06090099U�
CITY OF CUPERTINO
BUILDING DIVISION PERMIT
I L DINGADDROS:
LOS GATOS ROOFING
FERMI'NO'06090099
91614
OAK SPRING CT
NER'S NAME:
PER Tr ISSUEDATE
SHARMA
888 FAULSTIQH CT
09/14/2006
NE:
-
SANITARY NO. CONTROL NO.
(408)298-9399
ARCHITEC fENOINEER:
BURRING PERMIT INFO
BLDG ELER PWMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
al 1 am lamed under provisions of Chapter 9 (commcming
hereby affirm Nm
with Section 7000).f Division 3 of he Business and Professmas Code, and my license is
nfailfamatwaffrft. w
'��
REROOF- REMOVE EXISTING SHAKE ROOF. INSTALL
Lina Clma 1 _`OO
Dau
ROOFERS SELECT FELT AND GRAND CANYON SHINGLES.
AR CHIT LLAT. DN
TSDEC
24 .SQUARES. CLASS A
1i
he mcd a
I uMcrwnd my pins shall he uutl u Public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors Uceae Taw for the
fallowing motor. (Section 7031.3, Business and ProfeWnm Code: Any city Of county
which mquirm a permit to construct, aher, Improve. demolish. or repair any suucture
prior Of its issuance, aim requites the applicant far such permit o file asigned statement
License Law(Chapur 9
Sq. Ft. Floor Area
Valuation
Nal he is licensed pursuant to the pmvisiam of the Contractor's
(commencing with Section 7000) of Division 3 of Ne Business and Pmfassions Cade) or
$5687
that he is aaempl Nemfmm and the bull for due alleged eeemptim. Any violation of
APN Number Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant m a civil penalty of
not mare Nan fiw hundred do16n (SSW).
'
D I. u °wrur of ft Foperty, m my erapl°ym withwps u Deb ml mmpem don,
70 M, BYmIW
will do Newark. and the armmumleons',
Required Inspections
P
was
Taw dao rot apply lf an ower of
and obu Cade: The Conlnctnfs Lamew LawApply
9
thefean, and Mmaelfs Nmugh his
erty wh and
pmpeny who
/
s. provided thiw,
erm Am .1imseWe forests. IL
Avon employees. ed Natsuch dmprewmanuartml inteedtdor
mplaned
however. the building ordmpmwmmtg the ower-
the bolding aid within am year of comPve
for
builder will Nw the burden of proving that he did ml build or imprew far purpose of
t
ute.l.
/ )
!A`
D I, As owwr of properly.am exclusively connecting with lcesed mnuacmn
cmutmm project (See. 704 Business Rofadom Cade) The CornerstonesL.
cense law does am appty n an wmer of progeny who Wilds or impmvu Nortrs. and,
/
who contracts far such pmjecu with arnnuactm(s) Ottttssd pvnunl to the Conuutoh
Licerann law.
^�
E31 am aempl undo Sea . B d P C far dtia reason
Owner Dau
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury am of 1hC following declaratiam:
D I leswatb will maintains Ceniffam. Comemmself-ImurtfArWarker'°Compca-
sman, As provided for by Section 3700 of the labor Code. for Ne performarute of tlm
work for which this permit is issued.
❑ Mare and will mdnudn Workers CompmeNm Insunna, As required by Section
_
3700 Also. labor Cade. far she perfafmameafthe work fa which this permit u W.&
,
My Waftes Compensation Inmram ander "KINK ( number art:
04
Caller. Policy I'Ib.: Q94-7 Z� 9L
CERTIFI TE OF EKEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Tab section wed not becmnploted if lbe permit is fafanc hundred dallan ($1 00)
nr leu)
I Gentry Nat do the performance of the wark fm which this permit is iced. I shill rot
employ any permn in my summer an As an became subject m Ute Workeri Cmnpeeutim
'
Laws of Cdifomda Dau
Applicant
NOTICE TO APPLICANT. If. Afar making this Certificate of Exemption, you should
became subject an the WOrkefa Compensadan provisions of the Labor Code, you met
' forthwith comply wish such pmvidons or this Permit shill be deemed rtwkcd.
CONSTRUCTION LENDING AGENCY
Thaffvm deal Jam Isconstruction lending agency for tiro perfdrmance of
which Nis permit Is issued
' the work furor which (Sec. 3097, Ci, C.).
Lenders Name
LerWera Address
1 certify that 1 have read this appliation and sum Wt the above information is
' correct. I agree An comply with all city eed cdunty aNinamas end sum laws relating Of
building construction, and hereby aalhorim representatives Of Nis city to error ulmn the
above-menliuned properly far inspection pugmus.
(We) agme to rave, indemnify and keep harmless the City Of CuWnino against
I liabilities. judgmcnu, casts and exporter which may in anyway acme against mid City
In consequence of the gmating of this permit.
" APPLICANT UND R3TANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by; Date
SOURCEREGU ON3. �j����
�7 L
Re -roofs
Type of Roof
Silmomele ofA i O° OOUS MATERIALS DISCLOSURE Date
Will dm applicant a future building occupant emre At handle Income. material
As deRed by the Cupertino Municipal Code. Chapter 9.13. and tic Health and Safety
Cam.Secuonss53z(a)7
All roofs shall be inspected prior to any roofing material being installed.
Dy. pea
If &TOOT IS installed WIIhOUI first obtaining an inspection, I agree to remove
'VIII the applicmt of future building Occupant use equipment m devices which
emit haaadom air conuminanu u d Rned by the Bay Am Air Qadily Management
all new materials' for inspection.
D suict7
❑Yes u
I hive read the hanaNws m,urialsrtquirtmenuundcr Clupter6.95 of Ne Califar-
maHealth& SafctyCode, Sectiam 25505.15533 am125534.1 uralerRa d thmifdu building
dee rat curtemly have a tenant. that II b my respomdhilily of Unify cite occupant Of she
Acquire '_hmuRbemel rigrtoissuance Ads CeadOateafg a
Signature of Applicant Date
Mor "
/ or
All roof coverings to be Class "B" or better
Owner orr author Dote
CITY OF CUPERTINO
om 1 of 2 PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 36652067.00
DATE ISSUED.......: 09/14/2006
RECEIPT #.........: 36041
REFERENCE ID # ...: 06090099
SITE ADDRESS .....: 11614 OAK SPRING CT
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OWNER ............: SHARMA
ADDRESS ..........:
CITY/STATE/ZIP ...: ,
OPERATOR: amyw
COPY # : 2
RECEIVED FROM ....: LOS GATOS ROOFING
CONTRACTOR .......: RANDY BROWN LIC # 23481
COMPANY ..........: LOS GATOS ROOFING
ADDRESS ..........: 888 FAULSTICH CT
CITY/STATE/ZIP ...: SAN JOSE, CA 95112
TELEPHONE ........: (408)298-9399
*EE
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
•
�J
0
CITY OF CUPERTINO 0( 0 -��q
REROOF '"'l1
PERMIT APPLICATION FORM
APN #
Bld Permit Fees
Date: 8
Building Address:
BUILDING
117
Owner's Name:
Phone #
r s a r m 6(
yob SS -
Contractor:
Cls
Phone #: 4
,
License #: �QO / 0
Contact: �-
Phone #:
Cupertino Business License #:
l
Sa�rne�
358
Type of Roof Covering:
Existing:
Proposed:
❑ Built -Up Roof
❑ Built -Up roof
❑ Asphalt Shingles`
Asphalt Shingles
X Wood Shakes
❑ Wood Shakes
❑ Wood Shingles
❑ Other (Specify)
❑ Wood Shingles � //�1
/' Other (Specify) IC0 Be S & I'P f rl-/ -
Number of existing coverings 1
❑ Provide I.C.B.O. Report #
�( To be Removed
OK Provide Mfgr. Installation Specs. -fAe_
I Have Read, Understand and Will Comply
With Cu ertino's Tear Off Po 'c :
Job Descriptio
Q/
Residential Commercial W W
Fire Zone: Yes El No
Confirmed with Planning De t. if.
there are an restrictions: u
Cost of Project: S� g '7, Type o
Constructs : Occupancy group:
Qty. if
ADDlicable
Fee Tr)
Fran 1lPcrrie�t'nn
eve r
BPERMFEE
Bld Permit Fees
BUILDING
BENERGY
Energy
BUILDING
�__-..._—
BPLANCHK
Plan Check Fee
BUILDING
BUSLIC
Business Ucense
BUILDING
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=4nspector. 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.
IMPORTANT:
1. Flat roofs must have a minimum of Y4 " 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'sy�
Name: 1' i r 4- Mrs. ` 11 a r m C.t
Greg C�teel
is
Building Official
Revised 1/30/03
Printed on Recycled Paper
� *COF
UPERTINO
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Building Department
JOB ADDRESS:
�)(.Q1Ll
PERMIT #
C?6o
rl�
BUSINESS NAME
OWNER'S NAME: i_
PHONE #
GENERAL CONTRACTOR
FAX #
I am not using any subcontractors:
Ignature Date
Please check applicable subcontractors and complete the following informafinn-
• Owner/ Contractor Signature
Date
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
Septic Tank
Sheet Metal
Sheet Rock
Tile
• Owner/ Contractor Signature
Date