08010057 (2) CITY OF CUPERTINO
BUILDING DIVISION PE MIT
BUILgTytGgQOBEsEDWARD WAY TBD - TO BE DETERMINED Papal'08010057
OWNER'S NAME: PERMIT ISSUE DATE
RAJARAM SUBRAMONIAN 01/10/2008
INNE: SANITARY NO. CONTROL NO.
ARCHITECTMNGINEER: BUILDING PERMIT INPO
BLDG ELER PLUMB MECH
�00 LICENSED CONTRACT'OR'S DECLARATION - Job Description
to 1 ne.by affirm that 1 me licensed under premium of Chapter 9(ammcming p
CC whoSecdonTIXKBafDiNa(on3ofMeBeArmsandProlamiamCode.andmylicenseI. RE-ROOF,T/0, SHT, 7/16 OSB CLASS A, 15LB FLT.
eV
in fan to.and attract.
nqz License Clue Lle.g BRAWDUS ROOFING PD FOR BUS LIC 1/10/08
Dam J`_ —Cormsl,_
ARCHITECT'S DECLARATION
U 1 understand my plans shall he used as public records
;u. Licensed Professional ---
5a OWNER-BUILDER DECLARATION
I batch,aRmm that 1 am exempt from the Cenaamar's License law far the
O O following roman.(Section 703 1.5.Business and Profesaiom Code:Any city or county
which rtquims a permit to comwct,alter.Improve,&..run,or.,.I,my structure
.�< prior to 14 issma m,alm 6Qeima Ne applicant far such varah as file asigneda4malem
O
(hat W is licensed pausunflL 10 in.provisions of Me Commuter's Lice.Law(Chapter 9 Sq.F[. Floor Area Valuation
$ (commencing with Section 7000)of Division 3 of the Business and Profession Crude)or 10(]00
Q Net Its 4 exempt therefrom and the bola for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects Ne applicant to a civil penalty ofNumber O
not mom than five hundred dollars(5500). 3 5 619 012�� Occupancy p y TyPe
0 1,u ownerof Ne property,army employe.with wages as their solecompensation,
will do Ne wmrkmd theavucture iseotin4Med or offered formic(Sm.7006,Business. Required aired Ins actions
and Pmfassiom Code:The Conuantar's License Law don not apply to an owner of q p
property who buildaarimproveslAmrmn,andwhomesmch wok himmlforthrough his
awn employees,provided thatsuch improvements art notimmnded oro@red formic.IL
however.the building o improvement la sold within am year of mmpleuon.Ne owner.
Wilder will Mve t,burden of proving that W did not Wild or improve for purpose of
saes.).
0 1.as owner of the property ern exclusively mnuaming with licensed conmcton to
construct Ne project(Sec 7040,Basin.and Professions Cade:)The Convector's U.
team law does not apply to an owner of property who Wilds or bnprows Hereon,and,
who contracts for such projects with a ammetar(s)Handed pu mant to tW Commences
License law.
0 l oro exempt under Sec ,B k PC fer this mum
Owner Dao
WORKER'S COMPENSATION DECLARATION
I hereby same under penalty of perjury oro of tiro fallowing decluasiom:
haw aM w01 mainuin a Cenifmamof Comm,to mlf-Insure for Workers Compeer
an provided fm by Section 3700 of dm later Code,for the performance of He
ark for which this permit is issued.
0 1 haw and will maintain Workers Compema0on Insurance,as required by Section
3700 of tht LaWr Cole,for the performance of the wok for which this permit is issmd. '
My Work: C�ym�np�,mamoon Insurance
�ammrand Policy number
art:
Cartier. 'vy +a[ � t•_,�'Pollry No.:2.30 1000�✓� U�
CERTIFICATE OP EKEMPI'ION MOM WORKERS'
COMPENSATION INSURANCE
(Thin section mod not W completed if Me Permit Is far one hundred dollen($100)
or less.)
1 certify that In Ne performance of the work for which this permit is ivum.l shall and
employ any person in any manmrsu as to become subject o the Warkers'Compenu0m
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should
become subject to Ht Workers Compemkdon previsions of Ne Tabor Cade,you most
.JO forOwith comply with such provisions or Nu permit shall W deemed mwked.
Z,~y. CONSTRUCTION LENDING AGENCY
'[•r thereby of ran Hat them is a construction lending agency for He performance of
p: Nism
ad work for which this permit is ied(See.3097,Civ.C.)
W Q Lender's Name ,
z Lenders Address
V Q 1 tardily Nal I haw:rad Nis application and sue Nal Nc anew information is
ly F Centel.I agree to comply with all city and county coarseness and sum lawn missing m
.Q V
building construction.and hereby sutharim repmenusiws of Nis city.enter upon the
W above-mentiunad property for impaction purposes
LL (We)agree to saw,indemnify and keep harmless the City of Cupertino against
CA liabilities,juils cna,cmtsandexpemm hich mayin anyway seems agaimusaid City
V z incan ext mil the gnnung o pe It. A/0 i 11-
APPL ANT UNDERST S A WILL PLY WITH ALL NON-POINT Issued by: Date (f�f/
SO CE REGULA770N5.
is Re-roofs
ign Applicm n Dem
R ATERIAIS DIS SURE Type of Roof
Will de applicant or future building aouPantnort or handle hazardous material
as defined by de Cupenina Municipal Cade.Chapter 9.12.and the Health and Safety
Cade.Smash 25532(.)+ All roofs shall be inspected prior to any roofing material being installed.
0y. ff V.—
Will He applicant or futum building occupant use equipment or devious which If a roof is installed without first obtaining an inspection,,I agree to remove
I hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
CR
DYn Nu
Ibl an the harvdnus VE." Chep au6.95oftheC.lifm-
niaHaom 25505mdoes te. heyhewaunml.tyaHto notify the rcapmt of d.
mmcntswhich must Is p' uto of(3capway. Signature of Applicant Date
Own r wthorizad a Dam'
All roof coverings to be Class"B"or better
I '
CITY OF CUPERTINO
Q" REROOF
CIT'OF
•CUPERTINO PERMIT APPLICATION
APN # Date:
Building Address:
v2 / 6,3
Owner's Name: Phone #:
yo
Contractor: Phone #:
gzs
Fax #: 390- 266 7
Cupertino Business License #: Contractor License #:
9 �2c/
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles X Asphalt Shingles
)a 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 Mfgr. Installation Specs.
Job Description: Tfz�2 D FPS 0 S(3 , G1. s A
l� ,(n r-rA
7 A
Residential Commercial
Fire Zone: Yes ❑ No Confirmed with Planning Dept. if
there are any restrictions: ElValuation: �
/0000 �
I Have Read nders Will'Comply with Cupertino's Tear-Off Policy:
•Si ature
CITY OF CUPERTINO
REROOF
• OF
CUPEkTINO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1REROOFCOM Re-roof Commercial B 1COMMLROOF
1BSEISMICO Seismic Commercial B
1RER00FRES Re-roof Residential B 1SFDWLR00F
1BSEISMICRE Seismic Residential B
1RER00FMRES Re-roof Multi-Family B 1MFDWLROOF
1BSEISMICRE Seismic Residential B
1BUSLIC . Business License B
•
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
• Telephone: (408)777-3228
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 maid 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: G4 -( ,q R+/n
Job Site Address: v3
Roofing Company Name: V £�'�r�✓b Clot . "
Applicant's Signature: Date:
• Greg Casteel
Building Official
Revised 11/2/04
CITY OF CUPERTINO
2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35619012 . 00
DATE ISSUED. . . . . . . : 01/10/2008
RECEIPT #. . . . . . . . . : BS000003659
REFERENCE ID # . . . : 08010057
SITE ADDRESS . . . . . : 21639 EDWARD WAY
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : RAJARAM SUBRAMONIAN
ADDRESS . . . . . . . . . . : 21639 EDWARD WY
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4764
RECEIVED FROM . . . . : DONALD B BUSHONG
CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096
. COMPANY . . . . . . . . . . : TBD - TO BE DETERMINED
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . .
TELEPHONE . . . . . . . . :
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 10, 000. 00 1.00 0. 00 1 . 00 0. 00
1REROOFRES SQ FEET 30. 00 390.00 0 . 00 390. 00 0. 00
---------- ---- ---------- ----------
TOTAL PERMIT 391.00 0 . 00 391 . 00 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- ------- --------------------
CREDIT CARD 391. 00 VISA
TOTAL RECEIPT 391. 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
- ---------------------------- -------- ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
603 ROOF BATTENS 604 ROOF IN-PROGRESS
605 FINAL REROOF
•
Community Development
10300 Torre Avenue
' Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
®CUPEkTINO
Building Department
JOB ADDRESS: / PERMIT#
2/6 3 -GCG.�r o l oc�sr7
OWNER'S NAME: G ,- PHONE #
GENERAL CONTRACTO : ,�dvs FAX#
I am not using any subcontractors: �
e ! 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
•
Owner/Contractor Signature Date