05070084 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMITCONTRA.CTORTNFU�'RMA.TIUIV
BUILDINGApDREss: ABOVE ALL ROOFING PERMrrNP05070084
10241 MILLER AV
OWNER'S NAME: PERMIT ISSUE DATE
ZAREH SAMURKASHIAN 700 NORTHRUP 5
.HONE: SANITARY NO. CONTROL NO.
(408) 292-4188
ARCHI'IECDENGINEER: BUILDING PERMIT INFO
BLDO ELECT PLUMB MECH
3Oo
LICENSED CONTRACTOR'S DECLARA71ON JbDescriP tion
1 hereby af0mn m
i N 1 am Iimed under pmo
viaimu or Chapter 9(commencing
NthSection 70110) DI fthe Busineuu s .anbrlly licenmis
infallr anile e T/0 WOOD SHINGLES/INSTALL LAYER 3OLB FELT
i g� Licca I Lic.{
G Dig am confincher 0 YR COMPOSITION
acxnEcl'sDEc A
`u IundewndmyPansslWlbe used As public m<nrds /13/5 ABOVE ALL ROOFING #23092 RENEWED BUS LIC
is
oil� Limand Professional
y 1.1 OWNER-BUILDER DECLARATION
0I I hereby a�Om that 11. exempt frem the fesuncmrsLicense: c Lew for the
Oo followwhich
recon. emits ]0313,Buaineuand n.loons Code:Any city or county
cture
Z 3 ui which require Issuance.permit re rnres the alter,impreve,h Permiit or mpeir any a mamma
_xi duartosl nsedIulmantso ns previsions the Commerce.
LicnseLaw(hteel ummem
< (com inimnwithSeumton 70the 00)dvWouoflfthefl sinnum WxvelAw(sCode)9 Sq.Ft. Floor Area Valuation
3
(commencing ngwlN erefroID00)ofDivisianrofthceedeuaul ption. yvioladonof $5500
diet he h exempt therefrom and the bath for the alleged exemption.My Noladm a(
Section 7031.3 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Oe
not mom than Rve hundred dollars(5300). Occupancy Y TYP
❑I'm awrear of the preperty,m my emplu3mes with"Am"thehaole campensatim.
will do dR"*-Nd meapuelum la nal intended mofrend foraam(sm.7044,BW mass 36942003 . 00
and Professions Code:The Contractors License law des not apply 0 in owner or Required Inspection
property whobuildsorirepreves thereon,and whodonauch workhimselfor through his
Own employes,provided thalauch improvements are not Intended warmed farula If.
however,the building Or improvement is sold within aro year of completion.the owner.
Wilda,will have der When of proving dk that did tet build or Improve for purpose of d
0 1.).
1,he mvnsr of project,
pec.erty.am704.Business e a d ca tension s with:)Th ed cnnucures to
cam,La the prefect pply o an wnrorand rty whoons Cade:)The Contactors L6
cerise law coca not apply to a owner orpaOperty whe Wilde or Improver Nonan,and, O�
whocontracts
Law.
0Lm for such prefects with a conuuwr(O licensed pursuant to the Contractors
1License am exempt undo Sea .Bk PCfor this reawn
Owner Date
WORKERS COMPENSATION DECLARATION
41 I hereby dorm under penalty of perjury One of the following tkclentioris
1 haw and will malnuin aCeNOcom of Consent to ulFimun far WOhers Compete
upon,As provided for by Section 37M of Inc labor Codc,for Ne performama of the
weak for which this permit is issued.
❑1 have and will maintain Workers Compensation Insurance,As required by Section
3700ofthe L, C e.Tor the perf njIltheweakforwhiehuh..pernil leiuued.
My War urian laugmce nnirlAnd Policy nu ppb
Grtier. t/LyPolicy No.:
CE(TI CAOF (EMPf1ONFROMWORKPERS'
COMPENSATION INSURANCE
(ITh scctim rues rot W completed time permit isforove hundred dollen($100)
or itis)
I eeAry Nat in the performance of the work for which this permit Is issued,l shall nes
employ any person in say mumeru As to become subject to the WOrken'Compmeatlon
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,after making this Cenieuu of Exemption,you should
become subject to the Workers Compensation provisions of the labor Com,you must
.J O forthwith comply with such provisions or Nie Permit mall be deemcentral.edcentral.
M
CONSTRUCTION LENDING AGENCY
(-+ I hereby affirm mat then Lia construction lending agency for the performance Lir
I3:> dN were for which this Permit Is mood(Sm.3097.Clv.C.)
W Lender's Name
aZ Lander,Address
t.)Q 1 certify that I have reed this application and sum Nn the above Information h
W correct.1 ague to comply with all city and county Ordinances and sok law reining to
Q building construction,and hereby authorize upresenmhesar this city to enter urns the
W anovcmanuoned property for Inspection peNos which may
6. (We)agree to save.indemnify and keep harmless the City of Cupertino against
In in conueAjudgmenW aomud expenses which they in any wyacrnua{ainatWOCity
t.) incanugmnce theRSTANofthisDWIL Date
APPLICA DERSTANDS AND WILL COMPLY WITH ALL ON POINT Issued by:
SOUR ULATIONS.
7 t5M�L Re-roofs
f�a
MuntrafApplicardConimeor a Dam
HAZARDOUS MATERIALSDIscwsuaE Type of Roof
Will the applicant or futon Wilding aceuPutstore ea haMle narudoss material
u dented by the Cupertino Municipal odea,Chapter 9.13.and the Hulth and Safety
Code,Smtias 255334Y? All roofs shall be inspected prior to any roofing material being installed.
❑Yu o
Will the applicant or rotate Handing gausum use equipment Or levies whichIf a roof is installed without first obtaining an inspection,I agree to remove
Ii ha ardmus aircmuminants u den by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes
I have mad the harardnu materials requirements undcrChapter 6.93 ofthe Califon
niaHulthd:Safe ,Sstieats23505,23533arui23534,1underaWth ifthe Wilding
J.tete vee¢nut,that ithmy mapouihilitymnotify theamuput of the
squire ohm wmcofa ccmncam of�yk /�
"""�� "/ y' Signature of Applicant Date
Clatter m authorized agent D All roof coverings to be Class"B"or better
CITY OF CUPERTINO
em 1 of 1 PERMIT RECEIPT OPERATOR: suem
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36942003 .00
DATE ISSUED. . . . . . . : 07/13/2005
RECEIPT #. . . . . . . . . : 30366
REFERENCE ID # . . . : 05070084
SITE ADDRESS . . . . . : 10241 MILLER AV
SUBDIVISION . . . . . . :
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . :
OWNER . . . . . . . . . . . . : ZAREH SAMURKASHIAN
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP CUPERTINO, CA 95014
RECEIVED FROM . . . . : ABOVE ALL ROOFING
CONTRACTOR . . . . . . . : KEN SULESKY LIC # 23092
COMPANY . . . . . . . . . . : ABOVE ALL ROOFING
ADDRESS . . . . . . . . . . : 700 NORTHRUP ST
CITY/STATE/ZIP . . . : SAN JOSE, CA 95126
TELEPHONE . . . . . . . . : (408)292-4188
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
BPERMFEE VALUATION 6, 000.00 126.36 0.00 126.36 0.00
BSEISMICRE VALUATION 6, 000.00 0.60 0.00 0.60 0.00
BUSLIC FLAT RATE 1.00 102.00 0.00 102.00 0.00
______ __________ __________ __________
TOTAL PERMIT 228.96 0.00 228.96 0.00
METHOD OF PAYMENT ---AMOUNT --_ -NUMBER
------____------- ____
CHECK 228.96 10682
TOTAL RECEIPT 228.96
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
CUPEkTINO
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 ie-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 will comply
with the above stated policy on re-roofing.
Homeowner's Name: a, �V� sapA110,V-,
Job Site Address: (VY k\`t - Uex-sLpp—
Roofingg Company Name:
A plicant's Signature: Date: -7 L3 10S-
Greg
OsGreg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
= CITY OF CUPERTINO
REROOF
CUPERTINO PERMIT APPLICATION FORM `�SIJ�oDt��
APN# Date: ` U,
Building Address: M
Owner's Name: Phone
Contractor: \`n � •1 Phone �QZ / License
Contact: Ph a#: 6 Cupertino Business License#:
�o zaz- c i w 9-1;z
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles CV'Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
V Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report#
Cl To be Removed ❑ Provide Mfgr.Installation Specs.
• I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: ZCb
Residential Commercial ❑ ct,v Yr Cuv�po5 ��
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are anrestrictions: LJ
Cost of Project:,,,-�(�� Type of Construction: Occupancy group:
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