03050016 CITY OF CUPERTINO '� °'�
BUILDING DIVISION PERMIT CONTRA.CTOIi TNFURMA�.'ION
BUILDING ADDRESS: PERMIT NO03050016
Q3D0 5 0 0 1 6
OWNER'S NAME: - PEIUAIT Lg(J n5/2003
RIATHURAI SUGUMAR. Q AND SANDI,NE: SANITARY NO. CONTROL NO.
ARCHITEC 'ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
too LICENSED CONTRACTOR'S DECLARATION JbDescriDescription
I hereby affirm Nat I am Ilcenud under prooP
vision of Chapter 9(commencing
with Sauon]Om7of Division3oflM Buatrcae end Profcsatn otic.and roylkmse is
sL aeenm rc eomeffah
kiz WC_5 Lu.N s' Z.�z. REROOF FINALE®
5'�
° Dem Anc1�ciatu ia, N CONTRACTOR: BUENTIEMPO ROOFING
IundraanJ�nyRlaaapdmLb gMasPub{� MAY 14 2003
°yU
3Qg Licerued PmfWionel- -
OatNEm BUILDER DECLARATION BUILDING
cs y I hereby.(Su a n 1 em aempt from the Conoscmh License c tLawy o for the
°O which re masa.(Saito ND sur t.shod. and Pe(eVlun Cale:Any city or county
$� which requires•permit u construct.slur.improve,demolish,or repair say swctum
pilots,its iasuaae,oho requires du eppliant for such permit u fie a signed statement
HZ< that he is licensed pen ent.NepravisionofibeConoacm',U..Lew(Chapmr9 Sq.Ft. Floor Area Valuation
(commencing with Section 7000)of Division 7 of the Busincssend Professions Com)or
that he Is ca mpt duuf em,and the basis for the%listed esempden.Any vloladon of $13500
Section 7071.5 by any applicant for a permit ubjecu the applicant to a civil penalty of APN Number Occupancy Type
not marc Nan Res hundred dollars(5500).
0 I,As owner of the property,or my employees with wages u their sole compensation, 35913063 . 00
will do the work end the swctum is act intended or offered far eate(Sec.7044,Business
and Professions Code:The Contour's License law does not apply an an owner of 305 - FRAME Required Inspections
property who builds orimprovas thereon,end ad odousuch soh himulfor through his
own employes,provided that such improvement are not intended aroffered for sale.It. 307 - INSULA'T'ION
however,the building or improvement is sold within one year of completion,the owner.
wilder will haw ase burden of proving wt he did not wild or improve for purpose of 601 — ROOF TEAR OFF
ale') 602 - ROOF PLYWOOD NAIL
❑1,As owner of the property am achadyely conning with licensed mntnnon an
construct me project(See.7W,Balaea and Prefation Cade:)The contraomr,U- 603 - ROOF BATTENS.
am law does not apply m an owner of popery who wilds or Improves Na
onn.and 604 - ROOF IN-PROGRESS
who rontncu far such projects with a con rasd,(e)Boned puraunt or she Cmd amae.
License law.
❑ I am exempt under Sao .B k P C far this season
Owner
Data
WORKER'S COMPENSATION DECLARATION
I hereby affimt under penalty of perjury ane of the following declarations:
IMw end will mtinuinaCenificate of Conaenuo self-intro for Worker's Comps.-
teflon,u provided for by Section 7700 of the labor Code.for the performance of the
work f which this Permit is issued.
%w end will maintain Warted'Compensation Insurance,as required by Section
7700 of the labor Cau,for the performance of the soh for which this Permit is issued.
My Worke� pea=o 1 ttce a�Ip\tes end Policy num ram;
Grrier. w n r�d`-'Polley No.: � 4 V
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This radon used not W computed Bthe permit is form=hundred dollar.($im)
Or lea)
1 cerdfy that in the pufa eenum of the work for which this Permit is Wood.l shall not
employ any person in any manner an as in became subject to tbe Woraul ComPulstlon
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If,after making this CertlEeate Of Emaril ion,you should
become euhjat an the Woher'a Compcnaatiun provisions of that Labor Code,you most
Oforthwith comply with such provisions or this Permit shell be deemed revoked. .
yvy CONMUCT10N LENDING AGENCY
[r I hereby affirm that Neu is construction lending agency for the performrm of
ai 7 one work fur which this permit is issued(Sec.7097,Civ.C.)
QLender's Name
zLender's Addnea
U O 1 unify that I have read this application and rote that the above information is -
174 Fcomet.1 agree he comply with all city and county ordinances and sate law relating in
0U wilding mnsuuction,and hereby mthodwmpuumativea of this city to enter upon Use
4n move-mendoned Property for inspection purposes.
C (We)agree to save,indemnify and kap Iwmiea the City of Cupertino against
rfA tial lideajudpmmu.cosu and expenses whish may in%nay bey aameageint said City
in conseque
U„z" wung Of this rmit.
APP IL CANTPUNDEof the RSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Signature of ApplicaR .Deas
HAZARDOUS
US MATERIALS DISCLOSURE a Type Of ROOF
Willy ft Campion
OrfutureMunicipal
ode,Chapter
ate 9.12,handle Health and atedal -
sa defined by dte Cupertino Municipal Cade.Chapter 9.13,and the Health and Safety
Code, [-]Y.us7z(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Ya QNO
Will Nc ePplicst or(sat wilding Occupant use equipment at devices
which If a roof is installed without first obtaining an inspection,I agree to remove
Md.henrdnn air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Ya No
I haw mad the bar, 3 aerials requirements undo CMpterei.95 ofthe Glifor.
meHplgth.nzad.gmt
tyC 'au35505. 7 574.1 andcrssaM thulfthe wilding
dao croy At tenant.that it' m res 'hility m nodly tbe occupant of We
royuimcn a wmfpdor ofpanc�o 2 Signatureo Applicant Date
Owner (J �DJ All roof coverings to be Class °B°Or better
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
•/'`
CITY OF Telephone: (408)777 777-3228
L U P E kT 1 N O Fax: (408) -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.
IMPORTANT:
1. Flat roofs must have a minimum of 1/+" 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: 6k a
Job Site Address: 2- Z '5o `r
Roofing Company Name:
A plicarit s Signature:
\�lh6l�l1DC)C1
Greg eel
Building Official
Revised 1/30/03
___ _ Printed on Recycled Paper
CITY OF CUPERTINO0
REROOF
CUPEKTINO PERMIT APPLICATION FORM
APN# ✓2 �� r ! 3 — ,a—,c_� 6 3 Date: �` _ O
-13
Building Address: 0 r (� v
0 Lc4 —c-�T t
Owner's Name: �QT Phone #:
Contractor: hone#: License#:
�G 37! — !�'7 6 Z$
Contact: 6-TZ !� Phone#: C 1 CA Cupertino Business License#:
t l Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ &sphalt Shingles ❑ Asphalt Shingles
Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) M'Other(Specify)C*�—
Number of existing coverings�_ L3 Provide I.C.B.O.Report# /1 Ir �{Z j
• 0,'To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: rti- *12 5c+,Av� r ZGA C5 (41-G (,C-V-1 -VD 5k-&/ 77l&
Residential Commercial ❑
Fire Zone: Yes ❑ No Confirmed with Planning Det. if
there are anrestrictions: i5
Cost of Project: 1 �%G_ Type of Constt-qction: 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
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