05110043 CITY OF CUPERTINO
BUILDING DIVISION PERMIT y-. oL`I!1'�� Q • , ORmT.�
BUILDING ADDRESS: - OLD COUNTRY ROOFING PFJ1A1RNO'05110043
11547 FALLCREEK SPRIN CT
OWNER'S NAME: PBR'WYL%IIHOATE
ASHOK SWAMINATHAN 125-B GROBRIC CT 11/08/2005
NE: 1 SANITARY NO. CONTROL NO.
(707) 864-5557
ARCHITER/ENGMILER: BLDG BUILDING PERMIT INFO
OPLUMB 0
loo LICENSED CONTRACTOR'S DECLARATION Job Description
1 1 bemby affirm But I am licensed under provisions of Chapter 9(Comil ung p
with S..d.70(XT.f DiWtia 3afthellmi esaend of d ylicense is
in full forceand.0,3 REROOF-T/O SHAKES, RESHEET OSB,
'•34 o;re"'°c�° COMP. SHINGLES
i ARCHIMCr ECLARATION
1 1 undenund my plans"I be used As public remNa
U L'a
a'LLp Licensed Professional e /
N
OWNER-BUILDER mDECLARATION ��P
p 1 hereby affirm that 11.esempt from the Canlns Goa I:My LAW O for Ne yes
O O which regroamn.(Section 1031.5.I!.Bknpa and improve,
Professions Cade:Any elly or county CUnC
Swhich requires•permll m aim au, ally.hnProsc,demaMh.m repair ed atoms
z: priwmmwualtea..lwmyui«,The.pplicwrm,uchannamnm..ianedeumment
that he is licensed pursuant lO the provisions after,Contacule,License Law(Chap=9 Sq,F[. Floor Area u � 000
$ (commenclnO with Section 7000)or Division 3 afthe Businevud Profesdons Code)or
Nat he Is exempt tbemfmm and site bub for the alleged exemption Any violation of p Isi {, _
Section 703"by any Applicant for a permit subjects the applicant m a civil penally of 3 AP1rI l`�QIKe�0 0 Occupancy') p�
nor mom thm me hundred dollars($300). 0606�5j 1 17
❑I,mowtrraf rile property,«nay employee with ngauthev sulec«npensaBaa.
wmdo the work.anduleaaucl«elelmtmtendw«aaetm rar,alo(s�.7a+,Baannsa
Required Inspections
And RORssions Code:The Coronations License lAw does not apply m N PYllef of q p
Property who bund,«impro asthereon.and wMdoe,webwanhimamyr«wooNhis
Owns employ«,,provided Bulsuch improvements K notintedded«aRered f«sale.U.
however,the building or improvement Is veld within can year of c,OplCutur the mrner-
holder .will bow the burden of proving IMI k did not build Or Mpraw for purpose of
ole.).
0 1.as Owner of the property,am mclusively contacting with licensed Contraclan An
consumer the ProleeL(See.700PI,Business and Pro(culom Code)TM Cns IKIM S Li-
come Law does not apply On an Owner of property who builds or Improves therean,and
who c„xets fat such pmjero with a anwek(a)uk..ed Pursuant An the Conukor's
License Law.
I are exempt under See ,01 PC fen mis reaaaO
0. Dam
WORKERS COMPENSATION DECLARATION
I hereby I=order penalty of perjury one,of the fallowing dMMdons:
I Mw and will mdnuio a Certificate of Consent in ulf-mn a f«Wortefa C—Pen-
kion,u Pmvided fw by secdon 3700 of w I&bw Code.f«the perfmmenm Of Bre
work for which this permit b issued.
1 Mve and will maintain Worker's Compensation(m lance,u required by Section
700 of the Labor Code.far the performance of tee west for which this permit is luted
My Work Capµpe-w'tioa^�and Policy number am:
Grrier. /,ak�a01/avwii// Policy No.: t 3 YN
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Tbb mctmn need wtbc completed ifft permit is Forane hundruddaihn($100)
or leas.)
1 certify that In the performance of tho wont for which this permit It Issued,)shall nen
employ any person in buy mannerm As m become subject to the Workem'Compemadon
Laws of Califomin Dam
Applicant
NOTICE TO APPLICANT.If,after masrng this Ce tiRwe of Exempdon.you should
became Subject to the waher'a Compensation provisions of the Lab,Code,you moa
.J O forthwith amply with such provisions Or Nb permit mail be deemed Onn act.
Z' CONSTRUCTION LENDING AGENCY
`
L•~ 1 hemhyafrirm then them la a eamuuninn lending agency forty performance of
13:a> the wars for which dm Permit is issued(Sce.3097,Civ.C.)
�W Q Lenders Name
2, lender',Addmu
U O t Certify that 1 have read this application and sum du the above information IS
W U COMCL 1 agree to comply with all city and county ordinances and Aute laws retawg m ,
O building construction,and hereby wthoice rtpmsenutws ofthts city menu,upon ft
W alarm-mentioned property for inspection purpoms.y,C. (We)agree to an.indemnify And keep harmless the Cty of Cupertino agaieSt
a;wy flabinues.)mgmeou,eoss and mpeaam whichmaymanywayaccocaga)mlmid CilY
to coluequrm of the two.ol orthb IL
^ APPLICANT ERSfAN ILL C PLY YQT}I A�t y0h{r S� Issued by:9 Date / L/
SOURCE0. LAT10 �ae/,y .i
Re-roofs
SlfnuumofApplicantlCantraemr Data
HAZARDOUS MATERIALS DISCLOSURE Type Of Roof
Will tee applicant or future building Occupant kre or handle hakdous maurial
As defined by the Cupertino Municipal Cade.Chapter 9.11.And the Health and Safety
we,section 25332(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑yes 0 N
Will the applicant or future buliding occupant use cquipnmnt or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit hvardoes aircunuminwu u defined by the Bay Area Air Quality Management all new materials for inspection.
tst ct7
❑Tb ❑NoI haw reed Ne huaoLns mauriab 5533m !255 undcrCMpwd.9n i flea Gldingix Hrall Cr5nall Code,umanuut ikj nn33snt25534.1 mktsund thalfwbuof ftocs notcwrtnrl ve a unit Wt I�.P,y mspansl ililY m notify w a«upmt of thequlmmcnu may kveruyksuamaor crtrmglmara ancyf I Signature of Applicant Date
owner DAM em CSC D/eSm9 All roof coverings to be Class"B"or better
11/02/2005 16:31 7075297663 PERMIT SERVICES INC PAGE 12
NGV-02-2003 11=31 OLD COUNTRY ROOFING 408782MOI P.12/15
Comm itYDsWlermmt
10300 Tota A vm=
J Cup=&*CA 93014
} Telephone(40 )797.1333
CITY Pax(4084)777.3333
CUPEkTINn C,c�_o� R
Building Department
1 c ADDRE55: PERM T 8
0Wi'JEX5 NA1-fE� K1 M � P1.10NE D 3v o
sI'1GENz RAL CON11�4CTOROL!� C.DG4N' FAX O 4" e oq 3O:�
I atn not using any subcontxaet06r—�/ '
Signarwe [Wo
1'ie:ue ,:h:�ck aonticable: suhcenitaetors and coni (ete rhe faTlovrirt�itformabon:
orf— ; SUNC:()NTRACTOR BUSINESS N.AA E I BUSINESS LICENSE
j Cabinets &Millwork
Cement Fiayshin ,
rticavkjon ^ ._
F2I1Clnti
—!_
F1 nor
f I Li.nol6,Urn / wood
lnsuluior.
� �Landsca .ing
Ip f.�th.irt,P, _
IT Masonry
C�ritatl'd7ltal SI ect Iv'e,10 �—
�_ P,111 IG. / bvailrmPrx
Plumbing — — —_
Tzoofing I--�—.
rSe"tic T=k
Shcet Meta)
Tile
O%vner/Contractor Signarare Datc
Community Development Department
Building Division
(/F(� City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
U PEI�TINO 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 withtheabove stated policy on re-roofing.
Homeowners Name: �.2QifLo re. —
Job Site Address: 115 q 7 14 e, C-NA_
Roofing Company Name: 0
Applicanfs Signature: Date:
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINO
K it IWO
REROOF OS�II
CUPERTINO PERMIT APPLICATION FORM
APN# 36Date:
6 - s / - ois
Building Address: �QZ1� C�
Owner's N e: Phone#:
6 -767
Contractor: Phone#: License#:
U _S3 o u G z z 3 I
Contact: I Phone#: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
O Asphalt Shingles �1( 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 Polic :
Job Description: 7Xq
O 5 Y .
Residential X Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: LE
Cost of roject: Type of Construction: Occupancy group:
D00 • CTT
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
31 66
S-7.