05070196 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION
s 5 mtvrz.�'-.. ..Te w,-k d¢,a, e.'i,4 P„�`•^-7ds=.
oil Dwc ADDRESS: FOUR SEASONS ROOFING PERMIT N°.05070196
22890 CRICKET HILL RD
rNER'S NAME: PERMIT ISSUE DATE
BALAJI DONDALAPATI 502 HORNING 2T 07/29/2005
PHONE: SANITARY NO. CONTROL NO.
(408) 278-0330
ARCHITECGENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Op LICENSED CONTRACTORS DECLARATION Job Description
u C 1 Wmby affirm mat 1 am licensed under provisions of Chapter 9(commmncing -
i with Seaiun7")of Division 3 of NC Business and Professions Code.and my license is if-I a Y-1!
+may inOsnfmme defPor _ 9 L d �( O� REROOF-REMOVE EXISTING ROOF+ AP.PLYI
o,v�? Li<cnx Class J ic.
❑ Dam - - Cumtrmmr 1 2 CDX PLY FELT/40 YR GAF
AR HIiELTS DECLARATION
I undcrgand my plans shall W used As public records
Po'a C ti Licensed Prufessianal y ppp ryryry a
3 Oat I am exempt
from
DECLARATION BUILDING rt q q D fl
a 1 hereby affirm OW I am exempt from theRATIO Contractors License Law for tW If`lll9fl't IfBll heldlyra 'N!J1
9 0 o fallnwing mason.(Sccfien 9531.S.Business and Professions Code:Any city or county
<$E which requires a permit to construct.a mr.impmm,demolish,of repair any atruaure
o�'^
prior o its issuance,also requires the applicant for such permit ro Ile a signed aummcm
-�i that he is licensed pursuant to the provisions of pre Comforter License law(Chapter 9 Sq. Ft. Floor Area Valua[i`',�6000
yF$ (commencing with Section 70)(3)of Division 3 of the Business and Professions Coca)or
- Nat he is exempt therefrom and the basis for dim alleged exemption.Any violation of
Section 7031.5 by any applicant fat a Permit subjects the applicant to a civil Penalty of APN Number Occupancy Type
not mom than five hundred dollar,(M). 34235016 . 00
-
I,as owner of On property,of my employees with wage,As their sale eempemadon.
will do me work and the amuemre is not intended moffered for sale(Sce.7044.Business
Add PramagoCade:The Conuxmor's License Law does not apply m an owner of Required Inspections
m
property who builds or impmva thereon,and whodoce such work himselfor through his
own employees,provided thatsuch improvements art not intended or offered for sok.If,
however.the building or improvement is mid within am year of completion,the awmcr-
W ilder will have the burden of proving Nat be did not build or improve for purpose of
sale.).
1,as owner of the property,am exclusively contracting with licensed co eracmrs to
consumer me projca(Sec.7044,Business and Phofemiam Code:)The Cmura mar'.V-
cemc law dos not apply in in owner of property who Wilds or improms thereon,and
who contracts for such projects with a eonlemmr(s)licensed pursuant to the Contractor's
License Law.
❑lama mmpsondo,Sea .B&PC for this an
Prior Dam
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of Oc following declarations:
❑1 ham aM will mainWn a Cerdfi am of Commnt m self.imum fm Work esCompcn- -
aasion,as provided for by Section 37M of dm IoW,Code.for do,peripromme of me
work for which this permit is issued.
Aave aha will maintain Wmkeri Compensation Ins...as required by Section
l of the 1Wf Code,for the performance of the woh for which this rembit is issued.
My Workct's Comparramican Inss^trimee carrier and Policy number�y/c /� �/((�� tt/�
Carrier: A. H •A • Policy No.:�J.._]_
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This=man need but w completed Uthe permit is know hundred dnllars($IDB)
or less.)
1 cenify mut in the haef ureanee of the week for which Nie permit is issued,10.11 not
employ any person in any m rnnerm As An become subject to Ihe Wortrri Compauodon
Laws of Califomia.Date
Applicant
NOTICE TO APPLICANT.IL after making this Cmur.cale of Exemption,you should
become subject to the Worker Compensation provisions of the Labor Code,you mug
.J Z foMwith comply with such provisiots"is permit shall W dremed mw,kcd.
'ZO CONSTRUCTION LENDING AGENCY
rThereby affirm mat mere is a construction lending agency lot the performance of
W 7 The wish for which this pemtil is issued(Sec.3(197.Civ.C.)
6W. m Lender's Name
7 Z Lender's Add.
U 0 1 certify mat 1 have read this application and sum that the aWve information is
(y F comma I agrte to comply with all city and county ordinances and sum laws relating to
0U Wilding moswction,and hereby auhonae representatives of this city to curer upon the
I27 shove mentioned property for impaction purpaxa
(We)agree in um,indemnify and keep harmless the City of Cupertino against
F'y liabilities,judgments.ensu and expenses which may in any way accmcagainst Arm!city r7
U z APPLICAcnccof due UNDEgmTAng of this D WILL COMPLY WITH ALL NON-POINT Issued by: Date / -�2
SOURyGUL NS
�'n_3 �-a 7 Re-roofs �r k
ofA HtAZ¢yrsOUS MATERIALS DISCLOSURE Data Type of Roof
Will me apPlicam66666ratem building uccupanumm a'
hand].havardous matenal
as defined by the Cupertino Municipal Code.Chapter 9.13,and the Health and Safety
otic.Section 25532(x)?
(]Yes All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or f ore building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit havardnus air ruealon as w defined by the Bay Area Air Quality Management all new materials for inspection.
Dixtrict7
C3 Yes
I have oaf me hvaNnusmaterials requirements under Chapmr 6.93of the Glifor-
niaHcalth&SafctyCWc.Sccdom25505,25533and8534.1understandmntifthc Wilding
dos not careful,ham a¢man at itis my."nubility to m tily the occupant of the d-
mrit, hist on at pn r w issuoce of.CrNdcge of Occupancy. SignatU pplican Date
Owner ar anOmmul. D,m All of overings to be Class"B"or better
® CITY OF CUPERTINO
I CC'fn 2 of 2 PERMIT RECEIPT OPERATOR: Suem
COPY # 3
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 34235016.00
DATE ISSUED. . . . . . . : 07/29/2005
RECEIPT #. . . . . . . . . : 30570
REFERENCE ID # . . . : 05070196
SITE ADDRESS . . . . . : 22890 CRICKET HILL RD
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : BALAJI DONDALAPATI
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2635
RECEIVED FROM . . . . : CARLOS CAZARES
CONTRACTOR . . . . . . . : DIAZ, ALFRED LIC # 21323
COMPANY . . . . . . . . . . : FOUR SEASONS ROOFING
ADDRESS . . . . . . . . . . : 502 HORNING ST
CITY/STATE/ZIP . . . : SAN JOSE, CA 95112
0 TELEPHONE . . . . . . . . : (408) 278-0330
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
BPERMFEE VALUATION 6,000.00 126.36 0.00 126.36 0.00
BSEISMICRE VALUATION 6, 000.00 0.60 0.00 0.60 0.00
---------- ---------- ---------- ----------
TOTAL PERMIT 126.96 0.00 126.96 0.00
METHOD OF PAYMENT AMOUNT NUMBER
_-_--__----
OTHER 253 .92 VISA
TOTAL RECEIPT 253 .92
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
OUPEkTINO
Building Department
JOB AD ESS: PERMIT#
SO -? O i z
OWNER'S NAME• A414
4:1PHONE #
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors.Qe2z,2r, 71'
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
Glass/ Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
• Tile
Owner/Contractor Signature Date
%&,'
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
t 'pCl[�OF Telephone: (408) 777-3228
C r CI I p�I® 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.
7. NOTE: If you call,for a plywood nail inspection and-the job is not ready,
you will be charged a re-inspection fee of$176.18. The re-inspection fee must
be paid before another inspection can be scheduled.
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 stated poll'l
on re-roofing.
Homeowner's Name:' !1
Job Site Address:
Roofing Company Name:._ /p .
Applicant's Signature: Date: 2_-2_z_-6r—
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINO
RE ROO F
ary or / /0
GICUPERTINO PERMIT APPLICATION FORM l/
APN
Date:
V1,6-
- C1 ,6- 3 27 -o,,r --
Building Ad ress:
la
Oner's Name: Phone#:
tractors ' Phone#Lt26_0 ?C> License #:
C Phone# � D Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles / LlWood Shingles
Other(Specify) ❑ Other(Specify) ,
Nurffber of existing coverings ❑ Provide I.C.B.O.Report#
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
I Have Read,Understand and Will Comply With Cu ertino's Tear Off Policy: ❑
Desc iption: �jA�oP Q Ept may'
P /
Residential Commercial
Fire Zone: Yes ❑ N Confirmed with Planning Det. if
there are any restrictions: LJ
Cost Pr0j,ect: Type onst on: Occupancy 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
• I