04100055 ;,. 7585
ITYOFCUPERTINO y `� -
BUILDING DIVISION- PERMIT T A W11= ri ION -
n� �. _x�. . �_
BUILDING ADDRESS: ROOFCO OF SILICON VALLEY - "'u"O"No04100055
RAINBOW DR NER'S NAME: PERMRIEEUEDATE
SURESH KUMAR 844B
NE: SANITARY N0. CONTROL NO.
(408) 795-3335
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
ee o 0 0 0
il00 LICENSED CONTRACTOR'S DECLARATION Job De$CTIpUOn
r� F 1 thereby affirm that 1 am lianwd under previsions of Chapter 9(commencing -
n 4 wlh Sec n70f10)af Division of Ne Buaineuand Prefbmia sCo ,andmylicenmis
EEEE in til eanderce "� V (t REROOF W�COM�I����
j�'z Li Class
Lm.g
n F am �/ Conlrscar
AR HITECTS D
U rmcrstand my plena(hall W used as p tc mCords -
;;� Licensed Professional OCT 21) 2004
5 OWNER-BUILDER DECLARATION
<� 1 hereby affirm that I am exempt from the Convector's License Law rut the
0O fallowing rcuson.(SectionWKS 1.5.Business and Profcmimm Cole:Any city or county
K g j which requires a Permit m cnnsuuct ellen improve,demolish,or repair any sumctum
r-i�� prior to its issuance.also requires the applicant for such permit to File a signeusammcat
Fthat he is licensed pursuant to Om prov(sioan of the COMMOals Licomen LAW(charter 9 Sq.Ft.F r Valuation
y $ (commencing with Section 7")of Division 3 of the Business and Professions Code)or
that he u emmpt Research.and Use breis far the alleged emntptian.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of ST4QiQZcr0 0 Occupancy Type
not mom than live hundred dollars(5500). - -
0 1.as owmt of the properly,or hey employees with wages As thebmin compensation,
will do Rework,and the structure Is notintended An offered foment(Sec.7044,Business
and Professions Cade:The Contractor's License Law does test apply an an ownu of Required Inspections
property who builds or i mproves mercon,and who does s uch work himsel f or through his
Man employees.provided that such improvements re not intended oroffered forsam.If,
however.the building or improvement is mid within one year of compledon.the owner-
builder will have me burden of proving that W did nal build or Improve for purpose of
mlc.),
❑I.es owner of the properly,am exclusively conVacling with licensed contractors to
construct des pmjea(Sec.7044,Basin=and Professions Code:)The Comment's Li. '
came Taw does not apply in in owner of property who Wilds or improves desmon,and
who contracts for such projects with a emtrmmu(s)licensed pursuant to this Contnnara
License Law.
❑I am exempt antler Sec. B R P C far this rcuon
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury am of tite following declarations:
I have and will maintain a Certificate of Consent m self-insure for Workers Compere
sedan,an provided for by Section 3700 of me labor Code,for the performance of the
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,m required by Section
37W of the labor Code.for the performance of the work for which this permit is Issued.
My Warkc 3Co tpe ation Ile moaca erend Politynumberam:
Cartier: / .G Policy No.:
CERTIFICATEOFEX MPTIONFROMW ERS'
COMPENSATION INSURA -'
(Thu action medmalaccompleted iftW Permit Is tamminumdrad dollars($1110)
less.)
1 certify that in me informer.of me work for which this Permit is immd.I shall Out
employ any person in any mmmrm as m Wcome subject to the WorkeW Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT.Jr.after making this Ccninate or Excerption,you should
become suhject to the Workers Compensation previsions of me Labor Code,you must
,J O forthwith comply with such provisions or this Permit shall W decreed revoked.
,'Z,t ~�. CONSTRUCTION LENDING AGENCY
.
[+ I hereby affirm that inert is a contraction lending agency for the performance of
C> the work for which this Permit is issued(Sec.3097,Civ.C.)
Q Lenders Name
r7- z Lender's Address
V 0 I certify Out I have mad thin appli mum and Shim that me s Ww infom atim,is
Fcorrect.l agme to comply with all city and county ordinances and sum laws relating to
C) building construction.and hereby Aud ire representatives of this city to enter upon me
W amw-ancramacd property,for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupenina against
fa/) Ilabilities,juigmemis,costs end menses which may in any way came against mid City �e
U In consequence of the granting of this permit v
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NO -POI Issued by:9 Dat
<q�_
SOURCE REGULATIONS. /lt
Re-roofs
taro Con for De
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicam or fumrc building occupmistom.,handle hanrdaus mncri it
as unlined by the Cupertino Municipal Code,Chapter 9.12,and tW Health and Safety
Conk.Scctien 25532(a)+
p Yca All roofs shall be inspected prior to any roofing material being 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
met hazardous air conmmimnts u dcfincel by me Bay Arca Air Quality Management all new materials for inspection.
District?
C3Ym o
Ihave mad Ce ,S.fi.mcriaumquircmc5534.1rChapter..G9tifine Califor.
dixflaWt&Safety Cade,meant, ha50S x5533 anJ 25534.1 undersand a Blume Wilding
Jars not cunan0y new a tenant Nat it is my rcapomihility w notily the accupmt of On
requirements which must met pump I. ofacertifiataofap'y..�� nature Of Applicant e
All roof coverings to be Clas "B"or ester
ser authorised agent A Dam '
Community Development
o„ 10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY 0' Fax(408) 777-3333
IFUPEkTINO
Building De cutment
JOB ADDRESS: RMIT#
� _( ( ;
OWNER'S NAME: /, PHONE #
G �e:, AX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
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
�J
ontractor Signature � Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
OC�71 �F Telephone: (408)777-3228
UPEkTINO Fax: (408)777-3333
Building Departmenta� � D
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.
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: GL/�5,1 2 ) LLO�%'�/
Job Site Address:
Roofing Company Name:
A plicant's Signature: Date:
• Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
aw REROOFOF
�CUPERTINO PERMIT APPLICATION FORM
c OF
APN# Date:
3 t��ZZ � 00
BuildinAddress:
Own 's Name: Phone#:
ur.Y/•c-✓ 253 - / 3 �
Co acto •- Phone #: License#:
e� _or UcvG &3 36 le
Contac Phone#: Cupertino Business License#:
,�% —D >J3 Z23�/ S
Type of Roof Covering:
Existing: Proposed: f
❑ Built-Up Roof ❑ Built-Up roof ?^
❑ phalt Shingles Asphalt Shingles l
B' 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 ❑
3
Fire Zone: Yes ❑ No Confirmed with;2
ng Det. ifs
there are any re ctions: IJ
Cost of Project: Type of Construction: cupancy gr up:
,,,,,-,-
y. if
Pl)
]' abl Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Energy BUILDING
SEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
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