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04070052 CITY OF CUPERTINO . - .'.• Y.. BUILDING DIVISION PERMIT ' CONTRAC vINFORMATION:.. BUILDING ADDRESS: MANADA ROOFING INC PERMIT"04070052 1 SSS A..T)TNC:TnN rT OWNER'S NAME. PERMIT ISSUE DATE ASHWIN & NILA SHAH 24717 FATR vrrtxi atzii— __ 2004 ONE SANITARY NO CONTROL NO (510) 881-4727 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH .68 LICENSED CONTRACTOR'S DECLARATION lob Description V 1 Mreby air.Nat I am IkemrA under provisions of Chapter 9(commencing wNSati ?qla)of Division 3 of the Business and professions Code,and my license is n�s in full to ea 3q_ License el� (' �Ixe.g 'D077/ REROOF W/ASPHALT SHINGLES n X'O DOW y �T'S DEC Contractor F�< " ARCHRELTS DECLARATION 0dU IundcrsunJmyplansshallbeusedupublicrZ'!tip AUG 2 2004 GG Licensed Profess....I 3 OWNER-BUILDER DECLARATION � ' m<f I berehy affirm Nat 1 am exempt form the Conuam 'Y/ or's license law for the A 0 0 following meson.(Sccuun 70315,Business and Profmium Cale:Any city Or county `eDlivG xm which requires a Permit to ermstruct,alter.improve,demo)N.Or repair any structure C I n n o n Fiy poor to its issuance.also requires tbe applicant for such pemut to rile a signed summer t x Oat he is hCCnced pursuant to NC provisions of On Contractor's Limme Lsw(Chapter 9 Sq. Ft. Floor Area Valuation I-$ Oche is exemttSerefrom and Division mr the alleged ess aodon. ny vi Code)or of Net he k exempt therefrom and the biro far Ne alleged exemption.Any violation of Section 7031.5 by arty applicant for a permit set the applicant to a civil penalty of 3 C &1er0 0 Occupancy Type not more Nan five hundred doll.(150)). r ❑I.uowarOf thm proprny,or my emPloycem with vngau Neu mk compensation, will do the work.and the structure is not intended.,(hared for sale(Sec.7014,Business and Professions Code:The Conrrmmrs License law it.oat apply to an owner of Required Inspections property w ho builds or improves theswn,and who does suc h wort himsel f or through his own employnm,provided Nat such improvements are not intended or offered for We.IL however,the building ter improvemem I,sold within one year of completion,the(wan builder will have We burden of proving Nat he did not build or improve for purpose of teak.). ❑h as Owner of the property.am exclusively contracting with I=rise d contractors to Co.Ltothe Out (Sec.o a...Or property he nsCode:)The COnhetion.Lid come law dots not apply je an owner of prapeny who builds or improOss thereon,and , who conuaca for such pmjecu with a convacmr(s)Iittnsed pursuant to On Connector's Li m ' ❑I wo u exem mpt under Soc. ,B&PCfor this moon Owner Dare WORKER'S COMPENSATION DECLARATION is I hereby ffiion under penalty of pagury one of due following decimations: I have and will maintain a Certificate of Convent to self-maurn for Wod(ds Compcn- _ upon,u provided for by Section 3700 of the labor Code,for the perfa not ntt of the work for which Nis puma n rssad. ❑I have and will maintain Workcls Compensation Insurance,u required by Section 37M of the labor Code.for the performance of the work for which Na pcnmt is issued. My Worket's Cormpemat n Inmmntt tamer a�d P(I¢y number are: C tor., �/�Ii��!/ .i�olrry No.: C IFICATE OFEXEM=ONFROMW S' COMPENSATION INSURANCE This motion aced not be comoca l tithe Permit is for one hundred dollars(SI W) or Ica) 1 cerufy rAm in N4 perfmmaac of dte work for which tha permit a issued.I shall not employ anypermn in any manner m u in become subject to the Workers Compensation Laws of California.Dar- Appli., NOTICE TO APPLICANT If,after making this Cembca a of Exemption,you should hccome subject to due Worker's Compossmon provisions of the Labor Code,you most .,O roodwoh comply with such provisions or N it is perm shallbe deemed revoked. z CONSTRUCTION LENDING AGENCY [-. IhcrcbyaRrm Nat themaacommdeon lending agency for the Performance of > On work for which this permit is rated(Sec 309].CO,C.) z Lenders n a. _ -- U O 1 comfy Nat 1 have mad Na applicatum and state that the about in(omuuon L, Li.P carted.1 agree to comply with all city and county orddwttts and seats laws relaung to how building cO)agree(aand re,indhereby auNariaepmscnums.00f City Of m enter imaga NC y.��� W shove-menudnrd ProPeny for irepecu(n which ea D Xte / F G (WO)mode many,indcmniry and keep harmless the Cny o(Cupenino against N hahihtiequatur ofhecoats andof Onsnwhich may in anyway mcmc against mid City U z d APPLICANT of the RSTA gramung of Nu D WILL b ^' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT S�, !RCE�CATIONS i �� ,L'�5 /�6J�/ �J/��%�� �' Re-roofs Q SO�RCEd1 Applicanr/COnvamr !/ Dato �/ I HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will thc applicant or futme building,oceup rnmtod or handle humimis material u defined by the Cupemno Municipal Code,Chapter 9.12,and the Hcalut and Safety (JC,S❑aeon 25532(a)o Yon ff No All roofs shall be inspected prior to any roofing material being installed. Will On applicant or future building acupam use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove suit In adnus air contaminants as defined by Nc Bay Area Air Quality Management all new materials for inspection. DlSUICL? ❑Yom Ibasic ray tha a co t.materiats my respechlo,i ..fy one fire, ��� ma HalN&Safcsy Codc,SauOMMM5,25533w Z534.lun&m=dNwdthc holding Jars no iris why hmc a tensor Net n a my ..f. on i,war the f the mq nt is which rm�rsuana(r,cemraa(r�a�(,ncy. g)IatureofApplicant " ��j All roof coverings to be Class "B"or better ��9wncr(r auNorimd opens - L pmt g F Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 *UPERTINO �, Building Department JOB ADDREWS: PERMIT # /sss 6a 7—. CT _ ° Y0 7©©SZ OWNER'S NAME/fdLce,il/ A4 vlza, n4 PHO # SAv— 7,9e�-9517 � GENERAL CONTRACTOR F # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: �!] SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical I ( Excavation Fencing Flooring: Carpeting I I Linoleum / Wood Glass / Glazing I I Heating I I ( Insulation I I J Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper I I J Paving Plastering Plumbing y Roofing Septic Tank Sheet Metal I I li Sheet Rock I I I .I I Tile I I I e /Contractor Signature Date CITY OF CUPERTINO REROOF CITY OF CUPERTINO PERMIT APPLICATION FORM APN# S_6 Z Date: Building Address: Owner's Name: Phone#: s/a -758-9517 Contractor: Phone#: License#: S08771 Contact: Phone#: Cupertino Business License#: Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles ZF�Asphalt Shingles Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other(Specify) ❑ Other(Specify) Number of existing coverings .2(a ❑ Provide I.C.B.O.Report# ❑ To be Removed YgY ❑ Provide Mfgr. Installation Specs. • I Have Read, Understand and Will Comply With Cupertino's Tear Off Policy: ❑ Job Description: d/ 04,-iove �X/STiiv� /,vsrsr� GdX TL �s_l�lu/� Szi� P S Residential E ° Commercial ❑ Fire Zone: Yes ❑ No ❑ Confirmed with ng c. if there are estrictions: o Cost of Project: Type A// Occup Cy grou ' Qt ;illl A ' le Fee ID Fee Description Fee Group / BPERMFEE I Bldg Permit Fees BUILDING )BENERGY Energy BUILDING BSEISMICRE I Seismic Fee Res BUILDING BSEISMICOM I Seismic Commercial BUILDING BPLANCHK j Plan Check Fee BUILDING BUSLIC Business License I BUILDING I j - , I �-� 70 . s�