08020034 CITY OF CUPERTINO
BUILDING or 16ION PERMIT eCONTRACTnRINT`QRMATIO „ R,
PERMIT NO.
euagir�c�34q�rEsW00DHILL CT CASTILLO' S ROOFING 08020034
NEWS NAME: PERMrr ISSUEDATE
PRAKASH BANTHIA 1703 CATHAY DR 02/05/2008
PHONE - SANTrARY NO. CONTROL NO.
(408) 251-3565
ARCHIECI/ENGINEER: BUILDING PERMITINT I
BLDG mJ:R PLUMB MECH
300 LICENSED CONTRACTOR'S DECLARATION
I horeby alaW
rm t lam hawunder ed pmvWans of Chapter 9(commencing Job Description
wrath Soutar 701M)of Division 3 of the Business ani Professions Coda,and my license la RE—ROOF,T/O EXSTNG COMP INSTL #30LB FLT & 50 YR
n in full fora and effem n
Licenuclass G 3`/ Lia.p 30 S ELK CLASS A
OF
Data yI�C 2 Can
ARCHITECTS OEC A
1 understand my plans shall w used as public r5cards
D
{ted Licensed Profad...I '
y OWNER-BUILDER DECLARATION
N
i E I hmean .(firm on 1 1. exempt from the Cssion Co :Ante law for the
p 0 following muoa Permian 7rn LS Business and rva.d..Il Code:Any city or roomy -
5� which mqultca a Permit m cn.tmc4 a@r.hnpmve,dcmnllsh,or mpolr any cwnum '
3y prior to its iasuance,alw mquima the applicant forsuch permit to file&signed statement
�< that he islian¢dpraa.nt to the provisions of the Contractors Ucemr Law(Chapter 9 Sq.FI.Floor Area Valuation
$ (e mmendngwirdBeNo7000)ofDivision3ofoneBusinessandProfoasinnsCade)or $9200
`i—
that W Is exempt therefrom and the basis for the alleged exmmptiaa Any violation of
Sermon 7071.5 by amy applicant for a permit subjecu the applicant m a civil penalty of Number Occupancy Type
of mart than five hundred dollars($50M. 36604071 :Vl7'
1,as owner of the pmpeny,or my employes with wages as that,tarn comPe.amon,
will do the weak,uks the am.is not intended or affixed fm sale(Sec.1044,Busiws
and Prefesdoms Cade:The Conuowra License raw dos of apply m an owner of Required Inspections
progeny who builds or impr.veamemon.and who doessuch wmkhimulfor Waugh his
...play..provided thatsuch Improverecou...I inmmded ornRened Imad..It,
however,mm building or Wi m ream is to within one yew of mmpledon.the owne,.
builder will have the burden of moving mut he did of books m improve far puryom of
uteJ.
1,as owner of mil property.am exclusively canaacong with licensed canuammrs to
..suet the project(Sec.7044,Business and Proposal..Coda)The Con.anmra U.
cense law oma not apply m an ower of propeny who builds or Improves demon.and
who czammu for such prejems with a ommusens)Ilmnsed p rma t m the GnuamaM1
Licenw .law.
❑I em exempt under Sec ,B$P C fm this moon
nen Dau
WORKER'S COMPBNSATION DECLARATION
1 hereby amen under rousby of perjury sew of W fallevring deelarulmor
C I hm and will maintain aCcoirinm ofComrmt to uif-insure for Workers Compen.
cation,a provided far by Section 37W or the labor Code,fm to performance of the
work for which thls permit is issued. .
❑I ban and will maintain Workers Camperacom Iasuran¢,a required by Schon
3700 of the Labe Cadre,for the performance afmu work for which this permit u issued. '
My Workers Coope.tlon�unwe m and Poliry numa9b�oar ptaxn; �n
Grrier.FPION Na.:�
CERTIFl COMPENSATION
EXE Pf70NPRAN WORKERS'
COMPENSATION INSURANCE
f76u mules wed an,be completed trim Permit is fmaw hundred da0as(SIM)
or kis)
I certify that In the performance of the work far which Nie Permit u Wood.1 Nall of
employ anyperwn in any marm r re as In became subject u the Worker'Compemadon
laws ofcalircu ia.Dau
Applimnt
NOTICE TO APPLiCAND If,after making this Ccninmte of Exemption,you should
became Subject m The Warkcrs Compensation previsions of the Labor Code,you mum
wJ O forthwith comply with such povidons u this permit 001 be dmmed evoked.
'� CONSTRUCTION LENDING AGENCY
�.
[—t I for which
NatmartuaomSec.3nleading agency far the Performanceof
ai theLe work for which ods permit Is issued(Sec.7037,Civ.C.)
D 0 Landers Name
=Z Lenders Address
U O 1 aNfy the 1 have mad No application W room that the above Infarmadarn ls
LL cpsem.l agree In comply with all city and county oMn.nas and sem laws miming To
.O building consmnction,and hereby Suthodre mpresenutives or this city to enter upon the
Ibl above-mendowd pmporty for impaction purposes
C (We)Qua To save,indemnify and kap hamtlem The City of Cupertino against
Tn liabilities,judgmou.casu and expenses which may in my way aarnu gala coldCity
U in consequence of the{mating of this Permit.
^v APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCER GULA O _ —4y
Re-roofs
rt afA Iieanl7ConuaT.r Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building acupantstore or handle hazardous material .
as de0od by the Cupertino MuMci ode.Chapter 9,M and the Health and Safety
Section 25532(.)? All roofs shall be inspected prior to any roofing material being installed.
sae,
❑Yca o
Will the applicant or forum but "amen
tea eyuipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air...uurinanu need by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes No
1 have mad the hazardous materials ayuimmenu underClummr G95 of the Califor.
.is Health k Safety Cade.Seen=25505.25533 and 75534.1 undenued this if the building
dors of currently have a tenant,that It u my msponsihility m otify dm occupant of the
rogolmmcnta wMm m tpri.r ser,certirtea of 77
J7) Signature of Applicant Date
o rare hmixed.grm Dam All roof coverings to be Class"B"or better
D0 () .3 �
t CITY OF CUPERTINO
REROOF
•CUPEkj1N0 PERMIT APPLICATION
APN #
Building Address: I ��1
Owner's Name: Phone #:
Tl e- �oS k 3G 04fi )
Contractor: I
Phone #:
p SSS
N� I j �'1 C7` S �2p D Fax #:
Cupertino Business License #: Contrac or License #:
Type of Roof Covering:
Existing: Proposed:
❑ quilt-Up Roof ❑ wilt-Up roof
¢✓Asphalt Shingles ;- Asphalt Shingles
❑ 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 Mfg. Installation Specs.
Job Description: reQ� C) m
Iz--
Residential Commercial
Fire Zone: Yes ❑ No Confirmed with Planning Dept. if
there are any restrictions: ❑
Valuation:
•I Have Read, Under tand and Will Comply with Cupertino's Tear-Off Policy:
Signa e
�- CITY OF CUPERTINO
REROOF
CUPEkTiNO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1REROOFCOM Re-roof Commercial B 1COMMLROOF
1BSEISMIC0 Seismic Commercial B
�3 1REROOFRES Re-roof Residential B 1SFDWLR00F
/ 1BSEISMICRE Seismic Residential B
1REROOFMRES Re-roof Multi-Family B 1MFDWLROOF
1BSEISMICRE Seismic Residential B
1BUSLIC Business License B
• it
. CITY OF CUPERTINO
2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36604071. 00
DATE ISSUED. . . . . . . : 02/05/2008
RECEIPT #. . . . . . . . . : BS000003863
REFERENCE ID # . . . : 08020034
SITE ADDRESS . . . . . : 11917 WOODHILL CT
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : PRAKASH BANTHIA
ADDRESS . . . . . . . . . . : 11917 WOODHILL CT
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5149
RECEIVED FROM CASTILLO'S ROOFING -
CONTRACTOR . . . . . . . : JOSE CASTILLO LIC # 25850
COMPANY . . . . . . . . . . : CASTILLO'S ROOFING
ADDRESS . . . . . . . . . . : 1703 CATHAY DR
CITY/STATE/ZIP . . . : SAN JOSE, CA 95122
• TELEPHONE . . . . . . . . : (408) 251-3565
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 9, 200. 00 1 . 00 0. 00 1. 00 0. 00
1REROOFRES SQ FEET 23 . 00 299 . 00 0. 00 299 . 00 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 300. 00 0. 00 300 . 00 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 300. 00 #14923
---------------
TOTAL RECEIPT 300. 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
603 ROOF BATTENS 1604 ROOF IN-PROGRESS
605 FINAL REROOF
•
Community Development
10300 Torre Avenue
aClOF
Cupertino CA 95014
Telephone(408)777-3228
Fax(408)777-3333
4kUPEPTINO
Building Department
JOB ADDRESS: PERMIT#
OWNER'S NAME: VmkzLoch PHONE # 7 2 5 O
GENERAL CONTRACTOR y<ST FAX #
I am not using any subcon oma-
Signature Date
Please check applicable subcontractors and complete the following information
60 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
SheetMetal
Sheet Rock
Til
Owner/Contractor Signature Date