11090051 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22687 ROYAL OAK WAY CONTRACTOR:DRAEGER PERMIT NO: 11090051
CONSTRUCTION INC
OWNER'S NAME: SHIVKUMAR JAYARAMAN&DEEPA BALAKRI 605 COMMERCIAL ST DATE ISSUED:09/13/2011
'JNER'S PHONE: SAN JOSE,CA 95112 PHONE NO:(408)536-0420
❑ LICENSED CONTRACTOR'S DECLARATION
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BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class C-SO # 6- F
"d
�,��� MECH RESIDENTIAL COMMERCIAL
Contractor �2 ')]�U(I IUj Date
I hereby affirm that I am licensed under the provisions o Chapter 9 JOB DESCRIPTION:SFDWL REROOF,12 SQ,TEAR OFF SHAKE ROOK,
(commencing with Section 7000)of Division 3 of the Business&Professions INSTALL
1/2"CDX RADIANT BARRIER,INSTALL PRESIDENTIAL TL
Code and that my license is in full force and effect.
ASPHALT SHINGLES. INSTALL SHINGLE VENT(RIDGE
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.
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
permit is issued. Sq.Ft Floor Area: Valuation:$9400
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is APN Number:34232028.00 Occupancy Type:
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
indemnify and keep harmless the City of Cupertino against liabilities,judgments, PERMIT EXPIRES IF WORK IS NOT STARTED
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR
with all non-point source regulations per th upertino Municipal Code,Section 180 DA S FROM L ALLED INSPECTION.
9.18. -1
Signature - Date Issued by: Date:
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS:
the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
1,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agreetp remove all new materials for
will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection.
Business&Professions Code) �
I,as owner of the property,am exclusively contracting with licensed contractors to Signature VofA licnt: Date:
construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
declarations:
1 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
performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the
1 have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
Section 3700 of the Labor Code,for the performance of the work for which this compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Safety Code,Section 25532(a)should I store or handle hazardous material.
permit is issued. Additionally,should I use equipment or devices which emit hazardous air
I certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I will
not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Compensation laws of California. If,after making this certificate of exemption,I Health&Safety Code,Sections 25505,25533,and 25534.
become subject to the Worker's Compensation provisions of the Labor Code,I must
forthwith comply with such provisions or this permit shall be deemed revoked. Owner or auth zed ag
� Date:___
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
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 I hereby affirm that there is a construction lending agency for the performance of Nork's
to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.)
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name
i-' -nnify and keep harmless the City of Cupertino against liabilities,judgments,
and expenses which may accrue against said City in consequence of the Lender's Address
g.W,ting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION
9.18.
1 understand my plans shall be used as public records.
Signature Date
Licensed Professional
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO, CA 95014-3255
(408)7-7-3228•FAX(408)777-3333 • building(a�cuperrino.org
CUPERTINO
PROTECT ADDRESSA C4 V" APN 9 ,� G r%
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OWNER NAME.A YT4 9A�Av J M��I14�JA��I-" a10^ 161
STREt-I'ADDRESS O �� r CI Y. STATE,ZIP / )n o ^A
APPLICANT NAME v PHONE (f E-MAIL
STREET ADDRESS - CITY
STATE,ZIP ' F
❑OWNER ❑ OWNER-BUMDER ❑ COWNER AGENT ❑ CONTRACTORCONTRACTOR AGENT E3 ARCHITECT 1:1ENGINEER ElDEVELOPER ED TENANT
CONTRACTOR N LICENSE NUMBER/1? )® LICENSE TYPES BUS.LIC.9Z
COMPANY NAME / i ` E-MAIL jj FAX
STREET ADDRESS !v l_ CITY,STATE US c q5l]Z- PHO �
ARCHrTECT/ENGINM NAN E LICENSE NUMBER!/` BUS.LIC.4
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE of SFD or Duplex ❑ Multi-Family ROOF AREA: VALUATION: _ _
MUCTURE: ❑ Commercial I"UX)
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EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES AVOOD SHAKES ❑WOOD SINGLES ❑OTHER(SPECIFY)
REMOVE/RIPLACEKYES IF NO. PLYWOOD '/" ❑ PLYWD ❑ OSB PTrCIi ROOF
E3NO 9 LAYERS: THICKNESS: 135f8" TYPE: CDX '12 CLASS: A
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF AASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT 9
DESCRIPTION OF WORK jr
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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's 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 au rize r ntatives of Cupertino tc entcr the above-identifiedpropert;for inspection purposes.
Signature ofApplicant/Agent 7 Date:
SUPPLEMENTAL INFORMATION REQUIRED = _ - y - — - — -
_If building is associated with a Home Owner's Association,provide letter
of approval from HOA '
_Provide Planning approval to verify if there any restrictions. - - _- R --�EV _ te—P,
=r= te T=�-�..=���� �=-�-�•__-- ,�.�,==��. �:
Provide copy of Manufacturer's Installation Specifications.
y. — _-_ =. �.•r.--== OTHG`� __<_=-._ z=
Provide signed copy of CuP ertinG's Tear-Off Polio
ReroofApp_201 Ldoc revised 03/02/11
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(a-cupertino.org
PROJECT ADDRESS 6,3-0
,3 f0 r J\ / APN k
OWNER NAME r � V PC- PHONE qtl. E-MAIL
CITY, STATE,ZIP i n FAX
STREET ADDRESS ( I ]fir LK V'
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CONTRACTOR NAME rG1` l� �ICENSE NUMBER LICENSE TYPE BUS.LIC.#,�i
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHON d 6-ofl)
r
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 1/" 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. 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 2010 California Residential Code.
Signature of Applicant/Agent: A/� Date:
h Ad - I
ReroofPolicy_2011.doc revised 02/16111