05070011 ;71811
ITY OF CUPERTINO ,BUILDING DIVISION PERMIT VWW1IWINGADORESS: OLD COUNTRY ROOFING PERMfrNG)5070011
LTLAC CT
NERS NAME: PERMIT ISSUE DATE
KRISHNA KILAMBI 125-B GROBRIC CT 07 01 2005
ONE: SANITARY NO. CONTROL NO.
(707) 864-5557
ARCHITEC(ENGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
uoo LICENSED CONTRACTOR'S DECLARATION $
T,,,���{{{,,,TTT���e 0 0 0
w❑ Ion? affirm Na'1emlicensedinssod Professions
Code. 9(commencing Ii VOO YCar�
R with Section
Division li.c.dsi dssmdvieonsioms Codc.m(commenseis YC9rS®
n y
j� in full forte and ot C --z 7 -y REROOF W/COMP . SHI
M hianseLl Lin.a
i r! Dam —Z Contractor
ARCHITECTS DECLARATIO y)
�y�� 1 undcrsmnd my plans shall W used as Public mCold, - / 2005
G Licensed Professional f1lg�) e■®QY�
Q S OWNER-BUILDER DECLARATION 9 l�I ®'Y V
4 Y I herehy Alfirm Na'I am exempt from the Contractors License Law for the 6�
00 following reason. Arch in
](131.5,Business and lve,de ons Cade:My tiny or county
K$ which requires a Permit m cnnvnrcL alter,WPmve,demolish,Or repair any structure .10000
prior m is issuance.also requires the applicant for such Pcmilto Ole a signed sentiment
< Nan W is licensed pursuant to the provisions of the Caroni License law(Chapter 9 Sq.Ft.Floor Area Valuation
YFO (commencing with Section 7")of Division 3 or the Business and Professions Code)or
i Nat he u exempt therefrom and the baso for Ne alleged exemption.Any violation of
Section 7031.5 by any application for a permit subjects the Applicant to a civil penalty Of
nal mom Nan five handled della.(3500). E Occupancy Type
❑1,as owner of the property,in my employees with wages as their sole compensation,
will do'hn work end dee smctum is not intended or offend for sale(See 7066,Business
and Professions Code:The COnuacmrs License Law does not apply to an owner of Required Inspections
property who builds or improves thereon,and who does such work himself or through his
Own employees,provided Nan such improvements are notho meled oroResed for We.If.
however,Or building or improvement is sold within one year of m n,loumi.Ne owncr-
builder will have OR burden of proving Nat W did ret build or improve for purpose of
.to I.
❑1,as Owner of the propcny,am exclusively contracting with licensed contractors to
construct the project(Sec.7060,Business and Professions Code:)The Contractor's Li.
cense Law does not apply to an owner of propcny who Wilds or improves themon,and
who conuacts for such projects with a contramor(s)licensed pursuant to the Con colors
License Law.
1 am exempt under Sec. .B At P C for this lesson
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
1 heot and will maintain a Cenilcase of Consent to self-insure for Worker's Compen-
sation,ax provided for by Section 3]00 of the Labor Code,for the performance of the
work for which this permit is issued.
have and will maintain Workers Compensation Insurance,M requited by Section
]00 of the labor Code,for de performance of the work for which this permit is issued.
My Wilton- Ttt�e'on Inw.ntt.ria and Policy n qt (3 Its 57 1
Carlo.r�j� Poliry No.: 40� _
CERTIFICATE OF EKEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Crhis section need not W complomd if the Permit Is for one hundred dollam($1(X11
to IC,R)
I Ccnify Nat in the performance Of One work for which this Permit is issued.l shall not
employ any person in my manner an a in become subjcet to the Workari'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
Weome subject in the Worker's Compensation provisions of the Labor Code,you must
.JO forthwi th comply with each provisions or this Permit shall W deemed mmked.
z"" CONSTRUCTION LENDING AGENCY
[-+ 1 Wmby alarm Nat there is a construction lending agemy for Oc Performance of
D:9 the work for which Nu permit Is issued{Sec.3097,Civ.C.)
d25 Lemice,Name
= z Under's Address
U Q I ttnify Nan 1 have lead this appliesum.and sole Nn she Move informed.is
It, P correct.1 agree to comply with all city and county,Nine s and stato laws relating to
0 building cm0roclion,and hereby m'home mpmxmnives Of Nis City to enter upon um
W a1mve-mennloncd property for inspection purposes.
Ly�, CL
WC)agree to save,indemnify and kccp harmless the City of Cupertino against
Liabilities.judgments,costs and expenses which may In any way see=against Mid City
(„) Z in consequence of the grand ng of this permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON- 0INT Issued by: Date
SOURCE Rf1aU�TLa�S. /
a 7/ OS Re-roofs
Signature OLA IicmUCo ser Data
HAZ RDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupurt nom Or handle ha mous material
as defined by the Cupertino Municipal Code,Chapter 9.11,and dor Health and Safety
,MJLMh,,S❑hon 35533(x)?
Yea g All 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 Tum¢Willing occupant use cyvipmem or Jcvieea which �i
it haMminus air contaminants ss defined by the Bay Alex Air Quality Management all new materials for inspection.
vicl7
Ycs �J p/
I have real thehvmdnvs materials leyvirements under Chapter 6,95 of the Califon. r `
ria Health&SaoryCode,Seeutms 15505,15533 mJ 25536.1 understand thatifthe Wilding �--LIi1,f l .J
does not currently have a tenant,Nan it is my rcvpomibilily w notify the aeupcit or the
myuimmcrosw ' ustWmetpdor )exumccofa Ccruficamof Occu a Signature of Applicant Dale
owner nremm�rir 2 ,� All roof coverings to be Class"B" or better
JUN-30--7005 06:55 OLD COUNTRY ROOFING 40e7G28301 P.01/01
0
Commvoiry Devclopoicnt
10:00 Torte Aveoml
CupertJmo.CA 95014
�1 Tetepbme(408)777-3728
C1ry F! Fax(408)777-3333
CUPERJINO
Building ?)epaxtment
Jou' .A17URlss: PERMIT #LO 0 0 1
— -�L/ / L/ c.AC, Comer S
ow i�IR'S;�TA?ii 1 n40 IL�q/lli3 nriol r� rF o
r �r_R1eL CG TRACTOR: L y /L7 2P�rFAX #
) aIn not using ar.}/ =ubcone:acfora: J
Sim>natt re Date
1"C-n-`>8 ,_:!':,`Ck 'p'.tT1C31' C Slll7f.onl:[fatOrS 2.11t] complete t!1e :.0!JOIa"1I'I
; SUBCON'TT ACTOR ! Br- QJNT-SS NAME BUSINESS LICENSE #
� C binds a;;N1i11ti:or'k _
Cement Finishing I -
L'lectrical �
Fencing --�
Eloocinv,: CnzPetrnJ
I,i.nnlcvm / Vdood � f
-- Heating
insulation -
� Landycaninp�
m tsonry
I O:ncurn (113.1 Shect l^.eta.J
i Plumbing
X i R:tafin
— _ SLptic'l:mk
1 �itee+. Rock
Otivne.c/Contracloc Signahtre Date
TOTRL P.01
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408) 777-3333
tUPEQ INO
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 withp the above stated policy on re-roofing.
Homeowner's Name: YtAl o.�z/,,,.
Job Site Address: -7,F// (/�w('c� cJ C
Roofing Company Name: 1,
Applicant's Signature: Date: 7 / QS
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINO
aezi I REROOF 6 ��' 7`>COF
�CUPERTINO PERMIT APPLICATION FORM
APN# 6 -3 — Z C Date: _2 / 110 S�
Building Address: n
Owner's Name: Phone#:
Contract ri n Phone #: License #:
Irif z - � Loz27 3
Contact: 0 lPhone#: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ 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 Policy:
Job Description: / p 4,0, o's
Residential / d� Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project: �o Type of Construction: Occupancy group:
/OdDU
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