05070195CITY OF CUPERTINO'''�
M?-
BUILDIpG DIVISION PERMIT
CONTRACTOR3INFyORMATION$
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BUILDING ADDRESS:
22898 CRICKRT J41T.T. RT)
FOUR SEASONS ROOFING
PERMIT NO. 05 070195
NER S NAME:
PERMrr ISSUE DATE
BALAJI DONDALAPATI
502 HORNING
ONE:
SANITARY NO. CONTROL NO.
(408)278-0330
ARCHITEC (ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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LICENSEDCONTRACmR'SDECLARATION
I lereby affirm than 1 am lfc under provision of Ch 9 (commencing
'on
Job Descri t'P``an (p' �{��\ Ip' p yak f
p
eBu s
wish Sation7pK)7 of Divksion]of NC Busincaa vtd Professium Code.endm liccnm is
.
tl"" I "I lel 1
in sun tome antl
Ffnl . fIl'�j_''pItA�Bj
REROOF-REMOVE EXISTING ROOF APPLY
DamClua cmiN __
Dart_ - - cpmro<mr_
1/2 CDX PLY FELT/40 YR GAF
ARCHMiCrS DECLARATION
1 my shall Ir used u recamn
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ew q 05
understand plans public
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ps p U
tl ss
Licensed Pmfamional
OWNER-BUILDER DECLARATION
RATIOlai
R-exempt
I hereby affirm Not I road the License Law (Of the
'p�FpnJI
B
following mason. (Section 7131.5, Business and Propositions Code: Any City Or County
!t]IL�
which roquires a Penntll to consumer. alar, improve, demolish. or repair any swcmre
prior at its issuance, also mquims the applicant for mch permit to file a signed comment
that he is licensed pursuant to be provision of the Contractor's Licanse Law (Chapter 9
Sq. Ft. Floor Area
Valuatipis 000
(commencing with Section 7000) of Division 3 of mo Business and Professions Cale) or
that he Of exempt therefrom and the basion for use alleged enmption. My violation of
APN Number
Occupancy Type
SmOrn 7031.5 by arty applicator for a permit subjects she applicant to a civil Penalty of
not mom mato five hundred dollars ($!50y.
34235015.00
❑ I, an owner of be pmpcny, or my employees with wine as their sole compensation,
Required Inspections
will do the work, and be structure is not intended or offered for sale (Sec. 7044, Business
and Profession Cade: The Comsacteri License law does not apply to an owner of
Property who mildsor improves thereon, and who deessuch work himself m through his
Own employers, Provided Nat such improvements see not headed Or offered forsale. If,
however, be building or Improwmeal is sold within am year of completion, the owner-
builder will have the burden of Proving Nn he did not build or improve for purpose of
Bale.).
❑ 1, as owner of be properly, am exclusively contracting with licensed conoazmrs to
Construct the pmjcct (Sea 7044. Business and professions Code:) The Contractor's Li.
cense law docs not apply in in owner of property, who builds or improv thereon, and
who contracts for such pmjmis with actin ractor(s) licensed pursuant to the Conformities
License law.
C]I am exempt under Sec. . B A P C for this mason
wnef Dem
WORKER'S COMPENSATION DECLARATION
I hereby •Birth under Penalty of perjury, one of On following declaration:
(ham andwill maintainetion 37M of ConantoCash,
for performanceat be
cation, provided for Section 3700 of the labor Cotic, for Nc performans of the
mi
work for which this permit is issued.
r
have and will maintain Worker's Compensation Inthsna, an mquimd by Section
37W of the labor Code, for be performmcc of be work for which this pmsnil is issued.
My Worker's C(g/�tPenf/al/io Ins/ylnnm carrier and Policy number am:
n [�
Carrier. /1 H . A Policy Na.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu section need not M complied if the Permit is farone hundred dollars (3100)
or less.)
I cmify Out in the performance of the work for which this permit is issued, 1 shall not
employ any person in any manner m as m become subject o the Workeri Compensation
Laws of Califomia. Date
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption. you should
become subject to be Worker's Compensation provisions of the labor Code, you man
forthwith comply with such previsions or suis permit shall he dec raced restated.
CONSTRUCTION LENDING AGENCY
Ihereby alErm Natmere iss agency for the performance of
.CIO,
' the work fur which this permit is iuucd (Sec. ]097, Civ. C.)
issued
Landers Name,
,
Lcndcfs Atltlmu
1 century mat I have read Of. application and suit: met the above information is
'
' Cortes I agree to comply wish all city and county adinanms and tote laws rtlming to
building Construction, and hereby mthorife repfesenotives of suis city to cnmr upon be
I above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep Wholuer the City of Cupertino against
j Iimithes.judgments, costs and expenses which may in any way accrue, against suit City
ofinegrantingof Nis permit.
' APPLICANT Uf OngriTANDr AND WILL COMPLY WITH ALL NON-POINT
A APPLICANT
Issued by: Date Y1J
SOURCE REf�iCAT1�f1N�7
Re-roofs;
Type of Roof
Signature o pp man/ Data
HZA:& MATERIALS DISCLOSURE
Will the applicant or future building Occupant store or handle harandous material
ax defined by the Cupertino Municipal Code. Chapter 9.12, and be Health and Safety
giLcoadc, Section 25532(a)7 A331All
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
Will the applicant or future building occupant sex equipment or IcA. which
emit hatraMous air contaminants u dc0ncd by the Bay Arca Air Quality Management
all new materials for inspection.
Dixtrin7
❑ Yea
In ave maJ the hvaNOus mamrials rtquimmcnts under Chapmr 6.95 of the Glifor-
nuHwlth&SafctyCede,SeN.M%5.25533a 25534.1unde.dth.ifde building
docs not currently have a Icnanl that it IS my responsibility m rotily de occupant of the
requirements mug he unamoraccrdficamoraapancy.
Ns
Signature of Applica Date
� 7 —a' 9
roof coverings to be Class "B" or better
Owner m . g n Dam
W
® CITY OF CUPERTINO
ILZ[n 1 of 2 PERMIT RECEIPT OPERATOR: suem
COPY # : 3
Sec: Twp: Rng: Sub: Blk: Lot:
APN .........: 34235015.00
DATE ISSUED.......: 07/29/2005
RECEIPT #.........: 30570
REFERENCE ID # ...: 05070195
SITE ADDRESS .....: 22898 CRICKET HILL RD
SUBDIVISION .......
CITY ............. : CUPERTINO
IMPACT AREA .......
OWNER ............: BALAJI DONDALAPATI
ADDRESS ..........:
CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-2635
40
RECEIVED FROM ....:
CARLOS CAZARES
CONTRACTOR .......:
DIAZ, ALFRED LIC # 21323
COMPANY ..........:
FOUR SEASONS ROOFING
ADDRESS ..........:
502 HORNING ST
CITY/STATE/ZIP ...:
SAN JOSE, CA 95112
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
40
CITY OF
�UPERTINO
49
40
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Building Department
I am not using any subcontractors:
ignature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
• • • • • / /.
I am not using any subcontractors:
ignature Date
Please check applicable subcontractors and complete the following information:
Owner/ Contractor Signature Date
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
CITY OF .
CUPEkTIN®
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Building Department
Subject: Re -roofing policy for the City of Cupertino
Telephone: (408) 777-3228
Fax: (408) 777-3333
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 9kove stated policy on re -roofing.
Homeowner's Name: H/
Job Site Address:
Roofing Company Name:
Applicant's Signature:
• Greg Cast eel
Building Official
C
Revised 11/2/04
Printed on Recycled Paper
Date:
0
40
CITY OF
CUPERTINO
CITY OF CUPERTINO
RE ROOT'
PERMIT APPLICATION FORM 0_5-0 -2 lS
APN #Date:
J Bldg Permit Fees
BUILDING
3412-
Energy
7-2 - o
Build' nAdd res
Seismic Fee Res
i
BSEISMICOM
e:
��
Phone #:
/
-0 TO
BUSLIC
Business License
Phone #:
License #:
_
y7z /
Phone
Cupertio Business License M
Type of Roof Covering:
Existing:.
Proposed:
❑ Built -Up Roof
Built -Up roof
❑ Asphalt Shingles
�❑ •
�"� Asphalt Shingles
❑ Wood Shakes
❑ Wood Shakes
❑ Wood Shingles
❑ Wood Shingles
❑ Other (Specify)
❑ Other (Specify)
Number 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: ❑
Description-
ResidentialCommercial
❑
Fire Zone: Yes ❑ No AZf
Confirmed with Planning Det. if
i5
—
there are any restrictions:
Co of Project:
T f&nsotion: Occupancy group:
7tor
Qty. if
Applicable
Fee ID
4
Fee Description
Fee Groun
BPERMFEE
J 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