhit is issued.
1 cenify 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 cenificate of exemption,I CO,NSTRUC-FION LENUI VG AGENCM'
become subject to the Worker's Compensation provisions ohne Labor Code,I must I hereby affrtn that there is a construction lending agency for the perfonnace of
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this pemhit is issued(Sec.3097,Cie C.)
Lender's Vame
APPIACANf CERTIFICATION Lender's Address
I certify that I have read this application mid 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)agrm to sure
indemnify and keep harmless the City of Cupertino against liabilities,judgments, A RCI I ffECI"S DECLARATION
costs,and expenses which may accrue against said City in consequence of die I understand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with all nom-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Dale
2.�'��-��`y�"�"¢J.fK` `l'+• .i�:�G.�.t3C4.. - � --.-s�3m��a�ca - ��u
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
GUPERTINO 10300 TORRE AVENUE - CUPERTINO,CA 95014-3255
(408)777-3228• FAX(408)777-3333-buildingrDcupertino.org
PROJECTADDRE55� / /G( APN4 O � - - 0 3
OWNER.FAME PHONE E-MAIL
QO q(.3— cd,-
STREET ADDRESS CIN, STATE ZIP FAX
C 0 914
TMCTO NA1E LICEN5ENUM E LICENSE TYP BUS.LIC.0 O
1L l
IR 6
COMPANYNAME E-MAI ICY= FA%
77 - 0`-) cA,3
S ETADOaeFMCITY.STATE.ZIP 1 ONE
V
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$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: I 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
Signature of Applicant/Agent: Date:
RerooJPolict2011.doc revised O2/16/11
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 20661 gardenside circle DATE: 08/1412012 REVIEWED BY: bobs.
APN: BP#: / O > `VALUATION: $6,000
*PERMITTYPE: Building Permit PLAN CIIECKTYPE: Alteration / Repair
PRIMARY PENTANIATION
SFD or Duplex 1SFDWLR00F
USE: PERMIT'1'1'PE: �
WORK remove existing shake install comp shingles. :la . Cl `
SCOPE
Alech.Plan Check Plumb. Plein Check Flee. Plan Check
Mesh. Permit Fee. Plumb.Pcr•nrii Fee Elec. Permit Fre:
Other'Vech.Insp. Other Plumh/nap. Other Elec.Grsp.
dlech. /mp. Fee: Plurrrb. /n.cp.Fee: Elev.Lap.Fac:
NOTE: This eatinuue does not include fees due to other Departments(i.e. Planning, Public Narks, Fire,Sanitary Server District,School
District.etc.). These eev tire based on die prefintinan•information available and are onb•an eslim te. Contact the Dept for addh'I in a.
FEE ITEMS (Fee Resohuion 11-053 Eff 7/1/11) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 1,200 s.f. Re roof
Suppl. PC Fee: (D Reg. Q OT 0.0 hrs $0.00 $180.00 IREROOFRES
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee@ Reg. Q OT O.p hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Cousimction Tax:
Administrative Fee: O
Work Without Permit? O Yes Q) No $0.00 E)
Advanced Plannine Fee: $0.00 Select a Non-Residential E)
Travel Documentation Fees: Building or Structure
i
Strong Motion Fee: IBSEISMICR $0.60 Select an Administrative Item
Blde Stds Commission Fee: IBCBSC $1.00
SUIITOTALS: $1.60 $180.00 TOTAL FEE: $181.60
Revised: 07/01/2012
REROOF PERMIT APPLICATION _.
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 's=
10300 TORRE AVENUE•CUPERTINO.CA 95014-3255
C U PERT!IJ O (408,777-3228• FAX(408)777-3333•buildinO(okuoertino.orO
PROJECT ADDRESS APN a
OWNER NAGE S,5 V ` V PHONE yGO 0673 E-0WIL
STREETADDRE(S,Si.C STATE V O ].J FAX
CONTACT NAME PHONE E-¢Lin
STREET ADDRESS CITY.STATE. ZIP FAX
❑OWNER ❑ OWM-BLTLDER ❑ OWNERAMIT CONTRACTOR ❑cONTRACrOR AGENT ❑ AACFIIECT ❑E GRJEER ❑ DEVELOPER ❑TENANr
CONTRACr RNAAE LICENSENUMBER LICENSETOPE BUS.LIC.d ^c/ t-•
��
C&PANYNAME E-NLA VC �� FAX _ C J
STREET ADDRESS CT',STATE ZIP PHONE
n
ARCHITECBENCH EER NAME LICENSE NUam ER BUS.LIC.0
CObflA.NY NANM E.TAIL FAX
STREET ADDRESS CITY,STATE ZIP PHONE
USE OF ❑ SFD or Duplex ❑ htuhi•Fatnily aWFAREA: vuu.a,1lON:
STRUCTURE. ❑ Conunercial .�..�� a C31 =n
ECISTINGROOFTYPE:'/OBUILT{PROOF ❑ASPHALT SHINGLES QS"ODD SNAKES ❑WOODSHENGLES ❑OTHER(SPECffYJ
REh10VE(REPLACE (Si't"ES [F NO.
/,tI PLriY00D t5" ❑ PLYRD ❑JSB PITCH:
ROOF
❑ a c. 1� K� S.• ❑ "" ❑ D. :12 A
PROPOSEDKOOFTYPE: ❑BUILT-UPROOF ASPHALT SHINGLES 13 WOOD SMAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT
DESCRIPTION OF WORK: C-..
By my signature below,I cerdry to each of the following: I am the property owner or authorized agent to act on the propem,owner's behalf. I have read this
application and the information[have provided incorrect. I have read the Description of Wort:and verify it is actuate. I agree to comply swith all applicable local
ordinances and slam laws mladng In bu�ll//QQm/$ o ion. I aul odz presenmdves of Cupertino to enter the Rho
/ve-identifJ{ed property for inspection purposes.
SignatureofApplienadAgenD„t&Fj1 C= Date: 71� / �n}Z
SUPPLEMENTAL INFORMATION REQUIRED OFFICE USEONLY
_If building is associated%vith n Home Onver's Associadoo,provide letter PLAN CHECK TITS ROUTING SLIP
of approval from HOA. ❑ OVER-TRE-COUNTER ❑ BUILDING PLAN REVIEW
_Provide Planning approval to verity if there any restrictions. ❑ EXI�RESs ❑ PLANNING PLANRMEW
_Provide copy of Manufacturers Installation Specifications. ❑ NANDA_RB ❑ FTRE DEPT
Provide sisrled copy of Cupetdno'i Tear-Off Policy. ❑ OTHER:
Rerooj4pp_2011.doc revised 03.•'16:'11