04010105 (2) CITY OF CUPER'FINO :T �� �zzr`x� "3is?r2a1 t 'i^n a
j BUILDINGDIWSION PERMIT �kCONTRACTORINFORMATION
BUILDING ADDRESS: MURALIDHAR KALYANTHAYA PERMIT NO04010105
OWNERS NAME: PERMIT ISSUE DATE
ONE: SANITARY NO. CONTROL NO.
ARCHITECrIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
u o o LICENSED COKfRd under S DECLARATION
m I ionhereby70 affirm That 1 am liamcd undo provisions of Chapter 9 my Recreate
lob Description
�z� with Section 70c)(1)of Division Sof me Rusi sand Profcssiom Cock.and myliccnse is
^ o. in full farce and effect. �p
L q
REROOF LiClass Lic.a
4�o Dow Contractor
H ARCHITECTS DECLRATION ��r■�Wy
y al U 1 understand my plans shall he used u public records r /� s1
�o� Liccnseu professional MAY " 4 2004
S OWNER-BUILDER DECLARATION
<y 1 hereby affirm that I am exempt from rW Contractor's License Low for the BUILDING
00 following human.(Section 9DI.5.Business and Professions Code:Any city or county B.¢,1'���Np,�
m which requires a Permit to construct,ether,improve,demolish,lir repair any structure N
gnnn
prior m its issuance.also requires the applicant for such Permit o file a signed sutemem
that he is licensed pursuant o the previsions of the Contractor's Liconsc Law(Chapter 9 Sq. Ft. Floor Area Valuation
x
y t-a (commencing
(cwith Section)IXqof Divisionr nhW d ProfessionsCade)or
mso he is...pt therefrm and the Emu for me alleged ampsption.Any violation
of
Section 7051.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 svpAi,isp,se,Ss �.O O
not more man five hundred dollars(5500). `[LL Y!'i!MLr9e Occupancy Type
❑1,to owner of hhc property,or my employees with wages u their sole compensation,
will do the wart,and the structure is not intended oroffred foraaic(Sec.toad,Business
and Professions Code:The Contractor's Limine Law does not apply an an owner of Required Inspections
property who builds or improves thereon,and who does such work himself or thmugh his
own employees,pmvidcd that such improvements are not intended m offered for sale.If,
however,the building or improvement is sold within one year of er mpinion,me owner-
builder will hose de burden of proving mal W did not Wild or improve for purpose,of
sale.).
❑1,as owner of the propert,am exclusively contracting with licensed contractors to
consumer the project(Sec.1614.Business and Professions Cade:)The Contrazmr's Li-
me law dors not apply to an owner of property who Wilds or imprmrs Neuron,and
who conch for such projects with a contractors)licensed pursuant to the Convactoes
License Law.
❑`lam,eacm on ¢tSec, .B&P C for this reason
Owner `' DI 11 tr(f
--N'PRR£KS COMPENSATION DECLARA a
1 hereby affirm under penalty of perjury One of but folNwing declarations:
1 have and will maintain a CcniGae of Consent to self-insure for Worker's Compcm
Codon,u provided for by Section 37W of the Labor Cade,for are performance of the
work for which this permit is method.
❑1 have and will maintain Workers Compensmion Insurance,as acquired by Section
5100 of me Labor Code,for the performance of the work for which this permit is issued
My Worker's Cam Notation Imumance carrier and Policy number art:
Carrier: Polity No.:
CERTIFICATE OF EJC EM Pr1ON FROM WORKERS'
COMPENSATION INSURANCE
(Thu section ret not W complced if rk Mon ih is fnronc hundred dollars(SIOtB
Icu.)
I certify that in the performance of the work for which this permit is ismed.I shall not
m o in an manner cu sob'ect mhW Workers Com osatinn
employ any persn %%iFW �< I pc
Laws of Calif�p�( � D11 lY C's
N ticst 4APIs� IR�keR��I�9s� pd 'mus
NoW TO APPLICANT:If.aftermaking this a in`es of the Labor io c you a mdL
Wcome subjects it Worker's Compensation provisions of theLaborr Code,you mush
., O forthwith comply with such provisions or this permit shall W deemed invoked.
Z '-" CONSTRUCTION LENDING AGENCY
I Wrehy affirm that dere is construction lending agency far one,lerfurmana of
C the work for which this pmmil is issued(Sec.3011.Co,C.)
i Q 1<ndcrs Name
1-cruder s Addre i
U C) I certify that I how read this application and cute mal tie aura information is
ly P correct 1 agree to comply with all city and county ordinances and sum laws Misting to
pU building construction.and hereby awhOriTt mpracnmrives of oris city to enter upon me
} above(We)
iredagree
properly for intimater beep bs.
(•" y ewe,)agme to Cove,indemnify and tech harmless me City of =gamins against
y incoisequeceofthe he grats saidas atrocious which may in any way accrue against said City
U z m consequence of UNDERSTANDS
of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT issued by: Date
SOURCE , �LTHONS
L' ,` y Re-roofs
at re, (Applk OnIMLOf arc
HAZARDOUS MATERIALS DISCLOSN Type of Roof
Will the applicant or future building uecupant srom or handle hazardous material
u defined by me Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
Calc,Seton 35S13(ap All roofs shall be inspected prior to an roofing material being❑Yea p'fia P P Y g g installed.
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it hazardous air conmmmants as defined by rhe Bay Area Air Quality Management all new materials for inspection.
racist? ...,C'
C)Ycx yno
I have read the hazardous mamrialsrequiremems ander Chapmr695 of the Califor-
niaHcuBA&Safety Cas,Secdom 351)5.25535 slid 255341 understand mu ifthe Wildingh "l\ I`
dos rot cturenlly bavu a truant mm it u my rmporuibiliry m notify de<upant of de �� O4-
myuim n Qcry,must mcrpdonuissuanccofaCcnificamofQeupancy. 1 Si ture�pplican[ DBIe—t—
Der ueavRlBtNed agent Date All roof coverings to be Class "B" or better
OWNER-BUILDER VERIFICATION
1. (Check one) I or my immediate family (parent, spouse or child) will perform:
® A. All the work authorized by this permit
B. A portion of the work
C. None of the work
If B or C is checked, complete 2 or 3 below.
2. A state licensed contractor will be hired to do:
A. _ All of the work
B. A portion of the work (complete section below)
Contractor Address/City, Phone # State License # Type of work to
be performed
3. _ I will utilize unlicensed person(s) other than my immediate family to perform all or
portions of the authorized work. I understand that I may be an employer (see reverse side). A
Certificate of Insurance covering workers' compensation must be on file at the City of
Cupertino Building Department office.
Person/Firm Address/City Phone Number Type of work to be
performed
.....................................................................................................................................................................................
I declare under penalty of perjury that the above is true and correct. I have read and understand the
Owner-Builder Information (reverse
rr side).
Property Owners Signature: Date: 0J-r2,.)/D
r
Job Address: J o IS 7, 014 Permit#6> b d
Any changes to the information provided on this form shall be submitted to the City of Cupertino Build
® Department.
r
City of Cupertino Building Department
' I pCITY OF 10300 Torre Avenue`
C V f E kT I N O Phone: (408)777-3
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of
the property improvements specified.
For your protection you should be aware that as owner-builder you are the responsible party of record
on such a permit Building permits are not required to be signed by property owners unless they are
personally performing their own work. If your work is being performed by someone other than yourself,you
may_protect vourself from possible liability if that person applies for the proper permit in his or her name.
Contractors are required by law to be licensed and bonded by the State of California and to have a
business license from the city or county. They are also required by law to put their license number on all
permits for which they apply.
If you plan to do your own work,with the exception of various trades that you plan to subcontract,you
should be aware of the following information for your benefit and protection:
If you employ or otherwise engage any persons other than your immediate family,and the work
(including materials and other costs) is$200 or more for the entire project, and such persons are not licensed as
contractors or subcontractors, then you may be an employer.
If you are an employer,you must register with the state and federal government as an employer and
you are subject to several obligations including state and federal income tax withholding,federal social
security taxes,workers' compensation insurance,disability insurance costs,and unemployment compensation
O
contributions.
There may be financial risks for you if you do not carry out these obligations, and these risks are
especially serious with respect to workers' compensation insurance.
For more specific information about your obligations under federal law,contact the Internal Revenue
Service (and,if you wish,the U.S.Small Business Administration). For more specific information about your
obligations under state law,contact the Department of Benefit Payments and the Division of Industrial
Accidents.
If the structure is intended for sale,property owners who are not licensed contractors are allowed to
perform their work personally or through their own employees,without a licensed contractor or
subcontractor,only under limited conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure an owner-builder
building permit, erroneously implying that the property owner is providing his or her own labor and material
personally. Building permits are not required to be signed by property owners unless they are performing
their own work personally.
Information about licensed contractors may be obtained by contacting the Contractors' State License
Board in your community or at 1020 N Street,Sacramento, California 95814.
Please complete and return the enclosed owner-builder verification form so that we can confirm that
you are aware of these matters. The building permit will not be issued until the verification is returned.
Very truly yours,
Building Department,
City of Cupertino •
Printed on Recycled Paper
Community Development Department
Building Division
+� City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408) 777-3333
IUPEkTINO
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) h1-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 will comply with the above stated policy on re-roofing.
Homeowner's Name: M V P_A7 i 1)I'] 1 k'lA-L-X,4. m47 Hfl'P 6
Job Site Address: t o 1,SC-7 R I v,,�
Roofing Company Name: LY)y &4 - (0
r�4-(0 W N 610
A plicanYs/Signature: 1 n Date: "-`i
Greg eel
Building Official
_..., Revised 1/30/03
Printed on Recycled Paper
h
CITY OF CUPERTINO
REROOF
® CUPERTINO PERMIT APPLICATION FORM
APN # 3 2 1 ,1 16 Date:
Building Address: 10 15-:7, S. F6o4-ANJ 13)va
CuPE'RTINu , CA 9S61
Owner's Name: Phone #:
M U A t 10 rtR-r� X A-LV f1-ffT l t-A kv h
Contractor: Phone#: � o'� �� 1911
License#:
'DwN�R �
Contact: Phone#: Cupertino Business License#:
t
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles W" 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 Description: Int it be *k l o,/- fk% GuYr-a U"-7-4 8f• neCV u/�.� cv
he,w 0)4,as1}o Yrs C=12 A
Residential Q Commercial ❑
Fire Zone: Yes ❑ No 0' Confirmed with Planning- ee I. if
there are an ,restrictions:
Cost of Project: Type-of" ons c n: Occup ro r
6 -0Ts — ./ -
Qty if^�
A is ble ' Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
-BENERGY Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
SEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
� � 760