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05010116 (2)
CITY OF CUPER'11NO �°'"' %'° '`''� 'T""�'➢ �' ` '�"' BUILDING DIVISION PERMIT CONTRACTORINFORMATION ,! BUILDING ADDRESS: ABOVE ALL ROOFING PERMIT N005010116 7589 ORANGE BLOSSOM OWNER'S NAME: FERMR ISSUE DATE SRI DEEKSHITULU 700 NORTHRUP ST 01/20/2005 ONE: SANITARY N0, CONTROL N0. (408) 292-4188 ARCHITEC(ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH ±00 LICENSED CONTRACTOR'S DECLARATION O O O O OWE 1 W.by.rfiren that I am licensed under provisions of chapter v(commencing lob Description !S� Withll Force orcer and crof 11]nrl)1C BYSinC11 P ( COdC dlldapyll[[NCIy in mu rdm�anderr _� °� s \ REROOF W/COMP. j ? License C Lk.N -`C Date s -�5C Cdntrumr j ' rfr A-- RT CFiHEC& DECLARATION f lunxraand my plate shall he uadupuhlie records Licenced Pmfcssidnal O S OWNER-BUILDER DECLARATION Q`� C a O hereby so .('firm that I rte Cacmpt from the Comrnc or's :Any C Law for the COO fallowing arson.(Section)1131.5,Business and ve.dem li CWC:Any tiny m county 5 m which requires a permit pr omsrrthe alter.improve,demolish.ri repair any etrucmrc $7000 rEi prionoits issuance.dlomprm to themr;theappfor such Cmrermil to Otmicle a e Law(Chi mcnt Zcs< that cwitpuavantmlhoproviiiBn the OftheBusiiess niamel<w(Curie)9 Std.Ft.Floor Area Valuation I-O (commencingromithgCC11rm7WB)Of Division sor dlthCeged Business and Professions Any (hat he u eumpt therefrom and Bic buts for the alleged exemption.Any violrion of Section 7071.5 by any applicant for a permit subjects the applicant ld a civil penalty ofcuane Occupancy Type not..on Nan five hundred doll..(SSOy. BIO 0 P Y YP 0 I,a owner of the property,or my employees with wages as their sole aompenation, will do rise work,and the structure is not intended or offered for sale(See.70Ca,Business and Professions cox:The Conuaclm's License Law dors not apply in an owner of Required Inspections property who buildsar improves thereon,and whodd ssuch work himulfor through his own employers,provided that such improvements she not intended urorfered for ms.If. however,the building or Improvement i"old within one year ofenmpletion,the owner- builder will hue mr,burden of proving that he did not build or improve for purpose of sale.). ❑I,as owner of the property,on exclusively contracting with licensed mnuaclors to Conswen the project(Sec.]OCA,Business and professions Code:)The Contracmr's Li. cmc Law does not apply to an owner of property who builds or improves Neuron,and. who contracts for such projects with a conuaclor(s)licensed pursuant or the Contractor's License law. ❑Iamexemptunder Sea ,Bh PCforthismmmn Owner Data WORKER'S COMPENSATION DECLARATION 1 he.by affirm under penalty,of perjury one or the following dechratio ce I have and will maintain a Cenificere of Cnnscnl to alf-imenc for Intent'sCompcn- atren,as provided for by Section 37W of the labor Cade,for Bic performance of the work for which this penin is issued. ❑1 have and will maintain Worker's Compcmadon Incorrect,as rcyuired by SCcdon 37W of the labor Code,for the performance or the work,for which this permit is issued. My Work: 'G mpe slide I�gyjance riio rentl Policy nrfrerlpT.y; Carrier. ; Policy No.:� CERTIFICATE OF UEMPDON FROM WORKERS' COMPENSATION INSURANCE (This section need not W completed if the Permit is fodne hundred dnllanfll IXl) on less.) I cenifv that in the performance of the work for which thia Permit u issued,I shell not employ any person in any manner an or w become object to the Workers Compensation Laws..California.Date Applicant NOTICE TO APPLICANT:If,after making this CCOMUm of Esomprion you should become subject o the Worker's Compcmation provisions of the labor Cox,you muss �2 foMwith comply with such provisions or this permit shall be deemed invoked. Z O CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is comtnrtlion lending agency for the frefurmance or ]: the work for which this permit is issued(Seca 3D97,Civ.C.) QLender's Name Lenin's Address z J Q I certify that 1 have mad this application and sow that the above information is s.F torten.1 agree m comply with all city and county ordinances and sum laws relating to 7 V building comtrvcrion.and hereby authmire rcpresentALOCS of this city to enter upon meL b.'e-rocritioned property for inspection purposes / ,..ra. (We)Agree to ase,indemnity and keep harmless the City of Cupertino agaimn f/y liabilities,judg osts amdeaPcmeswhich may in any way acerae against mid City JZ in conayuC of -granting of this PCrre INT ^ �� '—' APPLIC T DERSTANDS AND WILL COMPLY WITH A ZWIssued by: Date V SOR7L LATIDNS. U URe-roofs Signature of Appbcam/Comrestio a Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building Occupant stare or handle haardous material IDistris,17 defined by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety We.Section 25532(x)? Cl Yes ON. All roofs shall be inspected prior to any roofing material being installed. Will the appliant or future building occ'upam use cyrup Tom,odevices which If a roof is installed without first obtaining an inspection,I agree to remove ilh....does air conm emants u defined by Ibe Bay Area Air Quality Management all new materials or inspection. ❑YCs ❑No IhavcraNns materiHmytrireeors exrChapter6.95oftheCaller- HCalthct ak'Ln'.m25W5,25533 and 25531.I unxrslod lnit(IM WildinB ; ��ys not rte haat a tenant Net il'u my rciTuminiliry m notify enc upant of theui :n non mast nc met pdm to isudan:edn cerefieaicof Deed ",Cey. Signature of Applicant Dale narror amhorisJ vgcm / D o 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 ByRding De artment JOB ADDRESS: �SC9 aQoPERMIT# �m a� (-) l 10 OWNER'S NAME: % PHONE # '1U4 Z9 i- 4 t 4 V GENERAL CONTRACTOR: jqbrjL,,e Sa FAX # f(og-ZCl z . - 4 I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Is 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 / za u t-( Owner/Contractor Signature Date , Community Development Department i Building Division City of Cupertino 10300 Torre Avenue Telephone: (408)777-3228 CITY Of Fax: (408) 777-3333 UPEI�TINO 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 will comply with the, above\ stated policy on re-roofing. Homeowner's Name: Sc\ t 1CQ��r1t�l Il l) Job Site Address: �Z5 �q//�� Dr- Roofing f� n Roofing Company Name: t'1 Aj2plicants Signature: Date:�o�; GregTteel Building Official Revised 1/30/03 Printed on Recycled Paper CITY OF CUPERTINO os I o REROOF CUPERrINO PERMIT APPLICATION FORM APN# l� 6 ) i O S Date: �O ©� Building Address: .�7� 1 Owner's Name: , Phonesf- # 1 U�� . 6 Zy2- 97Z .S Contractor: one License#: A fi,7 Zgz�i�� 7 qc11-165- Contact: Phon #: Cupertino Business License#: �lcS� N?,-4199 250- C Z Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles Q� Asphalt Shingles Qt Wood Shakes O 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: ear 6.L In: 1 t Icy cro 1r1S�o.11 t '�,l �Eall O)e - on X70., rod Residential .❑i Commercial ❑ Fire Zone: Yes ❑ No ,ES, Confirmed with Planning Det. if there are anrestrictions: LJ Cost of Project: r\ 1 Type of Construction: Occupancy group: J Re Coj Qty. if A lic Ie Fee ID Fee Description Fee Grou BPERMFEE Bld Permit Fees BUILDING BENERGY EneEgyBUILDING BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING BPL CHK Plan Check Fee BUILDING BUSLIC Business License BUILDING • �3 7. ��