08080106 (2) CITY OI:'.CUPERTINO .
BUILDING DIVISION PERMIT ^�"�TTW ¢'
BUILDING 440 ESS: PERMIT NO.
] O�yfi P:CNEVILLE AVE KNIGHT ROOFING SERVICES 08080106
OWNER'S NAME: PERMIT ISUE DATA
AMILi IT PHANSE 42035 OSGOOD RD 08/14/2008
NE
(510) 438-9077 SANITARY NO. CONTROL NO.
ARCHITECVP.NGINEER: - BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
3 0 p LICENSED CONTRACTOR'S DECLARATION Job Description
9Ii 1 beeby affirm,that 1 sen 14enra under provisions of Clupter 9(commencing
nt1 MO Section7000)ofDivisimt3oftheBusinessandProfessiomCode,sulmylicenrcu RE-RF T/0 SHK RF& INSTL SHETHNG, INSTL CLS A CMP
olj!Uuaucaji e — Lies SHNGL 29SQ .
S DamA CARAT
.ntrcur
e C.MCTS DECLON
< 1 undenund MY Plans shall he used as public mcn ds
5 (n Licensed Prof..most
5 � OWNER-BUILDER DECLARATION -.
I I borthy olEm
that I am exempt from the Contractor's License Law for the
O o fallowing mason.(seed..703 1.5.Business and Pmfusiuus Code:Any city ar county
9 which mqui es a permit m consutcL alter,barroom,demolish,or mpair any s mclum
�^ prior m its issue=.ales requires the applicant forsuch Permit on rile a signed statement
< thatbolslicensedpursuanttolMprovisionsoftheContractor'Umusclaw(Chapter9 Sq.Ft. Floor Area Valuation
gb, mmmningwith Sccdon7000)MDiv ion3ofdmBuslncesundPmfessiamOodc)ur $12040
�3.• that he is Commit,dominant and the basis fm the alleged eaemptian MY vluhadon of
Section 70715 by any applicants fan a permit subjects the applicant to a civil Penalty ofNumber Occupancy
m more man five hundred dollars($5011 36913023 n'pe
1,a hewer of and
the
smack an rota a inuesdod us wire wag for
Nab sole 04al.Business utioss
Nn Out
nnffesdons cock:::The c mmewr;Li offered Out apps"ly an an Ow'M� Required Inspections
properlywho buildsorlmproms demon,and Cabolaicachmors himself arduough his
owuemploycros provided than such impmwanau ice net ino-aded.roEered for sale If,
however.me building or improwmenc is said within arc year of ampledon,Na owsa•
builder M0 now the burden of proving that M did set Mid or impo m for purpose of
sale.).
❑1,a owner of the property,am eaelusively contracting with llama d mnucmn to
common On pmkct(sec.7044.Business and Rnfesslons Cade:)The Coavacmr's U.
cense Low does Cut apply m an owner of property who builds or impmm there...and,
who coomaeu far such pmjeeu wire a comae cmo(s)licensed puruunt m me Conuctara .
License
law.
❑Ima.mmptundarsee ,B&PCfmmbmalon ,
0. Date
WORKER'S COMPENSATION DECLARATION
I hereby unions under Penally of Injury one of me follmaing declamd.N:
I hsm and will maintain a GUdBGIe of Coman,m aclf-Insall far W.rtera Compea-
.tion,u poovided fm by Section 77M of the labor Code.far the pmfamanco Of the
work for which this permit is issued.
❑I haw and will maintatn Workers Compemation lasuram,as,required by Section
3700 of the labra Code,for the performance of the work for which this permit is umad.
My Worker'smmadon In..Cartier and Policy number ice:
Carrier. G F�yl Polloy No.: 2-1fQQ1Qq?1n
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPP.NSAMON INSURANCE
filtis section need not M completed If the permit is fanane hundred dollar($101
o eu.)
1 coolly the,in to pufanlnancs of On wars for which this permit is issued.I dull not
employ any person in any mummer an a an become subject m the Workers'Compensation
laws of California,Dam
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption.you should
become subject m the Worker's Compensation provisions of me labor Code,you muss
O forthwith comply Mutt such Pmvuma or this permit Mall he deemed mated.
z'"" CONSTRUCTION LENDING AGENCY
F .4. 1 hemb alliin Nu Nem la a com uctinn Icndin r g agency for the lerfarmwxe of
Uj> wort ter wale.Ebb H issued
b Permit 3097,em.ca
D, O Le lander{Name
=z LenderaAddma
U O 1 modify Nat 1 haw read this application send sum that the show information u
w y canecL I.gra 0 comply with all city and comely Ordinances and suss hen misting m
building Conslmction,and hereby auNadze mpuxnudm or this city lit enmrupnn Nc
Loy ahwe-mentioned property fan impaction purposes
y (We)agree on sant,indemnify+sad trap hn n a the City of Cupertino against
t'A 0abllida.judgmenu,cNE
may many way a a,a Slwaid City
t,)z to canxquence of the
APPLICANT UNDECOMPLY WITH ALL NON-POINT Issued by: Date
SOURCEREGULATI
vat Re-roofs
Signature of Appllun omrcmr Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant ar future building accvpanl Roe chandle haxardon material
as defiled by the Cupertino Municipal Code.Chapter 9.17,and me HCalth and Safely
Code,sauna 115324)7
❑ora All roofs shall be inspected prior to any roofing material being installed.
`frf7fh
Will the applicant or future building Occupant use equipment or devices which
DWricIf a roof is installed without first obtaining an inspection,I agree to remove
h haaNnua air con nnimmus u defined by the Bay AeatAir Quality Management all new materials for inspection.
t7 &/'L�_
❑rCa )[No
1 hew mad the hwArdmumamrialsmqulmmcnu under Chapw6.95 of Ne Caiifor.
nu 1L1=1af ode.sa7imu75505.255JJ and 255M.IwWcrsund mm Ode building
ones wt cunt. Y a am at,dict is u my rapomiMlitY m teor,me emoPans of de
tcymmmcnu hick metpriormissuanceofACardream.roeapam. Signature of Applicant Date
-nC of
Owner w mcomae agent Dam All roof coverings to be Class'J¢"or better
' '
CITY OF CUPERTINO
• 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36913023 . 00
DATE ISSUED. . . . . . . : 08/14/2008
RECEIPT #. . . . . . . . . : BS000005792
REFERENCE ID # . . . : 08080106
SITE ADDRESS . . . . . : 10491 PINEVILLE AVE
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : ABHIJIT PHANSE
ADDRESS . . . . . . . . ... : 10491 PINEVILLE AVE
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4522
RECEIVED FROM . . . . : KNIGHT ROOFING SVCS
CONTRACTOR . . . . . . . : DAVID RICE LIC # 27646
COMPANY . . . . . . . . . . : KNIGHT ROOFING SERVICES
ADDRESS . . . . . . . . . . : 42035 OSGOOD RD
CITY/STATE/ZIP . . . : FREMONT, CA 94539
TELEPHONE . . . . . . . . : (510) 438-9077
• EEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
- --------- ------------- ----- -- ---------- --------- ----- ----------
1BSEISMICR VALUATION 12 , 040 . 00 1.30 0 . 00 1 . 30 0 . 00
IREROOFRES SQ FEET 29 . 00 377 . 00 0 . 00 377 . 00 0 . 00
---------- ---------- ---------- - ---
TOTAL PERMIT 378 . 30 0 . 00 378 . 30 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CIIECK 378 . 30 410767
---------------
TOTAL RECEIPT 378.30
VOICE ID DESCRIPTION _ VOICE ID DESCRIPTION
-------- --------------------------- ------ ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
r
CITY OF CUPERTINO
• 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36913023 . 00
DATE ISSUED. . . . . . . : 08/14/2008
RECEIPT #. . . . . . . . . : BS000005792
REFERENCE ID # . 08080106
SITE ADDRESS . . . . . : 10491 PINEVILLE AVE
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : ABHIJIT PHANSE
ADDRESS . . . . . . . . . . : 10491 PINEVILLE AVE
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4522
RECEIVED FROM KNIGHT ROOFING SVCS
CONTRACTOR . . . . . . . : DAVID RICE LIC # 27646
COMPANY . . . . . . . . . . : KNIGHT ROOFING SERVICES
ADDRESS . . . . . . . . . . : 42035 OSGOOD RD
CITY/STATE/ZIP . . . : FREMONT, CA 94539
TELEPHONE . . . . . . . . : (510) 438-9077
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
------- ------------- ---------- ---------- ---------- ---------- ----------
1.BSEISMICR VALUATION 12, 040 . 00 1 . 30 0 . 00 1 . 30 0 . 00
1REROOFRES SQ FEET 29 !00 377 . 00 0 . 00 377. 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 378 .30 0 . 00 378 . 30 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 378. 30 #10767
---------------
TOTAL RECEIPT 378. 30
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
CITY OF CUPERTINO
REROOF
• CUPERTINO PERMIT APPLICATION
APN# o Date:
Building Address: 10 Y9 k Vm ON 1 Q A-4 2,.
Owner's Name: Phone #:
Abh►�; t PhQnse Log) gs°I - �3qo
Contractor: Phone#:(SID 4 'g 1'7
/
1 ni Yti Roam SeANt Q.SZS Fax#: cS t 3g '0Coo�
Cupertino Business License #: Contractor License #:
'34410K
Type of Roof Covering:
Existing: Proposed:
u Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles pt( Asphalt Shingles
34 Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings I ❑ Provide I.C.B.O. Report#
A To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description: Te&,C p4 8)102 VCQ n.-:wst0.� sh o fth�n q ,
�ns1a.0 cius-sA .Co)r.gasl-tion
Residential Commercial Lj
Fire Zone: Yes Lj No Confirmed with Planning Dept. if
there are any restrictions: ❑
Valuation: /oZ) Y'b40 �c�
I HaveeaUnd�erstand and Will Comply with Cupertino's Tear-Off Policy:
Signature
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
• Telephone: (408)777-3228
Fax: (408)777-3333
Building Department
artment
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 paid 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: Ajloll� Phan"-,2
Job Site Address: I ba-q l Pinp\ 1\e .dA& P
Roofing Company Name: K n I Qhk Q Oo�An G �CSLS
Applicant's Signature: Date:3 140?
Greg Casteel
Building Official
Revised 11/2/04
CITY OF CUPERTINO
REROOF
•CUPER Ivo FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1RER00FCOM Re-roof Commercial B 1COMMLROOF
1BSEISMICO Seismic Commercial B
Z � 1REROOFRES Re-roof Residential B 1SFDWLR00F
1BSEISMICRE Seismic Residential B
1REROOFMRES Re-roof Multi-Family B 1MFDWLROOF
1BSEISMICRE Seismic Residential B
1BUSLIC ' Business License B
•
Community Development
10300 Torre Avenue
I,aw,
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
OCUPEkTINO
Building Department
JO! ADDRESS: e v` t� k PERMIT
OWNER'SNAME: ARglTrr eFIANC67 PHONE # S0-q&,?jo77
GENERAL CONTRACTOR: ' Nt p 4-r cn/c, FAX # 57o- Y3tP--(Xo t{
I am not using any subcontractors: �� li7Y-aLf-
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
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