05090234 FBUILDING
F CUPERTINO '� _
ING DIVISION PERMITCONTRACTnR INFORMATION
DRESS: KEVIN SULLIVAN ROOFING PERMIT NO.05090234
MME: PERMIT ISSUE DATE
AWL ANAND CHERIYATHMADAM 1696 VALLEY OAKS DR - 09/10/2005
NE: SANITARY NO. CONTROL NO.
(408) 842-1057
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB - MECH
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LICENSED
atIamlCONTRACTORS DECLARATION JobDescri tion
fd�C 1 hereby affsm Wi I am licensed under provisions of Chapter 9(commencing P
U with Seaion]OW)af0iviaian3or NC Business end Profcuians Code.antlmylicenx is �% f7;\
in full fore,and clfcn. _ � \
>q? Lmensea , Lte.g 03' 1 a REROOF-T/O SHAKES, INSTALLt;AS'PHALT FMM, SHINGLE
�Conlr" .w J I] Ise .�.'ate •�:rl�
ARCHITECTS DEC'CLA ATION
1 undersand my plans shall W used u public records
t o Liccnu0 Pmfcuionel
3 OWNER-BUILDER mDECLARATION
aP I hcrthy affirm that 11. exempt from the C,tions at License Law for the
p 0 which
mama.(Section 7(131.3,Business and improve,
de inm Cole:Any cis Os countygill hI
ai m_ which myuimu a pomit re err smct,alk(,improve,demolish,m repair any structure ����f !�(� Q(]O
L¢i bit heits ccomd Issuance.also requires p.,is tcantfmumt.wch Permit m,,o.fific Lwedsatemcnt -- uu,.�,..y U V
(commencing
incing with Section" sh)of Disioiaorifilm nsuctuiandPnselaw(Chapter9 Sq.Ft. Floor Area Valuation
yF� Mime Ite MPI Sceion711W)of Divisionr ofthCBoslnmrotion.Any
Cmlc)of
j?,�� Nas he u exempt tMrtGam and Ue bun for the allegrA exemption.Any violation of
Section 7031.5 by any applicant for a permit subjem the applicant to a civil penalty of 999Fer-70 Occupancy.Type
not mom Nan rive hundred dollars(5500).
❑I,uowner of she propenY•to mY employers with wageulhetr sole compensstian,
will do dwwork,and themucsum is not intended or offered forage(Sm.7W.Business; Required Inspections
and Professions Cade:The Contractor's License Law does nos apply m e ns an owner of q P
property who buildsorimproxss thereon,and whodoessuchwork himselfor through his
Own cmployces.provided that such improvements;are not intended mrmRemol forsale If.
however.the building or improvement is sold within owe year of completion,the owner-
builder will have the Wrden of proving that M did not Wild or improve for purpose of
sale.).
❑1,as owner of the property,am exclusively contracting with licensed contractors to
construct she project(Sec.70x4,Business and Professions Code:)The Contractor's Li.
cense law docs not apply to an owner of pmpeny who Wilds or improves thereon,and
who contras for such po jecu with a conuactor(s)licensed pursuant to the Contractors
License law.
❑I am cmmpt under See. ,B At P C for this reason
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby affirm under parody of perjury owe of Ne following decla aukdo:
I haw and will maintain a Ceniricate of Consent In self-mium for Workers Comfort.
737W
ion.as provided for by Section 3700 of the labor Code.for the performance of the
rk for which this permit is issued.
1 nave and will maintain Workers Compensation Insurance,a mquired by Section
of the Laixr Code,for the performance of the work for which this permit is tssued.
y WorkeessCoom peemation lnsuancc carrier and Policy.sihe�r amrrier. SNTT� -a•alvj() Polity No.: AA5'Z��—W
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(this action need oat beeompleted Hshe permit is formic hundred dollars(SI W)
or less.)
I cenifv Out to the performance of thc work for which this Permit H issued.I shall root
employany perun in any manner an as to become subject on the Workers meNcesadmn
Laws of C.lifo.ia.Date
Applicant
NOTICE TO APPLICANT:If,after making this CcniGate of Exemption.you should
become subject on the Worker's ConiNnation provisions of the Labor Code,you must
J O forthwith comply with such provision or this permit shalt be deemed revoked.
Z � CONSTRUCTION LENDING AGENCY
F•r I hereby affirm that there is a conssmctinn lending agency ror the performance of
the work for which this permit Is issued(Sec.3097,Co.C.)
CA Lendces Name
:D z Lenders Address
U C) 1 coolly Nat 1 have mad this application and sme that the show information is
W F' COMM I agree to comply with all city and county Ordinances and sum laws relating to
O Vbuilding constrOction,and hereby authoine MPocXWdjws Of this city to enter upon the
H4U .1mm-mcmiorod property for inspection purposes.
y (We)agree on saw,indemnify and kap harmless the City of Cupertino against
rq liabilities.judgmens,cuss and expcmes which may in any way accmc against said City
rJ z in consequence of Ne granting of this permit. ?_ _7^ APPLICANT UNDERSTAbR*AND WILL COMPLY WITH ALL NON-POINT Issued by: Date C, ^O•
SOURC acrsJLATIONb.//
9 ��t Re-roofs
Srgnawre of ApplicanUVourractor
HAZARDOUS MATERIALS DISCLOSURE ate Type of Roof
Will the applicant of future building occupant store or handle hatum mus criminal
u de0ned by the Cupertino Municipal Cade.Chapter 9.11.and dx Health and Safety
Coale.
Sc yes 155R
(a)? All roofs shall be inspected prior to an roofing material beim
❑Ica p.af� P P � Y g g installed.
Will the applicant of future Wilding occupant um equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
not hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District'isutriirtnciatm'❑It
hccanuYvfeereswmnsaltydnthham^ewaha ater nan0esttmp2Chnaal
iaHalNhSaetYCo .Sevm1mms rr05a
ur.lsi]ssm55ay3an3m«manpmdtuoerr2tnaa5si5hc3uiel4nint.dyi1ehmranCaJrtehmroatipfteynrthfi cuottsotf uNpoee nWilding
ilding
orOceeye
Signature ofApplicant Date
D„pI All roof coverings to be Class"B”or better
£ Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
� CITY OF Fax(408)777-3333
UPEkTINO
Building Department
JOB ADDRESS: PERMIT #
Z7
O R'S NAME: , ,Qa�jPHONE # Z4, >
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors: 'i0 b
Signature Date
Please check applicable subcontractors and complete the followinginformation
60 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/q! actor- ignature Date
_ Community Development
10300 Torre Avenue
:�- Cupertino CA 95014
Telephone(408)777-3228
ICITY OF Fax(408)777-3333
UPER,TINO
Building Department
JOB ADDRESS: PERMIT #
l q gS`L'
` OWNER'S NAME: A-oJ O PHONE #
GENERAL CONTRAJlfi! C • _
�V4—r-1 FAX #
� J
I am not using any subcontractors:
Signature Date
Please'check applicable subcontractors and complete the followinginformation:
SUBCONTRACTOR BUSINESS NAME> BUSINESS LICENSE #
0
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 n ,
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/C fijtractor Signature Date
Community Development Department
aRIS
Building Division
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
Fax: (408) 777-3333
C O P E IST I N O
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: A tg- , A44Z
Job Site Address: I W S-13 y- 09::
Roofing Company Name: K6 eri (� , S'U'VAIJ
Applicant's Signature: ate:Jt6�
z,
• Greg Casteel
Building Official
Revised 11/2/04
Pnnfed on Recycled Paper
CITY OF CUPERTINO
( � REROOF DP 2-3y
1
6CUPEkTINO PERMIT APPLICATION FORM /
APN # Date:
Building 'dress:
Owner's Name: Ph ne —S`7 ie — Z
C,Rg ATN-t�
Contractor: Phone #: License#:
L ✓i 1 �, Su �c l s OS d P7
Contact: Phon it: Cupertino Business License #:
80' —D
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ t-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 Polic
Job Description:
Z�vW S S 6 NDS
Residential Commercial ❑
Fire Zone: Yes ❑ No Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project: Type of Construction: Occupancy group:
lit
Qty. if
Applicable Fee ID Fee Description Fee Gro up
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