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CITY OF CUPERTINO
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BUILDING DIVISION PERMIT
�kCOC'I`1RA AOR
BUILDING ADDRESS:
R E ROOFING & CONSTRUCTION
TtiLNi15070069
10431 PLUM TREE LA
OWNER'S NAME:
PERMIT ISSUE DATE
MURUGA CHINNANANCHI
15230 CLYDET.T.R AVENUE
n7/12 2oorz
NE:
SANITARY NO. CONTROL NO.
(408)626-9320
ARCHITECDENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
1 Wrtby amrm Nn 1 am licensed under provlaiana of Chapter 9 (commencing
- P
with Section ]IXg1)afD Wai 8uaineu Prof, 'a s0ode.and mYlicmuc is
I. fan far, and mete 1 GIS
REMOVE EXISTING 2 LAYERS OF ROOF, INSTALL NEW 3
Llceme Cl
Dete A- coumcnr
amour
ASTM FELT & STEEL TILE
IJU A cHDEcrs I
FIIV�L�®
I undewn my ph t he used u putlf r
Licensed Professional
OWNER -BUILDER DECLARATION
w�
CRATIonneONaffirmn came,
1 hereby arm N 1 em LD from the lar. License Law for me,d
/ 2005
following moon. (Section 703 I3, Business and Professiuns Code: My city ar only
-
which requires a permit to consumer, alter. improv. demolish, or repair any tuucnm
prior m its issuance. also requires the applicant for such permit to file a signed Comment
Neth is licensed pursuant in the provisions of the Conuxmes hcensc law( Chapter 9
Sq. Ft. Floor Area
00
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that he h exeapl therefrom and IN, bash for the alleged eumption. Any violation of
APN Number
Occupancy Type
Section 7031.5 by any applicant fm a permit subjects the applicant to a civil penalty of
not Come Nan live hundred dollua (S500).
31633117.00
❑ 1, u owms of sire pmpmy, m my employes wW wgea u Neb cele rompewdon,
Required Inspections
e
will do the work,md Ne structure ilnnimersed oraBertd fanale(Seo. 7044. Business
and Profesalans Cade: The Conlran.rs Lynx Law don not apply W an owner of
9 P
property who Wilds orimprovn Nercon,and who doeatmhworkhimselforNrough his
awn employes, provided thatsuch improvmonu art nollnseMed maBerW fmsale, if.
however. the buildingorImprovement hsoldwithinone Xuofcompletion,becomes.
'
builder will Wv the Wrdca of proving that he did runt Wild Cr Improve for purpose of
ask.).
❑ L as owmr of Use property am exclusively contruning with licensed ronuxmn n
Construct the project (Sec. 7014, Business and Professions Cade:) The Conumctue. Li-
cense law docs not apply on an owner of property who Wilds or improves Nemon, and
who commets for such projects with a eonuanor(s) licensed pursuant to the Conlnnor's
Lynx law.
❑ I am exempt under Sec. ,B d PC for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby amrm under penalty of perjury ox of the fallowing declaratorm
I have and will normal. . Certificate of Consent t. self-insum Ice WorkefaComfort.
asdon, as provided for by Section 3700 of the labor Code, for the performance of the
wo for which this permit is freeze.
I have and will maintain Workees Compensation Insurance, as required by Section
00 of Ne law CUdr. for Ne performance arms work for which Nis permit is' red.
'
My a Cape dant n, came, and Palicyparypy.m:,
Carrier. Policy No.: �M
CE FICATE OF EKEMPION FROM WORKERS'
COMPENSATION INSURANCE
'
('Det section med rot heCompladl if the permit is Forane hundred dollars (SIM)
or less.)
I artily Net in he performance of Ne work for which this permit is issued. I shall not
employ any person In any mumrx as to became subject n the Wortrn' Commuadon
laws of California. Date
Applicant
NOTICE TO APPLICANT: If. After making this Certificate of Exemption, you should
became subject in Ne worker's Compensation provisions of the labor Code, you most
forthwith Comply with such provisions or this Permit thall be deemed mvked.
'
CONSTRUCTION LENDING AGENCY
1 hereby smrm Nat dam ha ronswctinn lending agency for dm,rfmerance of
the work fm which this permit h issued (Sze. 3097. Civ. C.)
Lender's Name
Lender'sAddress
1 certify that I have read this application and suis Nn the salve information is
COMM 1 agree to comply with all city and century ardinsnces and slow laws retailing in
building construction. and hereby l hOdZe Mpresenutiva of Lots city n enter Cites site
ahove-mendomr! property for Inspection purposes
(W.) agree n save, indemnify and keep harmless the City of Cupenim against
liabilities, judgments, casts and expenses which may in eery way accrue against Said City
amour a of Ne granting of this Permit.
APPLICA D N .A COMPLY WITH ALLON-PAINT
Issued by: Date %--tl'Z —
SOURCER U S. (. t1
A V
Re -roofs C7
Type of Roof
Sig a pecan ""Mor Data
HAZAROOIiS ATERIALS DISCLOSURE
Will Me appBearrtfr (uum Wilding =Want store or handle h oils material
as &Rmd by Use, Cupertino Munid I Code. Chapter 9.13. and the Health and Safety
Cade, Section 25533(.)7
All roofs shall be inspected prior to any roofing material being installed.
YOU u
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or unre building accepted sax equipment or devices which
nu le"Ardnu air cm umi...%as fined by tits Bay Area Air Quality Management
w materials for inspection.
DluricO
YC. a
I have mW the s quimmrotsundcr Chapter 6.95.1' dmecalifor.
Wilding
rahsnhh&Snd,he .tions 255(15.3 Jand 255 ndedly
'j
/' I !) 1or i
/ ` {i v
ems not cumntiyW It h ' nsih' edify Nc m lot e
the
mquircments which 1pri0rn o Oc OI
Signa of Applic D e
All roof coverings to be Class "B" or. etter
______
ownerar am gent Dtte
I of 1
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 31633117.00
DATE ISSUED.......: 07/12/2005
RECEIPT #.........: 30333
REFERENCE ID # ...: 05070069
SITE ADDRESS .....: 10431 PLUM TREE LA
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OWNER ............: MURUGA CHINNANANCHI
ADDRESS ..........:
CITY/STATE/ZIP ...: CUPERTINO,.CA 95014
OPERATOR: kiersaw
COPY # : 3
RECEIVED FROM ....: R E ROOFING
CONTRACTOR .......: PROCTOR, PAUL LIC # 20615
COMPANY ..........: R E ROOFING & CONSTRUCTION INC
ADDRESS ..........: 15230 CLYDELLE AVENUE
CITY/STATE/ZIP ...: SAN JOSE, CA 95124
TELEPHONE ........: (408)626-9320
RE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL
______ _____________ ____________________ __________ __________ __________
BPERMFEE VALUATION 13,000.00 201.96 0.00 201.96 0.00
BSEISMICRE VALUATION 13,000.00 1.30 0.00 1.30 0.00
TOTAL PERMIT : 203.26 0.00 203.26 0.00
METHOD OF PAYMENT
-----------------
CHECK
TOTAL RECEIPT :
•
AMOUNT
------------
203.26
203.26
NUMBER
------------------
9167
Community Development
10300 Torre Avenue
aClOF
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
#UPEI�TINO
Building Department
•
JOB ADDRESS:
10
t - w4 /fuv d
PERMIT #
pS67066
OWNER'S NAME: AbjU
(2A1KWAt4AQCR1PHONE
# 4,1t -
GENERAL CONTRACTOR
wf-,�.t
FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information
Signature
12 6��
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
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Signature
12 6��
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
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 coly with the above stated policy on re -roofing.
m
Homeowner's Name: I Li "LL u+tI 14N A N W Ci-(
lob Site Address: 'V\09
Roofing Co me: 1� LC\UUFIN(� I
Applicant Signatur ; ��/1 Date: \�
isGreg Casteel
Building Official
Revised 11/2/04
Printed an Recycled Paper
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 coly with the above stated policy on re -roofing.
m
Homeowner's Name: I Li "LL u+tI 14N A N W Ci-(
lob Site Address: 'V\09
Roofing Co me: 1� LC\UUFIN(� I
Applicant Signatur ; ��/1 Date: \�
isGreg Casteel
Building Official
Revised 11/2/04
Printed an Recycled Paper
CITY OF CUPERTINO
a REROOF
•CUPERTINO PERMIT APPLICATION FORM
APN # 31w 3 J III—
Bldg Permit Fees
Date: I Z
U
Building Address:
l V I-{
BUILDING
Owner's Name:
u,.� K
�k� ,sof if
Phone #:
L- J`
Contract 6, �� I /
Phone #: _ �n,
License #: -I
Contactp at(( j��j
Phone #: � �r
2
Cupertino Business #I:
/
_
Type of Roof Covering:
Existing:
Proposed:
❑ Built -Up Roof
❑ Built -Up roof
❑ Asphalt Shingles
❑ Asphalt Shingles
Wood Shakes
❑ Wood Shakes
Wood Shingles
❑ Other (Specify)
❑ Wood Shingles
Other(Specify) TI l Y
Number of existing coverings ❑ Provide I.C.B.O. Report # KW_23Sb
J� To be Removed
❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: EMu>'L' L ISn\ 6f 2 M( -)Q UT- Oi)�1 ("TA -LL- Kt:1W 7jv�
TM v�
y , -L -nL6
Residential KCommercial
❑
Fire Zone: Yes ❑ No
Confirmed with Planning Dept. if
there are anrestrictions: LJ
Cost of Project: Ji 1, , v U U , (((),
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