04060226 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT NT RACT,OR INFURMATION :
4,0�BUILDING ADDRESS: PERMIT NO0 4 0 6 0 2 2 6
7574 ERIN WY
OWNER'S NAME: PERMIT ISSUE DATE
RAVI NYALAKONDA 06/25/2004
NE: SANITARY NO. CONTROL NO,
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
uo0 LICENSED CONTRACTOR'S DECLARATION O O O O
MI hmeby affirm that I am licensed under provisions of Chapter 9(commencing Job Description
i with Section TCIEM'Diviaion3ofthe Business and Proessions Code.aid my license is REROOF �tyyuyt
Z�' in full na cffe I ®tf � '��®
D'9i? Lic. 3 Lk.N - Ip91t
=-o Datecont CONTRACTOR: KEVIN FARRER
"� ARCHITECT'SD LA TION
4mU Its dc4, Y plans shall he used u p e' ords
;wi LicensedPmfessionel AUG 12 2004
OWNER-BUILDER DECLARATION
<f 1 therebyaNpt the
tEm al I am exempt from C.Lor.mrs License Law faf the
0 0 following mason.(Section?031.5,Business and Prole ions Cade:Any city or county
K$ which myuifa a permit m mnswn.alter.improve,demnlish,or repair any stmcture
y-r^ PHOT ltl its issuance,also requires the applicant for such Permit o file a signed statement
that he is)iccnsed punuanuo the provisions of the Commcmri License law(Chapter 9 Sq.Ft. Floor Area ❑ O
,i-c' (commencing with Section 7000)of Division J of the Businessand Professions CoM)ser
i
that he is exempt thc¢from and the basis for the alleged exemption.Any violation of
Section?031.5 by any applicant for a permit Subjects the applicant to e civil penalty of APN Number Occupancy Type
not mora manfivahundred eillanMCI). 35921026 . 00 p y YP
❑I,as owner of We propcny,ar my employcu with wegu u)Mir sole compenserion.
will do the work.and the stroctum is not intended oroRered forsale(Sec.?1161,Business
and Proleseinns code:The Conmctor's Liecoma Law docs not apply in in owner of Required Inspections
property who hands or improv(her amand whodeassuch wok himself orthrough his
own employaa,pmvidcd mat such improvements art not intended oro@red forsalc.If.
however.Ne building or impmvement is Sold within arc A.of complcoon,tine owner.
builder will have ote burden of proving that he did not build or Improve for purpose of
sale.).
❑1,AS owner of the propsny,am exclusively contracting with licensed conpacmrs m
construct the project(Sec.7614.Business and Professions Code:)The Contactors Li
cents Law docs not apply to an owner of property who builds or improo E,Nemo.,and
who contracts for such pmjecLO with a conuacmr(a)licensed pursuant in the Convectors
License Law.
❑1 am exempt antler Sec. .B S,P C for this mason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury ore of me following declanti ins:
I have and will maintain a Ccrtifiam of Consent to self•imum for Woskefi ComPEEn-
sation,u provided for by Section 37M of the labor Cade,far the peffmounee of @e
work for which this permit is issued.
I have and will maintain Workef's Camperaatlan Laurance,as required by Section
J7W of the labor Cade.for the performance of the work for which thia permit is issued.
My Workers Compenanlan Insurance arrics and Policy number AM
carrier. i7714TE Fbn..jf�> Policy NO.� f / C
CERTIFICATE OFEK FROM WORKERS' z 55 6O+Z00 y
COMPENSA ✓N URANCE
Gnih section need not W completed if the Permit is foronc hundreddollan(SIM)
of less.)
1 cenify mot in the perfonni of the work for which this Permit is issued,1 shall nut
employ any person in any manner So as in became subject to the Workeri Compensation
laws of COlifomia.Dam
Applicata
NOTICE TO APPLICANT.IL after making this CcnifiaW of Exemption,you should
Wcome subject in the Workv'a Compensation Provision$of sop labor Coca,YOU most
.0 O foMwith comply with such provisions or this permit shall W dccmcd rewki d.
Z D; CONSTRUCTION LENDING AGENCY
F` Ihemhyaffirm Nat there iso cemvucunn lending agency for the perfufmana of
IY dte work for which this permit u issued(SEES.2109?.Co.C.)
Lenders Nam.
z Landers Address
U O 1 certify that 1 have read this application and SLOW Net the above information is
LE.P correct.I agree m comply with all city and county Un insn¢s and suite laws aloin,m
0 building consumed...and hercbyeuNome fepresenutivesof Nis city to enter Ulmn one
r a ahove-mentioned pmKrty for inspection purpoms.
(We)agree to save,indemnify and keep hsrmlea me City of Cupcnino against 42
liabilities,judgments.costs cNosts and expcnxs whir ay in any way accme against said City
U Z APPLICAcn=11f STArantiN pt.AND WILL WITH ALL N-P Issued by: Date
SOUR EG LAT10N
LS �y Re-roofs
Sig at LEE n or Dam
H RDOLIS MATERIALS DISCLOSURE Type of Roof
Will the applicant or forum Wilding occupant norm or handla havallous material
AS defined by dm Cupertino Municipal Code.Chapter 9.12.and the Hcalm and Safety
We.Schon 25512(x)? 1❑Ya �No All roofs shall be inspected prior to any roofing material being installed.
eastiWill the Applicant Or future Wilding Occupant ase cqulp.Ant.f dc" which If a roof is installed.vitlout first obtaining an inspection,I agree to remove
mil hafafdous air contaminants as defined by he Bay Area Air alit Management /
Quality s all new materials for Inspection.
District?
❑Yes emu
I haveressits}a hazardous materialsfeyUi�remmu;under Chapter 6.95 afthc Cxllfof-
nia Heal ofcpJCodc.Sccdons255B52337 and255ld.lundcrsLOnd thoif NEE Willing _ !�- / �• D
des tune y hoc a t u' my respUmibility m nodi tees neo am of Lie v
1mmen ''h pri Iissuance of.0 o sup SI f 'cant Date
G erM ori,<d t All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408) 777-3333
UPEkTINO
Building Department
JOB ADDRESS: PERMIT #
-') 5'-7 X12/ wA O bb z �o
OWNER'S NAME: '�A-V ) YA LA le PHONE # 6SQ `1 7Z
GENERAL CONTRACTOR: r C_Gv t SQ Fg # S) O- 7
I am not using any subcontractors: Z y
Si a 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
Community Development Department
Building Division
a' City of Cupertino
y, 10300 Torre Avenue
CITY
l n OF Telephone: (408)777-3228
*UPERTINO 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.
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 ll comply with the above stated policy on re-roofing.
Homeowner's Name: kAyl tiYALA kQo SDA
Job Site Addres -11 -7 57 y ERW wA-
Roofing Company Name: i IJ P-
A plicant's Signatur . Date—
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO o Z z6
REROOF
OF
CUPERTINO PERMIT APPLICATION FORM
APN # / Date: 5
s 0 6y
Building Address:
757Y c R l 1'.7 L,-//Vy
Owner'sa e: Phone#:
\-, I ti ALAgoVoA 656 - 5- yy- /q7z
Contract Pho : S'd License
Kc. 1N F�9-w-r &-�F 9/- 6 57 yZ- 7 / 3
Contact: Phone #: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-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 Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑
Job Descriptio
L?
Residential
Residential Commercial ❑ co
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are an res ttc ons. 15
Costo j : �/ � Type of C ion: Occupancy g p:
Qty. if
A p P Kc5iblle Fee ID Fee Description Fee Grou
BPERMFEE BlTg 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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