06040062 CITY OF CUPERTINO
BULGING DIVISION PERMIT b m£�I acwTURUP0111
BUILDINGADDRFSS: ALL SEASONS ROOFING SERVIff
uARNO'06040062
1143 HOLLYHEAD LA
OWNER'S NAME: PERMIT L'SUEDATE
RAGHAVAN EMBAR 1720 SMITH AVE 04/12/2006
14 ONE: SANITARY NO. CONTROL NO.
(408) 971-4455
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECN
ions LICENSED CONTRACTOR'S DECLARATION Ilp JOb Description
�t 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing
with Section 7011)of Dlv1sm.3 of the Business and Prafeuium Ude.and my licenm 1.
+� inmEfarcearweffutt 1 75 ?v`! ( REMOVE 1 LAYER S ROOF & INSTALL 24
i yes License CI L A L"c.d
INALT Dam g contractor axxi ' A 50 YEAR COMP R 4
ARCHITECTS DECLARATION
1 I undersand my plans shall be used u public records
yj
yo3 Licensed botany res MAY ff 2006
rn OWNER-BUILDER DECLARATION
COS harcso a1Brm that 11. exempt from dm Canuacmts License Law far the
p O following moon.(Sadao 711]L3.Business and Rafudom Case:My ciIY car counN%i AAA r4j1h getty
COO
� which mortise a permit ro cmmre.alum.W prom,demulkh,m repair any srrcture
Zr prior m its issuance.also requires dm applicant rat such permit m file a signed statement
g < that he is licensed pursuant m the provisions of W Contractor's License law(Chapter 9 Sq.Ft. Floor Valuati$fl 9 8 2
9�9 (commencing with Section 701ofDivision 3 of the Business and Profaasions Code)or
— them he is motors Quadman and the basis for the alleged uempdan.My violation of
Section 7031.5 by any applicant far a permit sabjecu the applicants to a civil penalty ofN Number Occupancy Type
m
nos om than five hundred dollars($50). 3M26019 . 00
❑t,u owrcr of ted property.or my wploym with cages u they mk compensation,
wE dodmwoak.andlhe TW
IA.does
ul apply 7014.Burixu Required Inspections
propeana Pmfesslens Code:The Conuanan,License law ams Out apply lf rr owner of q p
Own crtywho ymes,premed that ulh Improvements
domaAmwolmandedch offerer Waugh his
ownver,the
psuch Impmvemwt anerot lmm�dedmeRued far mae.IL
however,the building ordepro emanttssoldme did oneoar Df improve fa.de roof
builder w1I1 have that Wrane of proving Was W did ems Wim a improve(or purpose of
Asia.).
0 1,as Omar of the p OIX11Y,am UCWhmIY contacting with flamed contractors In '
construct the pmjecs(Sec.7044.Busirlm and Pmfeadans Cade)The Contractors U.
careac Law does not apply At an owner of pmpwy who Wilda or impmws thereon.and.
who contracts for such projecs with a comacurrfa)licensed pursuant to the Contractor's
License Law.
O lemuemptunder See .BAPCfmthismasoa
Gaud, Das
WORKER'S COMPENSATION DECLARATION
I hereby&film under runway a(perjury one of the ftolkwing decluanionc
1 ham and will maintain a CeniOute of Cansem to selbinmm for Worker's Cooper-
What,as provided for by Section 37W of the Lobar Code,for the performaae a(the
weak for which Wu permit Is issued.
0 1 have and will maintain Worker's Compensation Warrants,as regWmd by Section
37W of the Labor Code,fm the performance orthe more for which this permit is Issued
My Worker's C��omplIeisdaxn—I�nsurance carrier and Policy numbers-are:
Cartier: a/-Tfl M_ f[.s.7 Policy Na: 1? t / U�C7
CERTiAOF .prnONFROMWORKEP_T
COMPENSATION INSURANCE
I
(This suction used Out bocompletedlines perrah ts foram hundred aaOm(SIO)
or lot)
1 anify them In the performance of the work for which this permit is issued,l shall not
employ any person In any mamnerm a to became subject to the Workers'CompensNon '
laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,after making tins Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of Ne labor Code.you mesa
O O forthwith comply with each provisions or this permit shall W dared revoked.
Z .ryasCONSTRUCTION LENDING AGENCY
[..' I thereby Affirm then them 4 a construction larding&germy for the performance of
!Yi the murk fur which this permit Is lured(Sec.3097,Civ,C.)
G.Q Lender's Name
2x Lender's Address
U 0 1 certify that I have road this applkuion and stat:that the above information t
LL.F correct.I agree In comply with all city and county or inamees And sum laws misting W
0U building construction.and hereby mdutfio epreseMiOS Of this City to motor upon ted
U above-mentioned property for inspection purposes
(We)agree to save,indemnify and kap harmless de City of Caperton.again
42 Ill
rA Ilebilitiee,judgments.cru and expenm which may in any way scene against aid City
UZ in consequence of the granting ofthis permit. /
APPLICANT UNDER 9
A DS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date �-/( ( b
SOURCE
y-12-o(y Re-roofs
Si turt ppli antamor Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
%it We applinnt or forum Wilding oaupanamm orhanale haumous material
As defined by Wo Cupertino Municipal Cade,Chapter 9.13.and the Health and Safety
Code,Section 15531(x)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes @T*—
'41 Will the applicant or future Wilding Occupant use equipment or device,which If a roof is installed without first obtaining an inspection,I agree to remove
AMR hamrdoa air contaminants As defined by the Bay Ara Air Quality Management all new materials for inspection.
Disuict7
Oyes 04K
1he,.reel the haallousmaterials requirements under Chaper6.95 olds,Califor. r/J,(�(,/(/
ria Health@Safety Cade,Scc7ianshat it
mymsp175334.1 to until, thaifLh.
Wor Om � �FE"v�
ng
dao cos cummay haw a nU cost It t 55 ruponbllhy W ratify de aaupam of the
requiramc rti h� be Ann prior se issuntsofa CeNfeamaf Ucupanry. Sig r Ap Icant Date
o rte r ads a e., ! Dam All roof coverings to be Class"B"or better
a40f
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
Fax(408)777-3333
SUPEkTINO
Building De artment
JOB ADDRESS: / t y 2 / I' PERMIT#
�! /4 06D / DUGz
OWNER'S NAME: t / PHONE #
GENERAL CONTRACTOR: / a$ irzss� FAX #
I am not using any subcontractors:
Sign ture 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
Z-aG
O�Vnerl Signature Date
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 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 policy on re-roofing.
Homeowner's Name: Ed F7 ' )W4-1Y '!/-SVA,-2
Job Site Address:
Roofing Company Name:
Applicant's Signature: Date:G�
• Greg Casteel
Building Official
Revised 11/2/04
CITY OF CUPERTINO OWNW(OzP-
REROOF
OCUPEZTINO PERMIT APPLICATION FORM
APN# 2_ _Ot Cl Date:
Building Address:
y LSc�\y
Owner's Name: Phone#:
- In - `\
Contractor: Phone#: License#:
\\ rs 5 qol�s) On\-ywss 5C\ C
Contact: Phone#: Cupertino Business License#:
Sc. Lko 0 - \O�
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof o Built-Up roof
❑ Asphalt Shingles -A Asphalt Shingles
A Wood Shakes ❑ Wood Shakes
❑ ,Wood Shingles , ❑ Wood Shingles
❑ Othet'(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report#
❑ To be Removed O Provide Mfgr.Installation Specs.
I Have Read, Understand and Will Comply With Cu eitino's Tear Off Policy:
Job Description: �PiMove � W"�ec e x� (� Sko`(� C��c '�r5�t^\\ a `�C
Residential 1% Commercial ❑
Fire Zone: Yes ❑ No ® Confirmed with Planning Dept. if
there are any restrictions: IJ
Cost of Project: Type of Construction: 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