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13060160 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20065 CEDAR TREE LN CONTRACTOR:MILLERS ROOFING PERMIT NO: 13060160 OWNER'S NAME: SIVA PANCHANATHAM 2246 LOS GATOS ALMADEN RD DATE ISSUED:06/20/2013 OWNER'S PHONE: 4082035032 SAN JOSE,CA 95124 PHONE NO:(408)356-6211 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIAL11 License Class_ L-ic..# �rU l TEAR OFF(E)WOOD SHAKE,INSTALL(1)OSB,30 LBS �C < Date l�'0�0 —�� FELT&40 YR COMP Z a Contractor��i �fS -11 - 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. 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. Sq.Ft Floor Area: Valuation:$10360 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 APN Number:31634003.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF T 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 180 DAYS FR LED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, / costs,and expenses which may accrue against said City in consequence of the Issue ate b granting of this permit. Additionally,the applicant understands and will comply with all non-points ce reguI tions per the Cupertino Municipal Code,Section 9.18. 1 RE-ROOFS: Signature Date —d(�^�G(� All roofs shall be inspected prior to any roofing material being installed.If a roof is installed without first obtaining an insp ction, gree to remove all new materials for inspection. ❑ OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVE INTO BE CLASS"A"OR BETTER I,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,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&Safety Code,Section 25532(a)should I 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 hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Pd. Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections05, 33,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date: ^' permit is issued. I certify 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 CONSTRUCTION LENDING AGENCY 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 I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 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 to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date REROOF PERMIT APPLICATION bo COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION (�`0` 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 oYJ CUPERTINO (408)777-3228•FAX(408)777-3333•building(cD-cupertino.org n PROJECT ADDRESS © �� APN# r / I (/ O 03 OWNER NAME S \ V V\C' L,405-,10 - E-MAH STREET ADDRESS r c)O �� Ir /r� CITY,STATE,ZIP V FAX CONTACT NAME of ' PHONE E-MAIL STREET ADDRESS LOSC��(q C r�CI ,STATE,ZI$ 2 FAX ❑OWNER ❑ OwNER-BUILDER ❑ OWNER AGENTCONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHrTECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME rlc"N LITNSEWIJO LIC NSE TYPE BUS.LIC.# 56 COMPANY NAME ` �l ` E-MAIL FAX STREET ADDRESS^Z JeG �VS CTTY,STATE,ZIP a� /� PHONE rAL ARCHITECT/ENGINEER NAME LICENSE NUMBER (- BUS.LIC.# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF P5,,SFD or Duplex ❑ Multi-Family ROOFAREA: TATION: STRUCTURE: ElCommercial ! O EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES AWOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY) REMOVE/REPLACE YES IF NO. PLYWOOD ❑%z" ❑ PLYWD t OSB PITCH: ROOF ❑ NO #LAYERS: THICKNESS: 115/8" TYPE: ❑ CDX '12 CLASS: APROPOSED ROOF TYPE: 11BUILT-UPROOF ASPHALT SHINGLES El WOOD SHAKES 11 WOOD SHINGLES ❑OTHER ICC-ES REPORT# DESCRIPTION OF WORK: 111 ��` k Woo A�. tis a � k VN. 4b VC, 9A 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 hav rovide 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 t ild7gnstruction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature ofApplicant/Agent: � Date: b 0 SUPPLEMEN AL INFORMATION REQUIRED OFFICE USE ONLY _If building is associated with a Home Owners Association,provide letter PLAN CHECK TYPE ROUTING SLIP of approval from HOA. OVER-THE-COUNTER ❑ BUILDING PLANKV*IEWProvide Planning approval to verify if there any restrictions. ❑ EXPREss ❑ PLANNING PL Provide copy of Manufacturers Installation Specifications. ❑ STANDARD ❑ FIRE DEPT Provide signed copy of Cupertino's Tear-Off Policy. ❑ OTHER: ReroofApp_201].doe revised 03116111 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 20065 CEDAR TREE LN DATE: 06/20/2013 REVIEWED BY: MELISSA APN: 316 34 003 BP#: *VALUATION: 1$10,360 *PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof PRIMARY SFD or Du lexL PENTAMATION 1SFDWLROOF USE: P PERMIT TYPE: WORK TEAR OFF E WOOD SHAKE INSTALL N OSB 30 LBS FELT&40 YR COMP SCOPE FEE H) ROOF AREA s.f. 1REROOFFRES 2,$00 Mech. Plan Check Phin1b. Plan Check F_Iee.Plan Check iWch..Permit Fee: Plumb.Permit Pee: Elec. Permit Fee: Other;Meeh.Insp. Cather Phrmh Insp. Li Other Elec,Insp. A3ech,Insp.Fee: Plumb. Ins].Fee: Elec.Insp. Fee: NOTE:This estimate does not include fees due to other Departments(La Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). These ees are based on the prefindna information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/12) FEE QTY/FEE MISC ITEMS Plein Check Fee: Suppl. PC Fee Pluinh.A/tech.;EIec Permit Fee: $420.00 .Suppl. Insp Fee Plumb./Mech.lEtee Plumb./Mech.%Ele c Perm it F'ee: Conso-ztction :Tax. A.dlnlnistrative.ee: Work Without Permit? ®Yes (E) No $0.00 Advanced Plat'rtting Fees: Travel Docuine>ntution Fees: A Strong Motion.Fee: 1BSEISMICR $1.04 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 - $422.04 $0.00 � $422.04 �' Revised: 04/29/2013 REROOF TEAR-OFF POLICY COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION ALBERT SALVADOR,P.E.,C.B.O.,BUILDING OFFICIAL CUPERTINO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228-FAX(408)777-3333-building(ftupertino.org PROJECT ADDRESSG© Ar 'ra O �- APN# OWNER NAME 1 E-MAIL vcti aV\G\n0,V% PH V% a0� STREET ADDRESS Z O© (� CrCt SATE Z�IPFAX CONTRACTOR NAME `t LIt�rUMB ;� LICEP SE TYPE BUS.LIC.# COMPANY NAME `1 PO a) t� E-MAILS l-3 FAX STREETADDRESS AIM, L , CITY TATE,ZI ��`� PHONEO; �� 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 one business day before the requested inspection date. Please call (408) 777-3228 from 7:30-3:30pm(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 available within one hour. 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. 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. 7. 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. 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 a ee to comply with the re-roof policy stated above. I also understand that smoke detectors and carbon monox' det tors are required to be installed in accordance with Sections R314 and R315 of the 2010 California Residential Signature of Applicant/Agent: Date: ReroofPolicy_2012.doc revised 10/7/12