12090180 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20638 GARDENSIDE CIR CON I'RACI'OR:BRADSHAW ROOFING INC PERMIT NO: 12090180
OWNER'S NAME: KURIAKOSE POULO 1821 S BASCOM AVE PNIB 160 DATE ISSUED:09/192012
OWNER'S PHONE.: 4089961386 CAMPBELL,CA 95008 PHONE NO:(408)2469930
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO: BLDG J ELECT '1 PLUMB —"
License Clas — Lic.# -) 1 3
' h1ECH (- RESIDENTIAL (_ COMMERCIAL (-
Commctor Date
hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REMOVE EXISTING WOOD SHAKE ROOF AND INSTALL
(commencing with Section 7000)of Division 3 of the Business&Professions NEN
Code and that my license is in full force and effect. COMPOSITION SHINGLES(AGED BARK)CLASS A 12 SOFT
hereby affirm under penalty of perjury one of the following two declarations:
1 have and will maintain a cenificate 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 Fluor Area: Valuation:$6000
permit is Issued.
APPLICANT CERTIFICATION APN Number:36232037.00 Occupancy Type:
I certify that 1 have read this application mid state that the above information is
cored.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 harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,the applicad understands mid will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source rwiflations per the Cupertino Municipal Code,Section
9.18.
2 Issued by: . �'Ghr/A� 6ITG� Dale: 9-ad -/d
Signature Date
❑ ON%'NER-RUl LDER DECLARATION
RF.-ROOFS:
hereby affirm that 1 am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is
the follmving two reasons: installed without first obtaining an inspection,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(Sce.7044, O
Business&Professions Code) Signature of Applicant: Dale
I,as owner of the property,am exclusively contracting with licensed contactors to
construct the project(Sec.7044,Business&Professions Code). AL1,ROOF COVERINGS TO BE CLASS"A"OR BETTER
hereby affirm under penalty of perjury one of the following three -
Ideclarations;
have a d mi D A7„ARDOUS MATERIALS DISCLOSURE
I have and will maintain a Cenif¢ate of Consent to self-insure for Worker's -
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 S Safely Code.Sections 25505,25533,and 25534. I 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 S
Section 3700 of the Labor Code,for the performance of the work for which this Safety Code.Section 2.5532(x)should I store or handle hazardous material.
Additionally,should I use equipment or devices which emit hazardous air
permit is issued. contaminants as defined by the flay Area.Air Quality Management District 1 will
I certify that in the performance of the work for which this pernit 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 Health S Safety Code.Sections 25505,25533,and 25534.
Compensation laws of California. If,after making this certificate of exemption,I
become subject to the Worker's Compensation provisions of the Labor Code.I must 0 emir/a�Jt1n izeJ //'`��l
forthwith comply with such provisions or this permit shall be deemed revoked. `` J'� Date: /q�flltll
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
I certify that I have read this application and slate that the above infor moon is I hereby affirm that there is a construction lending agency forthe performance of work's
cored.1 agree to comply with all city and county ordinances mid state laws relating for which this permit is issued(Sec.3097,Civ Q
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 againsi liabilities,judgments, Lender's Address
costs,and expenses which may accrue against said City in consequence of
granting of this permit.Additionally,the applicant understands and will comply ARCIIIT'ECI"S DECLARATION
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. I understand my plans shall be used as public records.
Signature Date Licensed Professional
l
REROOP PERMIT APPLICATION
►r1 y
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO.CA 95014-3255
CUPERTlNO (408)777-3228• FAX(408)777-3333 •buildina(dcuoertino.am
PROn:CT ADORFSS7 G`Z a ` n APN, ^�
J b � Ji 1
OWNER NAA 1 PHON ti E-MAIL
STREET ADDRESS^O 3(Z' C (_ 1 S 1 CI STATE.ZIP
CONTACT NAME PHONE
� d PHONE T E-MAIL
STREET ADDRESS CITY,STATE, ZIP FAX
❑OWNER ❑ OVINlift-BUTI.DER ❑ 0%\ RAGEIR EFIICOUCTOR ❑CONTRACTORAGENT ❑ ARCKJTECT ❑ENGINEER ❑ DEVEJAPER ❑TENANT
CONTRACT RNAM1IE LICENSE Ad3ER12 C� LICENSE TYPE Bus. 30
COMPANYNAA¢ E-NLA �C nC FAX
STREET.ADDRESS CRY',STATE IP PHONE
kL
r -qAn
ARCHITECTIENGNEER NAME LICENSE MID®ER BUS.LIC.a
COMPANY NAME - EdlAIL FAX
STREET ADDRESS CRY,STATE ZIP PHONE
USE OF ❑ SFD or Duplex ROOF AREA: `3 �Q
STRUCTURE ❑ Commercial 7' ��//
EXISTINGROOFTYPE:...,,//❑BUILT-UPROOF ❑ASPHALT SIi1NGLES bLVV'pOD SHAKES vOOD SHINGLES ❑OTHER(SPECIFYI
REMOVE rdEPLACE CrYEi IFNO- ❑ PLMD 11 OSB .PrrCH: :12 ROOF
1AEcs
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF R ASPH.0 T SHINGLES ❑WOOD SHAKES- ❑WOOD SHD:GLES ❑OTHER ICC-ES REPORT a
DESCRIPTION Olerkl ` -
f 1
By my signature below,I certify W each of the follOM I: I=the property owner or authorized agent to act on the propctn•owner's behalf. l have read this
application and the infomotion I have provided is correct. I have read dN Description of%VorR and verify it is accurate. I agree to comply with all applicable local
ordinances and sram laws relating to buil�in,�con Ian. 1 au riz epresentativa of Cupertino to enter the IdYo//ve�-Yidentif//fi�dd property Cor inspection purposes.
Signarurcot'ApplicandAgenr. Ut&J Date: 71oC
SUPPLE6fENT AL INFORh'L4TION REQUIRED OFFICE USE ONLY
_If building is associated With It Home OYcners Association,provide letter PLAY CHECK WPP ROVTING SLIP
of approval from HOA. (7�' OVER-THE-COUNTER QIP/-.�A BUB-DING PLAN REVIEW
Provide Planning approval to verify if[hero any restrictions. ❑ ECPRES- PLANNING PLAN REVIEW
_Provide copy of Manufacturcr s Installation Specifications. ❑ STANDARD ❑ FIRE DEPT
Provide signed copy of Cupenino's Teal'-Off Policy. ❑ OTHER
Reroof4pp_2011.doc revised 03:16/11
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 20638 GardenSide Cir. DATE: 09/19/2012 REVIEWED BY: Sean
APN: BP#: `VALUATION: $6,000
*PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Duplex PENTAMLA9'ION 1SFDWLROOF
USE: PERMIT TYPE: Al
NVORK Remove existing wood shake roof and install new composition shingles (Aged Bark).
SCOPE
FEEID ROOFAREA
s.f.
1REROOFFRES 1,200
rilech. Ilan Check Phmrh. Plan Check Flee. Plan Check
Mech.Permit Fee: Plump. Permit Fee: Frt.Permit Fee:
Other,Vcch. ln.sp. Ocher Plump Insp. L1 I Other Elce.Insp.
E37-
Me.ch.lap. Fee: Plumb. htsp. Fee: Elee.Insp.Fee:
NOTE: This evintate does not include jecv clue to other Departments(i.e. Planting, Public Warks, Fire,Sanitary Sekver District,School
District,etc. . These eev are based on the prelindnan information mailable and areonh,an estinmte. Contact the Det for acldn'l info.
FEE ITEMS (Fee Resolution 11-053 E!L 7/1///I FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Sappl. PC Fee
Phonb./dlech.11 lec
Permit Fee: $180.00
Suppl. hisp Fee
Phtnrh./hiech./Flet
Ph nth.hblech./Elec Permit Fee:
Cmtsriwciion Tax
Administrative Fee:
Work Without Permit? O Yes Q No $0.00
Advanced Planning Fees:
Travel Documentation Fees:
Strong, Motion Fee: IBSEISMICR $0.60 Select an Administrative Item
131dg,Stds Commission Fee: 1BCBSC $1.00
SUBTOTALS: 1 $181.601 $0.001 TOTAL FEE: $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•buildino(a)cupertino.ora
PROJECT ADDRESS _ APNu
-
OWNER NAME PHO E-MAIL
co 10 \ 4 Li R
STREET ADDS I CITY. In ZI �(n Q �� FAX
'TRACTO NA, E C t LICENSE NUM B LICENSE TYP BUS.LIC.0
COMPANY NAME E-MAI FAX `� - _ 4y3
STREET ADDRESS ; C� CITY.STATE,ZIP 1 24 6
HONE
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 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: 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. 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 C
Signature of Applicant/Agent: ode Date:
RemoJYolicv_2011.doc revised 0211611!
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t , Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228 '
C U P E RT I N O Fax: 408-777-3333
y' CONTRACTOR / SUBCONTRACTOR LIST
JOBADDRESS: �\C PERMIT#
OWNER'S NAME: PHONE #
GENERAL CONTRACTOR: BUSINESS LICENSE # q
ADDRESS: /1'11 CITY/ZIPCODE:
*Our municipal code requires all businesses working in the city to have a City of Cupertino business 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.
1 am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring/Carpeting
Linoleum / Wood
Glass / Glazing y
Pleating
Insulation
Landscaping
Lathing
Masonry
Painting./ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date