05090203 CITY OF CUPERTINOnpr`^
BUILDING DIVISION PERMIT 'CONTRACTOR INFORMATION '
BUILDING ADDRESS: LOS GATOSYROOFING PERMIT NO.05090203
20677 CRAIG
OWNER'S NAME: PERMU MUE DATE
RON KUMAR 888 FAULSTICH CT -----D-9/22/2005
)NE: SANITARY NO, CONTROL NO.
(408) 298-9399
ARCHITECVENGINEER: BUILDING PERMIT INFO
BLDG EIF.C'T P0LUMB MECH
0 0 0
uoo LICENSED CONTRACTOR'SDECLARATION Job Description
1 hereby affirm Nal 1 am licensed under provisions of Chance 9(commencing
i with Section 701 of Division 3 of the Business and Professions Code,and my license is
in full force Ind If 39 DD7707 REROOF--REMOVE SHAKE INII11STALL SHINGLES
n122 Liccnm Clan Lic.N rr(((T---'����
0 Dale Cuor,aztor a ` ...r I�
'Js ARCHRECI'S DEC ATIO -jL
g¢ s'1 understand my plans shall W used u public records
>yU
g u.G Licensed Professional . 9
03 OWNER-BUILDER DECLARATION
Y 1 hereby affirm Na I am exempt from the Consomme's License Law far the
00 following reason.(Soc4aa 7031.5.Business and Pro(casi IR Code:Any city 0f county / fnI
5 a which input.a permit to common,alter,improve,demobh,ar aero!,any structure $5350
-¢i prior m its issuance.also requires the,applicant for such rami,in rile a signed statement
< Na,he is licensed pursuant to the provisions of NC Contractor's License law(Charter 9 Sq. F[.Floor Area \�fi U;'_y(f�L)��\,II `va'uation
y�0 (commencing with Section 7000)of Division Sof NC B usineu and Professions Code)or V �/
i
that he is exempt memfrom and me bums for the alleged cxempdan.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 APRru Occupancy Type
no,more than five handrail dollars(1500).
0 I,m owna of tW pmpwy,or my employcu with urges u their role compcmadon,
will do 116 work and the structure Isnot Intended ofOBOmd raise.(Sce.7W,Business Required Inspections
and Professions Cade:The Connector's License law does not apply m an owner of q P
property who builds or improves thereon,and who doessuch work himself or through his
own employees,provided than such improvements am not intended or offered for Mile.If.
however,the building or improvement la said within one yet of completion.Ne owner-
builder wtH Irsve the burden of proving that he did act Wild w improve for purpose of
sale.).
0 1,as awner of tort progeny,am exclusively commuting with licensed eoancmu ro
construct the project(Sec.7844,Business and Professions Cade:)The,Contractor's Li-
ccnse taw docs not apply in an owner of property who Wilds or marrows dimmer.and
who contacts for such projects with a cantneumns)licensed pursuant in the Contactors
Licen Law.
0 1 am exempt under Sec. .B&P C for this match
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of pe,jury one of the following declarations:
1 have and will maintain aCer ifieare of Cement to self-inwm for Worker's Compen-
1c,
ion,as provided for by Section 3700 of Ne tabor Cade,for the performance of the -
rk far which this permit is issued.
1 have and will maintain wmkcr's Compensation Imuran,u required by Section
00 of the labor Code,for the pmfmmanee of Ne work for which this permit is issued.
yWorkesCnmpe�saty�Insunncyeartier and P."Youunt rare ✓1rtier. Policy No.:f1 0O 7 V 7
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
('Dais section zed not W completed if the permit is foroac hundred dollars(SIM)
or less,
1 certify that in the performance of the work for which this permit is issued,1 shall not
employ any person in any manner so n in become svbjeel to the Workers Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Cer ificae of Exemption,you should
become subject to the Weakm'a Campchann mn pmvisiou of the Latin,Code,you mut
.,Z forthwith comply wit such provisions or this permit shall W deemed revoked.
z CONSTRUCTION LENDING AGENCY
[-.� I hereby affron that Ncre is a eonswcti^^lending agency l'or the performance of
C45: Ric work fur which Nu (197
permit is issued(Sec.3 ,Co,C.)
Rj A tender's Name
n• Undoes Address
U O 1 certify don I have read this application and sine N6 the aWve imfomtuiun is
lr.E. canc4 l agree tae cmmplY with all city and county oNinmcu and Mute laws relating to
�U building emnswetion,and hereby awhOfiM representatives of this city to enter upon the
r W shove-mendozd propeny to,inspccdon purposes.
(We)agree to save,indemnify and lump harmless the City of Cupenino against
liabilities,judgments,costs and eapemu which may in any way...against said City
U Z. APPLLICANf UNDERSTANDSf AIND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REOUPiTION
//�i�1i /G�7 Re-roofs
Sig nature ofApprimandeafffiractor Dale
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant Mort o,handle Itvudous material
as declined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
We.Scetimn C2 5.5
All roofs shall be inspected prior to any roofing material being installed.
Vnsu
Will mea licant or future building mace ant use ,or devicea whim If a roof is installed without firs[obtaining an inspection,I agree to remove
taxpp g p aAirQn
.mit District, us air conuminanu u defined by the Bay Area Air Quality Management all new materials for inspection.
Distict? s.r'
❑Yes ,Ip nu
I have mal the hanuclous arsenals 6quiroaents under Chapter 6.95 of the Califon
ria Health&Sammy Code,Sections 25505.8533 and 25534.1 understood the ifthc Wilding
does not curren0y have a 6nane that it is my responsibility no madly the occupant of the
requimjenc,,nts wl/;�yh amt x act p� ole wwjaamemI camfiea6af°capency. Signature of Applicant Date
""'-"'rt' Ate— �9�r All roof coverings to be Class"B"or better
Own or addiiin cnl Dab
Community Development Department
Building Division
affl
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF
OCUPEkTINO Fax: (408) 777-3333
Building Department
Subject: Re-roofing policy for the City of Cupertino
1. Prior to permit issuance,you must agree to comply with 1997 UBC Standards .
and manufacturers specifications on re-roofing.
2. New roof coverings shall not be applied without first obtaining all inspection
and written approval from the building inspector. A final inspection and
approval shall be obtained from the building inspector when the re-roofing
is completed.
3. All roofs shall be inspected prior to any roofing installation.
4. To receive a final sign off from the City, the following steps are
required:
1) Pre-inspection and/or tear off approval.
2) In-progress inspection approval.
3) Final inspection approval.
® a) Spark arrester installation.
5. If plywood is installed, a plywood nail inspection is required.
6. Any roofing which is applied without first obtaining an inspection,
will require the removal of all new material down to the sheathing,
so a proper City inspection can be performed.
IMPORTANT:
1. Flat roofs must have a minimum of 1/4 " per foot slope and demonstrate
that there is no ponding.
2. An I.C.B.O. report is required to be on the job site at the time on inspection.
I understand and will comply with the above
eeestated policy on re-roofing.
Homeowner's Name:
-- Job.Site.Address: D(O
Roofing Company Name: S LJ'G!%T D S /LOQ //9
A plicant's Signature: Date: / OS
® Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
1 y REROOF
OF
CUPEkTINO PERMIT APPLICATION FORM
APN# Date:
z� �s
Building Address'129
, 0 7
Owner's Name: Phone
D Ci3 - 2d
Contractor: Phone#: License#: 600
70
XS 1 a - 3
Contact: Phone#: J Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles X Asphalt Shingles
Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood'/dShingles , _—
❑ Other(Specify) Other(Specify) —j7 ,�_
Number of existing coverings C3 Provide I.C.B.O. eport#
NA To be Removed Provide Mfgr.Installation Specs
® I Have Read, Under and and Will Comply With Cu ertino's Tear Off Policy:
Job Description: jw s•
Residential Commercial ❑
Fire Zone: Yes ❑ No Confirmed with Planning Dept. if
there are any restrictions: Ll
Cost of Project: Type of Construction- Occupant group:
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Energy BUILDING
- _..
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
SO
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