06090078 CITY OF CUPERTINO °
BUILDING DIVISION PERMIT X0NTRAGT0RjNFO MATION
BUILDINGADDRESS: JIM KRAUSE ROOFING PERMIT NO.06090078
10370 PALO
OWNER'S NAME: PERMIT ISSUE DATE
NIVEDITA MELINKERI 2310 DIANA AVE 09/12,/2006
NE:
SANITARY NO. CONTROL N0.
(408) 779-0704
ARCHITECrrENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
oa LICENSED CONTRACTOR'S DECLARATION - Job Description
w 1 hereby affirm then 1 am limned under provision of Clupmr 9(mmmcncing
_ withScdon?au)ofOcsay3�rmeeasn anePor= acada.ane trump is REROOF— TEAR OFF 1 COMP ROOF, INSTALL 30LB FELT
« in ren rarer aria erica
Z License Cl DECLARATION
¢ f//�//tY u30 YEAR COMP CLASS A OR B
Da
pp � rIECISConuoerror uter
i C e I understand my plans shall he used as public records
U, Licensed Prorearman.1
3 OWNER-BUILDER DECLARATION
9/
1 hcwhy strum that 1 am1. exempt from me Contractor's Lkcnx Law for the
O o which re mssoa Permian 113 str Business and improve.
do poli Coda:Any city or county
m which requires a permit m rnvwcl,ally,improve,demolL h,or repair any awnum
,2Y prior to its isseance.alm requires lk applicant for Such permit la fk a signed Statement
Fz
that he is licensed pursuant o de provisions of the Comnomla LJccnse Law(Clupmr 9 Sq.Ft. Floor Area Valua[i�
that ba s exom wit Section and of Division 3 of the Business edxe pt profeson.An inns CMc)of
—
that h<u eumpl therefrom and the bssu for the alleged exemption.Any violation of '
Section 1031.5 by airy applicant for a permit subiccu thou applicant in a civil penalty of APN Number Occupancy Type
not mare than five hundred dollars($500). 35702051 . 00
❑1,u owner of Uie property,m my employee with wages ss me'v rok eompevation,
will domework,ands, swnuuunori License LawdAtorula(Sec.10 a4,Owner
or
and eny whloW Code Tho Convertor's License Law uch ret apply if an owner of Required Inspections
pmpeny who Wilds or ed tato dwrm r and who are
in work himselfortluough his
own employees,provided Natsuchimprowmmuart trot ear cdc rs,kni t.for sale.If.
however,the building or improvement u sold within ane year of mpro a for me awe of
builder will have to Wrdcn of proving Nat he did not Wild or improve for purpose of
sok.).
1.u owner of the property,am exclusively contracting with licensed mntranon to
consumer me project(Sec.1014.Business and Procession Code:)The Cmtrerlors Li
eve Law does not apply ro an owner of property who Wilda or impmvus thereon,and
who contracts for such projects with a conVer101(s)Il4nYd promm'in the P.'an=wl a
Liceve Law.
❑Iamuemptunder Sec .BAPCformumwUcm
Owner Dam
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under pevlty of perjury one of the following dmlantions:
1 ham and will maintains C,milieom of Covcntto selr-Ivure for Worker's Compcn-
Saban,as provided for by Scotian 31W of the labor Codc,for the pc,in. m of me
work for which this permit is issued.
❑1 hast artd will maintain Workcfs Compensation Insurance,as required by Section
3100 of dre later Code.for the performance of the work for which this permit is issued. '
My Worker's Compensation lnsu cenrriaand Policy
� rt
rountera
Cartier u Policy Noip•� O o
/5
CER IFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
rrhu section need no Wcomplemd if the permit is fmone hundred dollars($]W)
Or less)
1 certify that in dm performance of the work for which this permit is issued.I shall not
cmploy any perban in any manner Or as On become subject in the Workcn'Compevation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If,after making;this Certificate of Excerption.you should
become subjca ro to Worker's Compensation provisions of the Labor Code you most
QfoMwith comply with such previsions or this Fermluhall x deemed mmkcd.
z "' CONSTRUCTION LENDING AGENCY
y
04 1 hereby alOrm Out @ere is s c d(Sce.30 leading agency,for tiro performmu of
a Ne work for which this permit is issued(tee.309T,Civ,C.)
W� Q Lcndcr's Namc
= Z Londcr's Address
V O 1 ratify that I have read this application and sum mu the aWw information is
C4 (•-' toren.1 agree be comply wit all city and county andinurtes and sure laws relating to
e m
�(J building cOnStnUcLion.and.rode amh and lop rp hommives of City
Of
mamine aupon m,
G zhow mcneonm Orreny for ivpcction p.rlmscs.
(s,ju age to saw.andcmmly and hi cp hay to m the City of Cupenmo agaivs
Ut,iZ Iiain embabuenceror tocvu and enpasus which may in my wayacme againstsaid City
^ "U'rong of this iL
APPLICANT UNDERSTANDS I ,WI COMPLY WITH ALL NON-POINT Issued by: Date yi
SOURCE REG LATIO ry.` '
Re-roofs
Signature of linor / t Dam /v
HA• RDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building accupnl store or handle huardaus material
as deftocd by do Cupceina Municipal Code,Chapter 9.11.and the Health and Safety
Cade.Section I5531(.)? �/ All roofs shall be inspected prior to an roofing material beim
[:1 YOU IQrve p p Y g g installed.
Will the applicant or future building occupant Use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
emit havrdous air cmumirunts as derinc l by the Bay Area Air Quality Management all new materials for inspection.
' District?
❑Yes Nu
IhavcuadthehvaNuusmaten.1spcquirt nu un der Chapmr6.95ofmc Czlifor.
is Healm&SafayCod=,S¢uau1550,75533 d25S34.l undersundmviflhe Wilding
does not CUT"haw xb l d responsibility to notify me mxupant of me
mquimmcnkwht et tssuanccaf.ccoificama(Occup my. Signature of Applicant Date
9 0 All roof coverings to be Class"B"or better
Owner err aut nt Dam
J
Community Development
10300 Torre Avenue
e f Cupertino CA 95014
Telephone(408)777-3228
CITY Of Fax(408) 777-3333
�UPERTINO
Building Department
JOB ADDRESS: PERMIT
-70
OWNER'S
� d (FO O?"7
OWNER'S NAME: PHONE # C:/6? -413 - 7/
GENERAL CONTRACTOR: I,rn - FAX #
V1G. I
I am not using any subcontractors: / (�
Signature E ate
Please check applicable subcontractors and complete the following information
21 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
CITY OF CUPERTINO
am 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 35702051 . 00
DATE ISSUED. . . . . . . : 09/12/2006
RECEIPT # . . . . . . . . . : 36001
REFERENCE ID # . . . : 06090078
SITE ADDRESS . . . . . : 10370 PALO VISTA RD
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : NIVEDITA MELINKERI
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : JIM KRAUSE ROOFING
CONTRACTOR . . . . . . . : KRAUSE, JIM LIC # 21415
COMPANY . . . . . . . . . . : JIM KRAUSE ROOFING
ADDRESS . . . . . . . . . . : 2310 DIANA AVE
CITY/STATE/ZIP . . . : MORGAN HILL, CA 95037
TELEPHONE . . . . . . . . : (408) 779-0704
•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
------------ - - --- ----------- - ------------------
CHECK 126 . 96 22149
TOTAL RECEIPT 126 . 96
•
CITY OF CUPERTINO
S-enREROOF
• CUPEkTINO PERMIT APPLICATION FORM
APN# Date:
-1 -
Building Address:
d 3 0
OwneNam
ro', . e: N ` Ph FSS :_ 77cl 070 I`
1 Q 7
Con tr or: License#:
•nti aw � � 5
Contac : Cupertino Business License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
Ci"*�Asphalt Shingles O"�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:
Residential Commercial ❑ C e-CT
Fire Zone: Yes Q No Confirmed with Planning De t. if
there are any restrictions: LJ
Cost of dect: c. Type of C
uStrIuction:
0Occupan(X group
0 llN � S
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
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:
Job Site Address: 1 U'1-70
Roofing Company Name: c I Vim- �NY__AOU,62 :o it i'of y,<—
Applicant's Signature: Date: �7�4CP
Greg Casteel
Building Official
Revised 11/2/04