06090252 CITY OF CUPERTINOt
HUILDING'DIVISION
PERMIT COI'1TRACnRI1F,1�R,MATp .,
BUILDING ADDRESS: KIIPIAR PERMIT N0�6 O 9 O Z S Z
10648 GASCOIGNE DR
OWNER'S NAME: PERMIT ISSUE DATE
VARINDER KUMAR 09/27/2006
NE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMa MECH
lo� LICENSED CONTRACTOR'S DECLARATION 706 Description
I batch,AM.Um I w Imsesed under provisions of Chapter (..1.$
nftto']Oftaion3aflhc Business and Profeuium Cude,anmy is
fullfacmefc. REROOF- PITCH 2 : 14 , 4-PLY INSULATION BOARD, 30L
to
i�3License Class Lm.w
Dam FELT PAPER, 17 SQUARES, CLASS A OR B
,SDECL
qqq ARCHRECDECLARATION
i I urtMrmanJ my New shah W used As public record)
.Q
Licensed Pmfcsdonal
OWNER-BUILDER DECLARATION
I thereby.(Scc Na)11. exempt fare the Contractors Llano Law for dm
O 4 following mason.(Section 7031.5.construct.
hBusiness and Improve.
de ons Code:Any city lir county
f$
which mquima issuance.permit re aresdo after,W pow,h Formic t or repair any mrtmearre
-Zi primas its nsedParaurequite tW applicant for such Pcrmtt to rile asigned sOmmcm
< NathcealicensNPursuant10that ofDivisos 3oftConuinessand rmLaw(Chodrtt9 Sq.Ft.Floor Area ValuatUO00
pq
(commencing b attempt
adlon70nd Dtvdtonroftha Bmlassmdon,Any
Code)or
` .. That k d exempt therUrafn and Ne but(a the dm{rA eaemptim.Any violation of
Section 7031.5 by any,applicant for a permit subjects Ne applicant to a civil penalty of 3 73 2 2 lT 9er0 O Occupancy'type
trot mart Nan low hundred dollars(5500)•
❑I,uawrmrafdmp0pmyumymPloyenwimwagaudmbmie=pm don,
will do the work,and thesuuctum b notlmmnded or offered forms(Sec.7044 Business Required Inspections
Nd Professions Coda The Contravenes License law does w!apply u Nwer e aoof q p
own enywho buipMarimpmtsuchimproven Mercer, who am Actihwuk messelfor croffrmforsgh his
own employee,provided that such improvements tie not intend mpleared for sale U,
buil ,Ne buildingordenowmentbhathedidnaneyeti ofaprowfrthepwner-
mehaw Nn burden of poMng that K did not ddb a hvpmw far purpose of
tile,)
I,a awes of 3)t property,.m exclusively contracting with Manned asnuaeau U. /r
mnswct the pmfta(Sec.n an Business rod Roladau Cade:)The Cao Mercer.
And,
mvc law dos not apply je ts owns m proper(who Wilda or Impmwa Co on,and, /
who nMIRC4 far aYeh pmJCtb with a canYiaOr(i)ImLRYd pnraanl m the CanVtloY1 O/
l am law.
0 lam aemPtundo See�� ,.,/ ,BdlPCfa Oda reason
war Due
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury oro of W following dechmionr, \J
❑IhawaMw imainuina Cer flamof Consentmulf-iaum("Workers Compen- (O
section,u provided(a DY Section 7]00 of Ne tamer Code,for Ne pRormence of the
work for which this permit is iced.
❑1 have and will maintain Worker's Compensation Irtsuua,As required by Section
3700 of the Laha Cade,for the performance of NC work for which this permit is issued. '
My Workers Cempeuatlan Inmranec artier and Policy number art:
Cartier: Policy No,:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
rr usacetion need notes complemd If the permit Is throw hundreEdailars($100)
m less)
1 unify that in the performance of dm work for which this permit is tssad.l WWI not
employ any person in any mammrm As to become subject mote�ortCM Compemadon
Law n of Cameo am / //
Appllan ` T;7
NOTICE TO AP NT:If.After making this Certificate of Exemption,you should
become subject N the Wofkers Compensation previsions of Ne lamer Cade,you mum
.J Q forthwith comply with such provisions m this permit"I Weem
ded mvked.
y CONSTRUCTION LENDING AGENCY
I..t 1 Wrohy affirm that mem is a construction handing agency for the perfurmanceof
a Na wart for which Nis permit Is issued(Sec.3097,Civ.C.)
W Q Landes Hone
7 2 tarmac's Adnm..
U O I temfy that I have rad We Application and Tum Mm the show information Is
F correct.I agree l9 comply with all city and county ordlnsaes and mm laws relating to
QU Wilding concoction,and hereby authome representatives of Ni)city to enmr upon the
W ahove-mentioned property for inspection purpofes.
(WU agree to saw,indemnify and kap harmless the City of Cupertino against
Ta/d liabilities,judgments,costs and expenses which may In any way acme against mid City /s—
U 7, in consequence of the granting of Nis Permit,APPLICANT
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE RE LATIONS.
\ S� 11?! �' b Re-roofs
Signaum of AppllcotuCanurcmr
HAZARDOUS MATERIALS DISCLOSURE am Type of Roof
\
Will leo applicant error=Wilding occupantstamorhandle haumousmamriel
As donned by the Cupertino Municipal Cade.Chapter 9.13.and the Halth and Safety
Corm,section 35533(.)7 /� All roofs shall be inspected prior to any roofing material being installed.
❑Ya O'Na
Will N3)applicant or future Wading occupant use Nuipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit Wvamnus air cenmmianU as defrncd by Nn Bay Area Air Quality Management all new materials for inspection.
District]
❑Yes p"14
1 have real the hutmrms materials requirements under Chapmr6.95 of site C.lifor.
nu He IM&SafctyCode,Sections 3550535533 and 355341 undermand Nuifdm Wilding
does not currently haw a man,that It is my responsibility as notify 0m occupant of Ne
requilrm, which must be met poor missuance ofaCrnifwamoarOccupancy 06 Signature of Applicant Date
12, 2
Owner of mmarimd agent Dam
All roof coverings to be Class"B"or better
CITY OF CUP ERTINO
em 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 37522019 . 00
DATE ISSUED. . . . . . . : 09/27/2006
RECEIPT # . . . . . . . . . : 36220
REFERENCE ID # . . . : 06090252
SITE ADDRESS . . . . . : 10648 GASCOIGNE DR
SUBDIVISION . . . . . . :
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : VARINDER KUMAR
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : VARINDER KUMAR
CONTRACTOR . . . . . . . : LIC # *OWNER*
COMPANY . . . . . . . . . . : VARINDER KUMAR
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
TELEPHONE . . . . . .
'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 126 . 96 MASTERCARD
TOTAL RECEIPT 126 . 96
•
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
• Telephone: (408)777-3228
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 i/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 cor
nwith the above stated policy on re-roofing.
Homeowner's Name: �l N 0 e2 I�i✓ A/Z--
Job Site Address: I D k Q �� Cel 5'y�2
Roofing Company Name:
Applicant's Signature: Dater 1 e
• Greg Casteel
Building Official
Revised 11/2/04
j OWNER-BUILDER VERIFICATION
1. (Check one) I or my immediate family (parent, spouse or child) will perform
A. All the work authorized by this permit
B. _ A portion of the work
C. _ None of the work
If B or C is checked,com Tete 2 or 3 below.
I
2. A state licensed contractor will be hired to do:
A. _ All of the work
B. _ Q portion of the work (complete section below)
Contractor Address/City Phone # State License # Type of work to
be --9 -.2
I
I �
i
3. _ I will utilize unlicensed person(s) other than my immediate family to perform all or
portions of the authorized work. I understand that I may be an employer (see reverse side). A
Certificate of Insurance covering workers' compensation must be on file at the City of
Cupertino Building Department office.
PersoryTirm Address/City Phone Number Type of work to be
erformed
I I i
L.. .......................... .....
I declare under penalty of perjury that the above is true and correct. I have read and understand the
Owner-Builder Information (reverse side).
Property lOwnei s Signature: \\ dpi Date:
Job Address: 14 6 H <'-Z CAk oiiC-t r y Permit#
Any changes to the,information provided on this form shall be submitted to the City of Cupertino Build
Department.
I I i I
I
I
I I I i
I I I
City of Cupertino Building Department
CITY OF 10300 Torre Avenu
Phone: (406)777-3226
C U P E f�T I N O
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of
the property improvements specified.
For your protection you should be aware that as owner-builder you are the responsible party of record
on such a permit. Building permits axe not required to be signed by property owners unless they are
personally performing their own work. If your work is being performed by someone other than yourself,you
may protect vourself from Possible liability if that person applies for the proper permit in his or her name.
Contractors are required by law to be licensed and bonded by the State of California and to have a
business license from the city or county. They are also required by law to put their license number on all
permits for which they apply.
If you plan to do your own work,with the exception of various trades that you plan to subcontract,you
should be aware of the following information for your benefit and protection:
If you employ or otherwise engage any persons other than your immediate family,and the work
(including materials and other costs) is$200 or more for the entire project, and such persons are not licensed as
contractors or subcontractors, then you may be an employer.
If you are an employer,you must register with the state and federal government as an employer and
you are subject to several obligations including state and federal income tax withholding, federal social
security taxes,workers compensation insurance,disability insurance costs,and unemployment compensatio10
contributions.
There may be financial risks for you if you do not carry out these obligations, and these risks are
especially serious with respect to workers compensation insurance.
For more specific information about your obligations under federal law,contact the Internal Revenue
Service (and,if you wish,the U.S.Small Business Administration). For more specific information about your
obligations under state law,contact the Department of Benefit Payments and the Division of Industrial
Accidents.
If the structure is intended for sale,property owners who are not licensed contractors are allowed to
perform their work personally or through their own employees,without a licensed contractor or
subcontractor,only under limited conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure an owner-builder
building permit,erroneously implying that the property owner is providing his or her own labor and material
personally. Building permits are not required to be signed by property owners unless they are performing
their own work personally.
Information about licensed contractors may be obtained by contacting the Contractors' State License
Board in your community or at 1020 N Street,Sacramento,California 95814.
Please complete and return the enclosed owner-builder verification form so that we can confirm that
you are aware of these matters. The building permit will not be issued until the verification is returned.
Very truly yours,
Building Department, •
City of Cupertino
Printed on Recycled Paper
Community Development
10300 Torre Avenue
v � Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
4FUPEkTINO
Building De artment
JOB ADDRESS: f 0 6 (1'� Vv- PERMIT #
OWNER'S NAME: /q- R t /J o6 R OM 4-a- PHONE # q 0 P - Lv 3 - G o
GENERAL CONTRACTOR: O FAX #
I am not using any subcontractors: �/i—T q L
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
oc NN15,�
CITY OF CUPERTINO
REROOF
• CLRO PERMIT APPLICATION FORM
APN # Date: 127 I
3�5 -�a— off ..
Building Address: 0 6 K CtgS GO t Wv 7Yi kC —9 -I
Owner's Name: I N n6z- I�0J M Phone#: Og 3 e6,0
Contractor: 0 /1 License#:
Contact: 0 / Cupertino Business License #:
Type of Roof Covering:
Existi�: Proposed:
❑ Built-Up Roof ❑ puilt-Up roof
❑ Asphalt Shingles QO 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.
Job Description V,ktAn 7- I ,A F tj ,^.Av( .6 .Qy4l, o V t>S
Residential f] Commercial ❑
Fire Zone: Yes ❑ No Confirmed with Planning Deft. if
there are an restrictions: LJ
Cost of Projec : Type of Construction: Occupancy gro
6oeO _3
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