13110078 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10412 MEADOW PL CONTRACTOR:CD ROOFING PERMIT NO:13110078
OWNER'S NAME: SAXENA ARUSH AND SHVETA 2909 WILBUR AVE DATE ISSUED: 11/12/2013
OWNS PHONE: 4089168111 SAN JOSE,CA 95127 PHONE NO:(408)898-6605
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL Ll COMMERCIAL[]
License Class `w Lic.# 2P `Q DUPLEX RE-ROOF-30 SQ-TEAR OFF WOODSHAKES,
INSTALL COMP CLASS A
Contractor Date Ii �-- t �--f '3
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:$9500
)(ion
will maintain Worker's Compensation Insurance,as provided for by
S ion 3700 of the Labor Code,for the performance of the work for which this APN Number:34229022.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above.information is PERMIT EXPIItES IF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 00 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 180 DA M LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertinoagainst liabilities,judgments, /
costs,and expenses which may accrue against said City In consequence of the Date:
granting of this permit. Additionally, applicant understands and will comply Issued by.
with all non-point source regulat' er.the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature Date 1/' All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed without first obtaining an inspection,I agree 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 RO COVER O BE CLASS"A"OR BETTER
1,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(x)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 Cuperbl o Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 255 , 53 25534.
Section 3700 of the Labor Code,for the performance oft e work for which this Owner or authorized agent• Date fir-12,r
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.)
p y p p 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
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION.
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPER"i'ENO. (408)777-3228• FAX(408)777-3333•buildingacupertino.org
PROJECT ADDRESS 24 1Q APN# 2 z a
OVdNERNAMEPHO O� 1 I E-MAIL
STREET ADDRESS CITY,STATE,ZIP FAX
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CONTACT P e 7 P �� 1 (O C, E •1A act
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STREET ADD SS CITY,STATE,ZIP FAX
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❑ OWNER ❑ OWNER-BUILDER ❑.OWNER AGENT l/com-RACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR N LICENSE NUMBER LICENSE TYPE BUS.LIC.#
t� S Z e
COMPANY NAME E-MAIL FAX
STREET ADREPS CITY,STATE,ZIP PHONE
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ARCHITECT/ENGINEERNAME LICENSE NUMBER BUS.LIC.#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF SFD or Duplex ❑ Multi-Family ROOF AREA VALUATION:
STRUCTURE: ❑ Commercial.
EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES OTHER(SPECIFY)
REMOVE/REPLACE El YES IF NO, PLYWOOD ❑ %d ❑ PLYWD OSB PITCH: ROOF
❑NO I #LAYERS: THICKNESS: El 5/g- TYPE: ❑ CDX 12 CLASS: A
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT#
DESCRIPTION OF Le 0
By my signature below,I certify to each of the following• a prope er ora orized agent to act on the property owner's behalf. I have read this
application and the information I�haveprovided is c ct. ave red e D scription Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating c I authorize rep sentat• sof Cupertino to enter the above-identified property for inspection purposes.
S ignature of Appl icant/Agent: Date: 1 r [ 2 •—
SUPPLEMENTAL INFORMATIO UIRED E rLX
✓iTw -E' 'G�.Ate.= ON@
_If building is associated with a Home Owner's Association,provide letter L _° ° �� = _
of approval from HOA. [ o _R o, Ex :: P aulLvGP�vANx R
_Provide Planning approval to verify if there any restrictions. EXPRESS A }„ ;°P 3 ivrEW
_Provide copy of Manufacturer's Installation Specifications.. DEPT •
Provide signed copy of Cupertino's Tear-Off Policy.
ReroofApp_2011.doc revised 03/16/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 10412 meadow pi DATE: 11/12/2013 REVIEWED BY: mendez
APN: BP#:. 'VALUATION: 1$9,500
*PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Duplex PENTAMATION 1SFDWLR00F
USE: P PERMIT TYPE: i
WORK re-roof- 30 sq-tear off woodshakes install comp class a
SCOPE
FEE ID ROOF AREA
s.f.
1REROOFFRES 3,000
ig
� rMR,
Mech. Plan Check Phvnb.Plan Check Elec.Plan Check
Ltecla.Perrxit Fee: Plumb. Permit Fee: Elec. Permit fee:
[,1,f,,
Alec .Insp. Clther Plumb Insp, Li L OtherLs'lec.Insp.
h.Insp.Fee• Plumb. hap.Fee: Elec.Insp..I ee:
NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). These ees are based on the prelimina information available and are only an estimate. Contact the Dept for addn'1 info.
FEE ITEMS(Fee Resolution 11-053 E . 7ff 11113) FEE QTY/FEE MISC ITEMS
Plan Check T ee:
Suppl.Pt:F'ee
Plumb./Mech./Elec
Permit Fee: $480.00
Suppl.Insp Fee
Plumb.IiWech./Elec
Plumb.!I1ech.lElec Permit Feet-
Construction
ee:Construction Tax
Administrative.Fee:
Work Without Permit? ®Yes (j) No $0.00
Advanced Planning Fees:
Travel Documentation Fees: A
Strong Motion.Fee: IBSEISMICR $0.95 Select an Administrative Item
Bldg Stds Commission.Fee: IBCBSC $1.00
,Q
, $481.95 $0.00 ® EE."�1y $481.95
,m -
Revised: 10/01/2013
rt-
REROOF TEAR-OFF'POLICY
COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION
ALBERTSALVADoR;RE., C,B4O,, BUILDING OFFICIAL
10300 TORRE AVENUE•GUPERTINO,CA 95014-3255
CUP1rRT[No (408)777-3228- FAX(408)777-3333•Lu lCl1nq@CUpertln0-0-'
APN 4
PROJECT ADDRESS
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(� PHO E E-MAIL
OWNER AME J �cOC C� Y� � �1�
STREET ADDRESS ®«�
L CrrY,STATE,ZIP FAX
CD
LI SE ER
LICENSE TYPE BUS.LIC.#
CONTRACTORNA! LD s C�
l- R FAX
E-MAIL
COMPANY NAME \ CITY,STATE ZIP �q 7 P ONE /` p /
STREET ADDRESS dna l e,11 . l7b� i "� �_. l�k 2-'` t Q. L l •-L�Xp 0
2�2
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 un 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, oofina 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/4" 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 agree to comply with the re-roof policy stated above. I also understand that
smoke detectors and carbon monoxide detect Ire to e i alled in accordance with Sections 8314 and R315 of
the 2010 California Residential Code...
Signature of Applicant/Agent: Date:
ReroojPolicy 2012.doc revised]017/12