B-2017-1493 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1493
10473 JOHNSON AVE CUPERTINO,CA 95014-3862(375 17 046) NEXGEN
CONSTRUCTION
CORP
SAN JOSE,CA 95116 '
OWNER'S NAME: AGRAWAL ADITYA AND CHUNG MIINI Y TRUSTEE DATE ISSUED:09/07/2017 '
OWNER'S PHONE:408-221-4214 PHONE NO:(408)768-6529
_ .. I •. U 6 1'_ 1. _ •. BUILDING PERMIT INFO:
License Class,l3 Lic.#929390
Contractor NEXGEN CONSTRUCTION CORP Date 03/31/2019 X BLDG _ELECT X PLUMB
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
license is in full force and effect. JOB DESCRIPTION:
REPLACE SEWER MAIN;.REROOF;TEAR OFF;INSTALL OSB;
I hereby affirm under penalty of perjury one of the following two declarations:' COMP SHINGLES(25 SQ) '
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
''ormance of the'work for which this permit is issued.
I,k 4,` I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of theLabor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$1500.00
APPLICANT CERTIFICATION
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 APN Number: Occupancy Type:
and state,laws relating to building construction,and hereby authorize 375 17 046
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,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
' Additionally,the applicant understands and will comply with all non-point
' source regulations�rtthe C�upertinoMunicipal Code,Section 9.18. 180 DAYS FROM LAST CALLED'INSPECTION..,
ature / C Date 9/7/2017 Issued by:ABBY AYENDE
Date:09/07/2017
• OWNER-BUILDER DECLARATION
I hereby;affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS:
following two reasons: •': All roofs shall be inspected prior to any roofing material being installed.If a roof is
t.• ' I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to removeall new materials for
compensation,will;do'the work,and the structure is not intended or offered for inspection.
' sale(Sec.7044,Business&Professions Code)2. I,as owner of the property,am exclusively contracting with licensed jr 'fan' e of Applicant:
•
contractors to construct the project(Sec.7044,Business&Professions Code). Date:9/7/2017
I hereby affirm under penalty,of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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
' performance of the,work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
2. I have and will,maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the
' ,; Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. I will
permit,is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
3. ,I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store or handle hazardous
material. Additionally,should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the
' � air contaminants as defined by the Bay Area Air Quality Management District I
I ' i Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of;the the Health&Safety Code,Se ons 25505,25533,and 25534.
' Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. i 0",i -er or authorized agent:
,APPLICANT CERTIFICATION
Date:9/7/2017
I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY
correct.I'agree to comply with all city and county ordinances and state laws , I hereby affirm that there is a construction lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued,(Sec.'3097,Civ C.)
to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments,costs,and expenses which may accrue against said City in Lender's Address
consequence of;the granting of this permit. Additionally,the applicant understands ARCHITECT'S DECLARATION
and,will comply with all non-point source regulations per the Cupertino Municipal
Code,Section 9.18. I understand my plans shall be used as public records.
Licensed
Signature Date 9/7/2017 Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
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to,
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
y:lvs. 1q43
- w (408) 777-3228 • building@>cupertirto.org PEMIT#B- �"
CUPERTINO REV# "DEF#
❑ NEW CONSTRUCTION ❑ADDITION ZLTERATION ❑T.I. 12/MEP ❑RE-ROOF ❑SWIMMING POOL/SPA
PROJECT ADDRESS I 0 tlo .-/CU�IVSTi A rt, APN# 3eiS q. FV lc
OWNER NAME
Dr 1 1' �'I IY`"F�t/°Plc--- . PHO 1F- !'/ 2Z)-4 21 9 E-MAIL Qa G{.�NInvM 1.1.01 e. Aloe, "
STREET ADDRESS ITY, STATE,ZIP
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Jam' 2f 34 S CAN) Izuv D {{_C -�ir0 COPEP-T/V di eA- a sD
)CONTRACTOR NAME (OWNER-BUILDER COMPAINY NAME LICENSE NUMBER LICENSE TYPE '
_O y—_ ;t/1. E-A-C--7J ez/\A (• 61/q;10 Ceemi -
STREETA = +5— -- - --- dy CITY.STATE.TIP
tom_
E-MAIL --. -. I PuONE 1, BUS.LIC II L-
0 ARCH ITECS WNER ❑OWNER AGENT CONTRACTOR AGENT ENGINEER 0 DEVELOPER 0'TENANT
CONTACT NAME E-MAIL
STREET ADDRESS CITY,STATEIZIP . PHONE '
,
a
DECRIPTO(^
4N1 TPr(--i- C►T^( C 1 rft3 0 UT p( ;&E r LACE D iG C> YAP°. Suwi
. L,Nic--- Zelibt I. 1 . . ,
t3tiSINGLE-FAMILY/DUPLEX 0 MULTI-FAMILY 0 INDUSTRIAL 0 COMMERCIAL I
EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES I TOTAL NET SF USE I TYPE :OCC SQ.FT. VALUATION($)
REMODEL REMODEL KITCHEN ' REMODELOTHR GARAGE ❑ATTACHED
BATHROOM SF - SF i SF SF 0 DETACHED
EXISING ❑YES EICHLER ❑YES SECOND STORY ADDTIION ❑YES
FIRE SPRINKLERS 0 NO ❑ NO 0 NO '
DWELLING SECOND,DWELLING ❑YES 0 ATTACHED 0 DETACHED OTHER
UNITS I UNIT ADDITON: ❑NO - - S F
POOLS! 0 FIBERGLASS ❑jViNYL=LINED ❑,GUNITE 0 PREFABRICATED „ I!
POOL-SF SPA-SF I SPA ATTACHED❑YES 0 NO • 'I TOTAL-:SF' '- '
•`!� RE- VEDBY:
T TAL VALUATION:
Commercial or Mull:Fanuly Buildings with h Public Soiiumins Pools requires Department of Environmental'Heath approval cL f.1 i ��PP J 1 j0
l�
RE-ROOF]EXISTING,ROOF TYPE' ❑BUILT-UP ROOF❑ASPHALT SHINGLES WOOD SHAKES❑WOOD SHINGLES /`_OTHER(SPECIFY)
REMOVE/REPLACE El,NO IF NOS ', PLYWOOD ❑3/8" ; 1 PLYWOOD TYPE: PITCH:e ROOF CLASS
YES P El LAYERS THICKNESS 5/8" OTHER i ❑OSB ❑CDX OTHER 12 A
PROPOSED ROOF❑BUILT-UP ROOF (]ASPHALT SHINGLES 0 WOOD SHAKES(]WOOD SHINGLES 0 OTHER I
*Provide a signed copy of the,Cupertino`s Tear-Off Policy H; ' SF #of SQUARES
By my signature
l':
elow 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 Phave read the Description of Work arid verify it is accurate.'I agree
to comply with all applicable local:ordinances and state laws relating ;o`building construction. I authorize representatives of Cupertino to
enter the above-identified property for inspection purposes. I acknowledge;and authorize all information contained on this application form
to be made available for public recor ti :; i
Signature of Applicant/Agent: e P\ 1 i :I,, Date 9 t
�.
7 1 -
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SUPPLEMENTAL INFORMATION REQUIRED
*New SFD/Second Dwelling Uriits/Multifarrlily Dwellings:A Demolition permit i 'required prior to issuance of a building permit for,all new construction.
*Commercial Buildings: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project.
*Copy'of Planning Approval Letter or Meeting with Planning prior to submitta ofIBuilding Permit application, •
*HOA-Provide a letter of approval;from the Home Owner's Association t1 P:. '
. BldgApp_2017.4oc revised 08/01/17
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.v,cfp, REROOF TEAR-OFF POLICY , '
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
ALBERT SALVADOR, P.E.,C.B.O.,BUILDING:OfFiC1AL
.A.11WV
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINO I • .
(408)777-3228•FAX(408)777-3333•building( cypertino:org
, .„„„„ —.... . „. . .,...... .
FRoJECT ADDRESS
tot-173 '30 Of's; PrV- CuPEAZTvvo
i
OWNER NAME . I E-MAP
A.0 "NA PPNl'.',Prupr,,s-ç _-:-__ 1 _ g – 2:2.1 – 12.u1
STREET ADDRESS CITY, STATE,ZIP i FAX
'.,.i . K."- : u t.W.Fo f24. p CUP E 71 No
i
CO^Int A4CTOR NAME ' NSF I.4IIN,),II 1 1,4C_ENSE T'PF ,. BUS.LW.if .
i 1 U1' DaLitZsavki Im g, el el° I CreikkAzoil ' ; .
COMPANY NAME E-MAIL FAX
MEM'ADDRESS CITY,STATE,ZIP PHONE
•
, . I UNDERSTAND AND AGREE TO TRE FOLLOWING:
I. The re-roof project shall comply with all applicable provisions of the 2016 California Codes.
2. An inspection request can be scheduled up to one business_ 2iested ins ectfon.date.
To schedule inspections call (408) 777-3228 from 7:30:.-330Pin(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 out to the
job site within one hour. The hours for this service are: 7:30-10:30ant 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.
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3. Tear7Off Inspection is required. Any and all dry-rotted wood shall be replaced prior to this inspection.
linleS new!plywood roof sheathing is proposed throughout, all the nails/fasteners shall be either
completely knocked-down or removed prior to this inspection.
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4. . 'It plywood is installed, a plywood Nailing Inspection is required,
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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 tj,emoval. of all new material down to the sheathing so a proper inspection can be performed.
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6. 'A Final InsPection and approval shall be obtained front fl building inspector when the re-roofing is
Conipleted. To receive a.final sign-Off,the following henswill be.verified:
,
a.' Flat roofs shall have a minimum of¼"per foot of Slope and demonstrate there is no ponding.
b. Listings from approved testing agencies for all pre,manlifactured 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 rd-inspection.fee. The re-inspection fee shall be Paid before another,inspection can be
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scheditled.
By My Sluing below, 1 certify each of the following is true I am the property owner or authorized agent to act on the
property Omer's behalf. I understand and agree to comply,with the re-roof policy stated aboye. I also understand that
smoke detettors and carbon monoxide detectors are required to be installed in accordance with Sections R314 and R315 of -:
the 2616 California Residents Code. A_
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. i--Siari4ttr of,AppIicintAgopt ,,,..:53--...n:-- Dare: 3--.---7, ------- .
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. . RerooPoliey2014.doc revised 06/017
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