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04050024 W 011 CITY OF CUPERTINO �g^'ax '��"'�b�}"'°," �. "'� ' BUILDING DIVISION PERMIT . '.,.: „�Tk y..':•�,. zx..,�{.,�e .,,a .-. BUILDING ADDRESS: KEVIN SULLIVAN ROOFING PERMIT 11%4050024 1091 S STELLING RD OWNER'S NAME: PERMIT ISSUE DATE ASHOK LAKDAWALA 1696 VALLEY OAKS QR - nc;' n4. 9QQ4 ONE: SANITARY NO. CONTROL NO. (408) 842-1057 ARCHITECDENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB - MECH 0 0 Lpp LICENSED CONTRACTOR'S DECLARATION ' ILED MU I tummy ARrm that I am licensed u OZZI of Ch Per 9(commcncing n� wilt Sm6�Ci00G�)of Diviaion3Of0i Businn dProfesslOav Co ,end myliccnse is in All REROOF tiq icenac c5 Lic.a G a RCHITECTSDEC14 TJON 9 " NOV fe 2004 �i I undersand my plans shall W used as put corns fyGy �yU ;a Limused Professional BUILDING OWNER-BUILDER DECLARATION HoI hcmhy affirm that 1 1. exempt from Nc CssiomC a e:Any c Law for the i pO following mason,wro(Section 71131.5.Business and Professions Cade:Any city S Mainlyture 9 which requires a permit m enmuucL elmG Improve,demolish,or repelr any slmclure88000 prior in its issuance.also requires the applicant for such Permit to file a signed statement < Nat he is licensed pursuant to 0m provisions of the Contractor.Umoc Liw(Chapter 9 Sq.Ft. Floor Area Valuation � $ (commencing with Section 7W0)of Division 3 of the Business and Professions Code)or , that In Is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by arty applicant for a pansif subjects the applicant to a civil penalty,of Occupancy Type not mom than Eve hundred dollars($508). 0 I,as owner of the pmp ny,m my employees with wages u their role WMPenssllon, will do the work and theswctum isnatinmhiscimoRerad forsalc(Sec.7044,Business Required Inspections and Profusions Cade:The COnuacmrs License Law does not apply m e ns an owner of q p property who builds Or i mprows thereon,and who does such work himself w through his own employees.provided than such improvements are not Intended Or offered finale.If. however,Ne building or improvement is Sold within one year of completion.the owmo- builder will have the burden of proving that he did not build or improve for purpose of sale.). 0 I.as Owner of the property,am exclusively contracting with licensed contractors in construct the pmjml(Sec.7044.Business and Profession Code:)The Centracwr'a Li- main law does not apply to an owner of property who Wilda or improves thereon,and. who contracts for such projects with a eantlutor(s)licensed pu alatto the Cenuacmr's License law. 0 1 am exempt under Sec .B&P C for this reason Owner Data WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a Certificate of Consent m self-insum for WOrkeraCompen- snion,as provided for by Section 3700 of the labor Code,for the performance of the work for which this Permit is issued. 0 I have and will maintain Worker's Compensation Insuranm,as required by Section 3708 of LaWr Code.for the performance of the work for which Nis permit is issued. My W ker's Caommmn�saaUan Iomumnlm�artier and Cam ✓ LK f�G I�WJY PoII y Nn � �'D� �- CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE Obisacelimt need not W completed if the permit is for on hundred dollars($1018 Or leas.) 1 certify that in Ne performance of the work for which this permit is issued,I shall not employ any person in any manner an an an become subject o the Workers'Compensation Laws of California.Dam Applicant NOTICE TO APPLICANT:IL after making this CeniOeam of Exemption,you should - become subject in the Worker's Compensation provisions Of the Labor Code,you mum �O foMMilt comply with ouch provisions or Nis permit shall Inc decmcd revoked. Zy CONSTRUCTION LENDING AGENCY 4 1 hereby affirm that them is a construction lending agency far the performance of tair� the work for which this permit is issued(Sec 3097,Civ.C.) aQ Under',Name D z Lender's Address U Q 1 Sonify that 1 have mad this applicedim and sate that Ne Also.infmmatiun is (y F connect.I agree to comply with all city and county muhromea and sate laws meeting w DU Wilding construction,and hereby authmbie representatives of Nis city to enter upon IN above-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against Taq liabilities,Judgments,coats and expenses which may in any way acerae against aid City U z in conaequen ac of the granting of this Permit. ^' APPLICANT UNDERSTA AND WILL COMPLY WITH ALL NON-POINT Issued by; Date r GULATIO 5 D Re-roofs I rZ4., (App man✓COntrscmr �D lc HAZARDOUS MATERIALS DISCLOSURE Type of Roof l the applicant or future Wilding mcupanl stere or handle ha'rardous material y the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety on 25532(x)? All roofs shall be inspected prior to any roofing material being installed. esl Ne applicantor(wore bildi amupant esu eyvipmem or Jcvices whichIf aroof is installed without first obtaining an inspection,I agree to remove ous air Mummies as Jcf d by Ne Bay Area Air Quality Management all new materials for inspection. ea I have mAJ Ne hoodnua malerialsreyuircments under Chapter 6.95Ofthe Calif., .is Health&Safety Code,Smdon 25505.25533 and 25534.1undeaand thatifthe Wilding does not currently haw,a moant that it is my responsibility to notify the occupant of the yui which Iprior m......cofaccrufmam party. S atureOfApplicant Date owner a a oriseJ agent Dam All roof coverings to be Class "B"or better Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 JCITY OF Fax(408)777-3333 UPEQTI I NO Building Department JOB ADDRESSt l S PERMIT#Q J � U /� OWNER'S NAME: ifl, GENERAL CONTRACTOR: FAXI I am not using any subcontractors: 1 d 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 Z6,0117 Contractor Signature Date Community Development Department Building Division City of Cupertino �i 10300 Torre Avenue CITY OF Telephone: (408)777-3228 *UPEkTINO 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. 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: t"gw= /r4K��/tW ►-fl Job Site Address: (.O2( S r W?,— Roofing ?Roofing Company Name: fir. S� C.f✓ 1 ( S� A plicant's Signature: Date: Q¢ Greg teel Building Official Revised 1/30/03 Printed on Recycled Paper CITY OF CUPERTINO REROOF CUPEkTINO PERMIT APPLICATION FORM l APN# ( Z 22 O v_ Date: C/ Building Address: t� Owner's Name: Ph o #: lb ole c B'a) 444 - Z7cz Contractor: Pho License#: Contact: Phone#• Cupertino Business License#: Type of Roof Covering: Existing: Proposed: ❑_ kBuilt-Up Roof ❑ Built-Up roof �tA sphalt Shingles O�sphalt Shingles 41/Food 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: 226' -W S t�1��G�?©/�L u/ttiD� ArtS7 Of— 4�, 546 ,, Residential Commercial Fire Zone: Yes ❑ No Confirme ith Planning D14 ep . if there aqlany re 'ctions: LJ Cost of Project: Type of Const n: Occup cy gr Qty A c le 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 1 X37. c_2