05100058 CITY OF CUPERTINO �a,�� � ' ` y a & '
BUILDING DIVISION PERMIT * 9 #��n�1'P >g j,f
BUILDING ADDRESS: ROOFCO OF SILICON VALLEY PERMITNo.05100058
0216 WILL CT
OWNER'S NAME: PERMIT ISSUE DATE
RAMCHAND NAGPAL 3801A CHARTER PARK C61JRT 10/12/9,005
NE: - SANITARY NO, CONTROL NO.
(408) 795-3335
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECTPLUMB MECH
O
poZ' LICENSED CONTRACTOR'S DECLARATION Job Description '
I hereby M.that l em licensed under provisions of Chapmr 9(commencing
with Scc,ion7O(Xrof Divlsion3of eBusuccas PJn es'nm Code,an tylicense6
in mu force ander L REROOF—T/O SHAKES, INSTALL COMP.
j License I e Lic.a
a Dam Conlrumr
eQ -ARCHITECTS DECublic.,LARATION ��
y�� 1 undcnund my plain shall W wed u public records ' L
It
G Licensed PmfcNonsl
g OWNER-BUILDER DECLARATION
9 0 1 hereby affirm thin 11. exempt linin do portion c License Law for the NOV 'le 2005
i c O� following mmaa permit
t ]1131.5,Business and Improve.
de lens Code:Any city at county
which mqumns a permit ac uireWCL alma improve,h permit t or mash any mmemm $14000
prior it)incensedssuance.aim
ant to the thevisiosorfor mchpermitm Nese Lawdaummem
6 thathe me licensed pursuant to the of Division
of the QBusinerSLlenselaw(ChapterCode)
Sq.Ft. Floor Area g V Ua IOn
(cat he is
(commencing Sectionre and
of hands or of the Busineseamidmpt Profeon.Any
vi Cork)ur fp'J
..
that he ts exempt therefrom and Ne buts for the alleged exemption.Any violation of
Section 7031.5 by any applicant fm a permit subjects the applicant m a civil penalty of p OCCUpahcy Type
not more than five hundred dollars($500).
❑I,uawnerafthepropery,army employees with wagesu Chansolecompenastion.
will do the work,and the awcmre is notimmraded or affemd formic(Sm.7044,Business Required Ins eCt10D3
and Prepossess Code:The Conmcmrs Lineman Law docs not apply m an owener of q p
property who builds or improves then amend whodoesauchwork himselforthrough his
own employees,provided that such improvements arc notimmnded ora@red forme.if, a
however,the building or Improvement Is sold within ane year of completion,the owner.
Wilder will have de,burden of proving that M did act Wild or improve for purpose of
safe.).
❑1,as owner of the property,am exclusively contracting with licensed conmemrs m ,
construct the project(Sec.7044.Business and Professions Cade:)The Contractor's Li.
am Law does not apply to an owner of property who Wilds or improves thereon,ad,
who contracts for such projects with a commulon(s)licensed Pursuant to IW Contractors
License Law.
❑I am exempt under Sec. .B&P C for this reason
t37,00
ner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penally of perjury ane of the following decimations:
1 have and will mainmin a Certificate of Coruent m selGimu a far Wmkcra Campm- -
ion,as provided for by Section Y?(C of the Mbar Code,fm the performance of the
rk for which this permit is Issued.
1 have and will maintain Worker's Compensation Insurance,as required by Scotian
of the labor Cade,fm the performance of the work for which this permit is issued.
y WorRn
ker's Co en tion Imes ce es 'cr end Policy nu fg; Ortier: Policy No.:
C RTIFICATE O•EJ EMPTION FROM ORKERS'
COMPENSATION INSURANCE
(7Tlsacedon load not W completed lfthe permit isforanchundreddollan,(51018
or less)
1 cattily that in the performance of the work for which this permit is issued.I shall not
employ any person in my manner an as to become subject in the Wmkmr Compensation
Laws or California.D u,
Applicant
NOTICE TO APPLICANT.If.after making this Ccnindam of Exemption,you should
become subject tU the Worker's Compensation provisions or the Labor Code,you must ,
,J O forthwith comply with such provinces or this permit shall W demand revoked.
„z'•'" CONSTRUCTION LENDING AGENCY
[n I hereby affirm that them is a construction lending agency far the perfarroman,of
pi 7 the work fm which this permit is issoed(San.3037.Civ.C.) '
W�Q Lender's Name '
z Lenders Address
U 0 1 certify that 1 have read this application and sum that the move information is
B.E correct.I agree to comply with all chy and county ordinances and sum laws misting to
0 Wilding construction,and hereby authodm representatives of this city to ever upon the
fg7 Notre-mentionrA property for Impaction purposes.
G (Wc)agree to save,indemnify and keep harmless the City of Cupertino against
h liabilities.judgments.cats and expenses which may in any way accrue against said City
V 7 in con erten of the grantingo this miL
F7 AP L- D I OMPLY WITH N -POINT Issued by: Date
S CE
Re-roofs
INS na a of ppliuntlCc o Dam
HAZARDO MATERIALS DISCLOSURE Type of Roof
Will theappllcant or return building occupant sore or bandit h ramous material
a defined by the Cumnino Municl Code.Chapter 9.12.and line Health a d Safety
Code,Section 25532(a)7
❑Yin o All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future Winding occupant use equipment or devices which 'If a roof is installed without first obtaining an inspection,I agree to remove
aaudnm air,.=!nants alined by the Bay Area Air Quality Management all new materials for inspection.
L\7
rt]Yc5 U' f
I have mad the hvtrdousmemdabrequimmentsundcr Chapor6.95ofthc Califon
5mw
Ith&Safety Codc,Seuom255r5.25533md25534.1undcsmndthmifum Wilding
of u n ly h a m y rcaponsibillty m nouly tW enc pent of IW
ui l tr aeenlnea Sigilatur6 of Applicant Date
war Dare All roof coverings to be Class"B"or better
F Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
�UPEkTINO
Building Department
JOB ADDRESS:OPERMIT #
OWNER'S NAME: PHONE #
GENERAL CONTRACTO FAX #
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
44er4PtractojrSignLatare Date
CITY OF CUPERTINO
REROOF
tUP,Ett?INO PERMIT APPLICATION FORM
APN # / .S' 6 Date: 1Q11BIOS
Building Addre s: 1
It�Zlb \DZ,k8) \N 1k C`k-A)tZr
Owner's Name: one#:
Contractor: � � Llc�ens
Contact: Cupertino Business License #:
--2 2
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles piAsphalt Shingles
O/Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Nugiber of existing coverings ❑ Provide I.C.B.O.Report#
Er To be Removed ❑ Provide Mfgr.Installation Specs.
. I Have Read, Understand and Will Comply With Cu ertino's Tear Off Polic :
Job Description:
Residential P-- Commercial ❑
Fire Zone: Yes ❑ No Confirmed with Planning De t. if
there are any restrictions:
CCt of Project: Type of Construction: Occupancy group:
14Gbo-�
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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