06120116 CITY OF CUPERTINO
BUILDING DIVISION PERMIT a.CONTRACTCIR INFORMATION
BUILDING ADDRESS: PERMIT NO.
OWNER'S NAME: A
PARAMESH GUPI _ 125-B GROBRIC CT 12/21/2006
NE:
SANITARY NO. CONTROL NO.
(707) 864-5557
ARCHTIECr(ENGINEER: BUILDING PERMIT INFO
BLDG ELECTPLUMB MECH
0 0 0 0
j C LICENSED CONTRACTOR'S DECLARATION
w 1 hereby grim that I am licemed under provinons�y�of�Chapter 9(commencing Job Description
zw with Sccuon70)O)ol'DivistonJofbcBusinessandrLNol/3ode,andmyliecee,is REROOF- TEAR OFF EXISTING SHAKE, REPLACE WITH
�= in fall fostt andLf(etta3
Li asue Clay, l Lic.N 10 30LB
Fp Dam Ste_-�Conuacmr0 �'^ Ki .� S
ARCHITECTS DECLARATION FELT, NEW COMP, 22 SQUARES, CLASS A
i¢ 1 mdc.d my plans shall be used as public mcnrds
myU
LLo Licensed Professional
3 OWNER-BUILDER DECLARATION
Contractor's
C C I hereby aro .(Seco on 1 em exempt from be ConmaerCo e:Any c Law sof She
C O following reason.a.(Sccuon 703 construct.
B.siau and improve,
de o i Cade:Any city or county
%$
which rtquima a e.als m mics;She alcor,improsu,&ter i t ri repair any swment
!ii priarmiu issmuac.also require be applicant for such permit&rilcaSigned summcnt
that he is licensed pufmant to he pnvisiom of be Cnmraemrt Liccmc law(Chapter Sq.Ft. Floor Area $10000
(• Valuation
i O (commencing with Section 70DO)of Division 3 of the Business and Professions Code)or y 10(]0 0
that he is exempt bemfmnt and the basis for the alleged eaempuon.Any violation Of
Section 7031.5 by any appii=t for a permit subjects the applicant to a civil penalty ofNumber Occupancy Type
not more Nan five hundred dollars($500). 3 6 6 5 2 016 .
0 1,as owner of the property,or my employees with wages as their sole compcnsaJon,
will do the wast and bes acham is not intended Or Offered fursalc(Sec.7014,Buuay.. Required Inspections
and Pmfestintu code,The Conmctnes Licenm law does Out apply m Oxe an wr of q P
property woo build,or improve Inereon,and whodoesaahworkhimself e,though his
own employee,provided that such improvements are not intended urulfcred for sale.If,
however.be building or improvement is sold within one year of completion,the owner-
builder will have the burden Of proving bar be did nor build or improve for purpo¢of
sale.).
0 1.as owner of be property am exclusively contracting with licensed mntracrars m
construct the project(Sec.7(I14,Business and Rofesimu Code:)The CommcmYs U.
ecce law docs not apply to an owner of property who Witas or improve bereon.and
who contracts for such projects with a conuactof(s)licensed pursuant to the Conuactoe,
Licence law.
0 I am exempt.under Sea .B h P C fa mit mason
Owner Data
WORKERS COMPENSATION DECLARATION
I hereby affirm under pmalty On perjury one of the fallowing&clamtioa:
I have and will maintain s Cerurmeateof COnuent teself-iwm rerwohets Compcn-
sauon,a provided for by Section 3700 of be labor Code,for She perfnnnvca of be
work for which this permit is issued.
0 1 have and will maintain Warkees Compensation Insurance,as required by Section
37M of be Labor Code,for the performance of be work for which Shia permit is i sad. '
My Warkse�Ys C�1Pm=.O1 Wun 3.,rim and Poliq numbevr art:
Caniot:lWl�[1.v1 s/ApJ1 Paltry No.: 71/ Svs 77-
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Ibis auum need not be completed if the permit is forane hundred dollars(5100)
of less.)
I verify that in She pulemoaae of the work for which bis permit's council.I shall nor
employ any person in any manftergo a b became subject o be Worker,''Com,mobou
Laws Of Califomia Dam
Applicant
NOTICE TO APPLICANT:If,after making Shu CcriGeta of Facmption,you should
become subject to be Worker's Compcsuauon provis ams of the Labor Code,you mus
.,0 fonhwib comply with such provisions ar Shu permit shall be domed n:voked.
z'y CONSTRUCTION LENDING AGENCY
[-+ I herby a1Brm that bort I,.cm mucunn lending agency for 0te perfunoamc of
!Y be work for which this permit u is ad(Sec.3097,Civ.C.)
W� A Undoes Name
Z Lendefs Address
V Q 1 certify Shat I ban mad bis application and sate bed the above informauun is
Fcorrect.1 agree to comply with all city and county ordinances and sea laws relating to
O V building construction,and hereby authonne reprtscnraives of this city to enter upon the
HLt] above m.judip d property for le pcaion purposes.
W (We)agree to save,indemnify and keep harmless be City of Cupenino against
h incoiue.jWgmcna,cassand expcnusmit. may in any way aamc agaiarsaid City
U z AcPLICANa NDERf ths TAN of Nis permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SREGULAT NS.
A�r � 'rte �a
SmDate Re-roofs
gnaurt ��Dam of AppliandConuanor -
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will do applicant or future building aeupanl store or handle hmmdous material
as defined by tk CtrpCnln r Municipal Code,Chapter 9.13.and the Health and Safety
Cade.cc on25533(a)7 All roofs shall be inspected prior to any roofing material being installed.
Ye �(Na
Will thea scant or future building area ant um equipment Of&.Ices which If a roof is installed without firs[obtaining an inspection,I agree to remove
pp g P a Airg
mit havardnm air canamimnu u defined by Ne Bay Area Air Quality Management all new materials for inspection.
Distria7
❑Ya ce Nu
I have read the heondtw.amaterials requirements under Chapter 6.95 of be Califon O ,f
nice Hcalb&$afnyCade,Seenleant. .1 it 455llandss53aty Or our,Six,..bebuil10.
dos
of en.currently�if le ant.bat it is u mspoI.cei fu ic notify be ancy. of be
rt in ,whim tris tprior te;auanccoracemurcatearacupanay. Signature of Applicant Date
owner or mthorim
D All roof coverings to be Class "B"or better
a c
' Community Development
10300 Torre Avenue
«? `✓' Cupertino CA 95014
' Telephone(408)777-3228
CITY OF Fax(408)777-3333
OUPEI�TINO
Building Department
JOB ADDRESS: PERMIT # O�I 2p J I' ^
//,5-1 y 5 ,, S etl- 5' ��'� C+ lY
OWNER'S NAME: q i-4 N. e S11 , 604 14 '1 PHONE # YaOO- zss- -,7,5- ?i
GENERAL CONTRACTOR Old Co v � ,R FAX # -8'3 D
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the followinginformation:
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
2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: amyw
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . :36652016 . 00
DATE ISSUED. . . . . . . : 12/21/2006
RECEIPT #. . . . . . . . . : BS000000051
REFERENCE ID # . . . : 06120116
SITE ADDRESS . . . . . : 11514 SUNSET SPRING CT
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
. IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : PARAMESH GUPI
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5134
RECEIVED FROM . . . . : RECEIPT INTERFACE -
CONTRACTOR . . . . . . . : FOLK, DIETER LIC # 20389
COMPANY . . . . . . . . . . : OLD COUNTRY ROOFING
ADDRESS . . . . . . . . . . : 125-BGROBRIC CT
CITY/STATE/ZIP . . . : SUISUN, CA 94585
TELEPHONE . . . . . . . . : (707) 864-5557
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
----- ------------- ---------- ---------- -------- --- -- -
BPERMFEE VALUATION 10, 000. 00 169 ..56 0..00 169 . 56 - 0. 00
BSEISMICRE VALUATION 10, 000. 00 1 . 00 0. 00 1 . 00 0. 00
-------- ---------- --- - --------- '
TOTAL PERMIT 170.56 0. 00 170.56 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- -- ------------
CREDIT CARD 170 . 56 MASTERCARD
TOTAL RECEIPT 170. 56
Community Development Department
Building Division
C� g City of Cupertino
F�J 7 9/J� SP^✓, oc_ 10300 Torre Avenue
Telephone: (408)777-3228
• 7� Fax: (408) 777-3333
y� 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: _ _R r of 1"I e S /1 0- up
Job Site Address: ll S / z Sun S a f S ,,r i g S C4 ,
Roofing Company Name: 0/�
Applicant's Signature: Date: �� " �7 UG
• Greg Casteel
Building Official
Revised 11/2/04
U-12i
CITY OF CUPERTINO
REROOF �(Q�2�IICo
• CUPEKTINO PERMIT APPLICATION FORM
APN# 3 C^ j Z — v/G Date:
Building Address: y
Owner's me: Phone#: _
n � c� 5h bj ni %O00 ' 7- S—y -
Contractor: License#:
Q/c1 C' v�n I•- �uo�rn
627-
Contact: Cupertino Business License #:
/e ss
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles Asphalt Shingles C4 S!' 14
XWood Shakes - Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O. Report#
❑ To be Rein oved ❑ Provide Mfgr. Installation Specs.
• I Have Read,Understand and Will Comply With Cu ertino's Tear Off Policy: cz .
Job Description:
Residential Commercial ❑
Fire Zone: Yes ❑ No Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project: Type of Construction: OccupanFy groyy2:
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
•