05120094 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT �,CU RACTOR0__ ATION`,'�:
BUILDING ADDRESS: OLD COUNTRY ROOFING PERMIT NO.05120094
0944 nRVnRN AV
• OWNER'S NAME: PERMITLSSUEDA7E
SUDHIR WALVEKAR 125-B GROB IC 12/15/2005
NE: SANITARY NO. CONTROL NO.
(707) 864-5557
ARCHITEC(ENGINEER: BUILDWO PERMIT INFO
BLDG ELECT PLUMB MECH
l� tT M
�oo LICENSED CONTRACTOR'S DECLARATION Job Description
�j 1 hereby arfbn fast 1 am licensed under prurWons of Chapter 9(eommanciny
with Section 70170)of Division 3 of the Business ad Professions Code,and my license is
; � Ltefalltae dr(_MA �� (4 :2-7-7 3 / REROOF-T/O SHAKES, RESHEET, ADD COMP.
DIIFn-- Dam �l U..# ar
ARCHf1ELTS DECLARATION y
1 undersand my plans shalt be omit an public records
k ii Licensed Professional
`y OWNER-BUILDER DECLARATION tltltlWWW"'fff
ii I I herchy affirm that I am exempt from the Continuities License law for the
E O following mean.(section ND 1.5,Business and Professions Cade:My city or county
1§2 which mquims a permit to construct,slur,Impmve,demolish,or repair any streetum *4� 000
prior to its Women,also requites the applicant forsuch permit to rile a signed atstement
FF< then he is licenced pursuant to the provisions of the Contractor's License Law(Chapmr9 Sq.Ft. Floor Area Vit to
Sg (rnmmeming with Section 700M of Division 3 of the Busiaasa dProfusions Codc)m A
that he is exempt Ihemfrom ad the bub for the alleged assumption.Any shuns an of
Section 7131.3 by my sppltantfor a permit subjects the applieat to•Civil penalty Of 3AWNW&P
o Occupancy TYPe
not mom than five hundred dollars($300).
❑I,uawnu of the progeny,or my employon with wguu Neo seta ampemtion,
will do the work.ad thestrucme is not intended in offered for sat(Sec.70,14.BusinessRwired Inspections
ad Prefesalans Code:The Corrector's Licemaw ldoes nal apply to an owrcs e of q P
property who builds or improves thermn,and who Oma auh wort himxel f u through his
own anployen,provided that a-h improvements are nmimmnded.tuff red forsam.if,
however.Bre building or Improvement is sold within am year of compledon,the owner.
builder will have the burden of proving that he did not build or Improve for purpose of
ark.).
❑1,as owner of the property,am exclusively aaecting with licensed cenrenas to
construct the project(Sec.7044,Business and Projections Cade:)The Contractor's Lt.
cense Law does not apply 0 an owner of property,who builds or improves themon,ad
who contracts for such projects with a conuutor(0 licensed pursuant to the Contractor
License Law.
❑I am exempt under See .B R P C far this noon
Owner Data -
WORKER'S COMPENSATION DECLARATION
I hereby afflon under pemRy of perjury arc of t e fallowing daclan lmo:
1 have and will m dmalo•CemOesmof Covent to aetfdnsum fm WaM1er's Compen.
uMon,u provided for by Section 3700 at the Labor Code,for the performance of the
won M for which this permit is Leaned.
1 have ad will maintain Worker's Compensation Wurance.u required by Section
00 Clain labor Cade,for the performance origin week for which this permit is issued.
My W rq�ket a nyylo I rnrte units and PoBcy number an:
Grier.I� �/ Policy No.:1 2/`3$71
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thi section mad trot he comp le ted R tiw permit ts fa enc hundred dol lar(SIM)
or test.)
1 certify Not in the performance of Ne work for which this permit Is issued.I still not
employany person in my manor an as in thame subject to the Workera Compensidan
Laws of Cahlomia.Dam
Applicat
NOTICE TO APPLICANT:If.after making this CeniOnm of Exemption,you should
become subject W the Worker's Compensation previsions of Ne labor Code,you mine
.JOforthwith comply with such provisions or this permits hall he deemed mvoked.
'E ^'ECONSTRUC ION LENDING AGENCY
1; T hereby affirm Nat Nen Is.anstru im lesdingagercy fm the perfmormana ,
the work for which Nb permit is issued(Sec.3097,Civ.C.)
LQ 0 Lender's Nam.
z lender's Addram
U O 1 eW fy Nn I have read this application and Can Nat the above InlOrontion b
0, commit.
commit.t aIrm to comply who all city ad county ordinates andum[am missing to
OU building covuuction,and hereby advance mpmsenutiva of this city to enter upon Ne
tk1 above-mentioned property for Inspection purposes.
gy (We)agme to save,indemnify ad keep benalm the City of Cupertino against
y liabilities,judgments,costs ad expenses which may in my coy acme against sold City
U in consequence of On granting of this permit.
.. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL ON-POINT Issued by:9 Date
SOURCE REOUL�TIOIIB� /1 1
„�_tr l 1510 5 Re-roofs
Signature ol'ApplicamisCoreammor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant in future holding attupetuam or handle huamous material
as defined by Ne Cupertino Municipal Cock.Chapter 9.17,and the Health ad Safety
Cod.,section 11333(87 All roofs shall be inspected prior to any roofing material being installed.
1 ❑Yes etjo�
Vfill Mm applicant or future building occupant USOequipment or&-vitas which If a roof is installed without first obtaining an inspection,I agree to remove
it Aavamoos mmu ck
air commentators Oned by the Bay Ams Air Quality Management all new materials for inspection.
11
a
❑Yon ❑va_�
Ihow mail thsuhuammonmamtiabmqutremenrsunckrdsman6.93 ofthe Califon-
cab HcalthBSalnybanaSections Me303,3333)aru175334.1uMerwalthnlfMe buildingdoes not currently hew a mock then it is my nen nsthtlry to notify Me=upset of the
mquircmenu which m Malpnor to hussar ra cemEnm of Occupancy. Signature of Applican Date
Owner anm omcd engem I
All roof coverings to be Class"B"or better
DEC-05-2005 1414 OLD COUNTRY ROOFING aee'rF3ld�uu� ey
• rill Cammuoiry Develapmso!
10300 TomAvooua
CUperoaq CA 95014
7oiephoao(401) 777.5219
OMF - FL-(408)777-3334
CC'PEI;TINn
Building Department
JUA i�TJR.F.SS: ' PERMIT# � � 6 0
• U`M�tER'SN:1N - (�',Dlil/� f/7�L.1t`r ° , PF3U1\TE # ' 0F �o't d`✓Q
GLN F1'4L COI ITIZ�C?OR�G, G�� PAX. # 9 �20�
u i am..nor usingar:y cubco.nlsactors✓_f�._ jr •��
Signa vre Data
P—l-e��a=ye check :0 iicable s1bcontracters and co.lite the EoGot rl:,,Ulio T=60n,
W —, sueu)NTRA;TOR BUSINESS-N,',.aMP FUSI.NESS LICENSE 4
C.abi.ncts & Mill-work
_CerrfeaeFinishinv
Electrical —
L•cca✓alr�on.
Fencing
Floorirta: Carpelina
I Uzi olmxi/ 4haod �
Gloss/ Gla2ing
g
Beatin �i
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Tr.7u:ation ,
� Land9caoin _--
r< T.a.thinp _
,onry
I prrowlental Sheet 'V, taJ.
Lr I tainting/ 4VrllPapet
� r-5vinb
Phur.bing_
�SepticTanh
_ Sheet Mew --- -
i _ Sheet Rock ^�
C lwne.r/Contro.ctar Signature Date
Community Development Department
Building Division
/ City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
U P E IST I N O 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.
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: e t_� VLA �
Job Site Address: /U 9 41zl
Roofing Company Name: L?/,t
Applicant's Signature: •C-^a /�[ . Date:
tGreg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
za CITY OF CUPERTINO
zw REROOF
CUPERTINO PERMIT APPLICATION FORM
APN# 33 6 /S O Date: ! 7—f( s/O S
Building Address:
Owner's Name: t � / �J Phone#: 3 -677
S
o
Contractor. O/ /� Phone#: License#:
Contact: Phone#: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles %, Asphalt Shingles
Wood Shakes 13Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings 1 ❑ Provide I.C.B.O.Report#
To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read, Understand and Will ComplX With Cu ertino's Tear Off Policy:
Job Description: 7/a Q-Aa 3o tr
az/:,,"..t
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project: Type of Construction: Occupancy group:
9000
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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