05120143 (2) CITY OF CUPERTINO +'
BUILDING DIVISION PERMIT CONTRACTQR INFORMATION
BUILDING ADDRESS: PERMIT NOQ 512 014 3
1040 RAINBOW DR
OWNER'S NAME: PERMIT ISSUE DATE
JATIN PATEL 12/23/2005
NE: SANITARY NO. CONTROL NO,
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
uOp LICENSED CONTRd DECLARATION
rChap
U I booby affirm Net 1 am licenced under and
Pror ssofsCodc, 9(commencing Job Description
with Section]0(IU)ofDivixion Sof the Business and Profcuiom Cgdc.end my license is
n�n in fullformandaffea /.� REMOVE 1 LAYER OF SHAKE AND INSTALL 37 SQUARE F
�? Licert�q%y Lie.• w
Dau 1l oZ37—S Conmemr OF 50 YR GRAND SEQUOIA COMPOSITION
ARCHITECTS OEC ATIOf
¢ U I understand my plans shall be used an public recnrds GUTTER WORKS PAID FOR B/L 12/23/05
a
3 C 1 Licensed Professional
S OWNER-BUILDER DECLARATION
ey 1 hereby.(firm Nal 1 am1. exempt from the Contractor's Eleoma Law for rW
20 following mason.(Smtiort co L3.Buiness and w.demob Code:Any city or s cwnty
$ which uyuiusae.And to reors;theppcgimprov,h Permits nr repair any cuuaure
—E< prim m its i licensed
pursuant
reports;to do,the applicant for sucContractors
m fele a signed suumcm
ESG (commthat he encing WJpSectio7")ofvisionsg On of the
mrutodnicenuLaw
onsCru(Chapter9 Sq.Ft. Floor Area Valuation
yH$ (commenexereitthereion]000)Ala Inumonrofthcciped uAnd Profeuiens1.6,.or $10732
Nat W k n1.5 b therefrom and Cu per for the alleged exemption Any violation of
Section]031.5 by any red dont for a permit subjects dm applicant m•civil penalty of APN Number Occupancy
not moo Nan five hundred dollars(5500). p y Type
I,u owner of the pmpmy,a mY employees with wgu u Cuv uk compenation36626e,
will do the work,and the structum is not intended or offered for sale(Sec.7W.Business aV
and Pronasions Cade:TW Contractors Licerue law docs not apply k an owner or Required I pecti$ns�
property who Wildsm improves therms,and whodoes such work himselforthrough his lq
awn employees.provided that such improvements art not intended dreamed for sie.If, A
however,the building or improvement is sold within arc)ear of completion,the owmr- ry�
builder will have the burden of proving that he did not Wild or improw far purpose of
_ vv
❑1,u owmr of the property,,B onus and contracting with)lamed ntacto's i. (/aa�s
ceng,La the project(Sec.]ad,Business and Profusions Code:)The vesn hereon. rad
who clawdorsnotapply man ownerorpropenYwW Wildsor improve thereon.and
who se Laces for such projects with a cantrutor(s)licensed pursuant ro the Cansnnara
[']Bion Law. V
❑1 am exempt under Sec. ,B&P C(or this reason
Owner Data
WORKERS COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
1 haw and will maintain a Cestifrcateof Consent u self-insure for Worker's Compere
cation,As provided for by Scotian 37W of the LAW,Code,for the performance or the
work for which this permit is intend.
❑1 have and will maintain WmkeYs Compensation Insurance,As required by Section
3700 of the Labor Cade,fm On performance or the work for which this permit is issued.
My Works/vTss�11Compensation Insurance carrier and Polity number au:
Cartier: ) urk 1`� 'b PolicYNor: s ZS/_ZJ-25
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(nds section need not W cimpleud if the permit Is forage hundred dollars(SIM)
or less)
1 comfy that in the performance of Cu work for which this permit is issued,I shall not
employ any person in any maggot so az W Income subject to the Worleri Compensation
Laws of California.Dau
Applicant
NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should
become subject to On Worker's Compensation provisions of the labor Cede,you must
.J z, forthwith cmrPIY with web Provisions or this permit shall be domed invoked.
z O CONSTRUCTION LENDING AGENCY
[•+� I hereby affirm Nat thou is a construction lending agency for the performance of
!Y the work fur which the permit is issued(Sec.3097.Civ.C.)
�W A Underi Name
z )angels Address
V C) I comfy that I have read this application and sum Nu the above information is
U.t" Conor.I agree W comply with all city and county ordinances and sum laws relating to,
�(') building construction,and hereby m000re represenutivu of this city to order upon the
ahovcmemioned property for inspection purports.
F 0.. (We)agree to save,indemnil and keep harmless be City of Cupertino against
h liabilities.judgmcnts,costsan which may any way.come against. City
U z in eoncequenec gr the gr gof is per
„fi�tt
^ APPLICANT UNO AN AND WILL COMPLY WITH ALL NON-POINT Issued by: Date W1'at�-23
SOURCE REG ONS.
'
Signature a! pp¢ onuacmr Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Dau Type of Roof
Will Ne applicant or future Wilding occupant more or handle hevardous material
u defined by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
Cade,Section 25532(a)?
❑res ON.
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtainingan inspection,I agree to remove
Will the applicant or future building occupant use equipment or devices which P
it harmdous air conuminanu u defined by ran,Bay Area Air Quality Management all new materials for inspection.
trim?
❑Yes 0N
I have read the hmard us els requirements under Chapter 6.95 of the Califor.
nu H.h1b&Safety Code. Sf15,25533 and 23534,1uMemaM Naz ifdn Wilding
Jots rpt currently ha arta s my responsibility p notify Cu aeupant of the
reyuimmcnu whin mbeme d u issunnce or a Certificate of Oce porter. Signature of Applicant Date
/2 Z3 CS
Owner authn reda D,te 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
UPERTINO
Building De artment
JOB ADDRESS: PERMIT #
OWNER'S NAME: e PHONE 66
GENERAL CONTRACTOR:G „k o FAX # S/o- 8f7 - 3955
I am not using any subcontractors: lClz-W
ignature 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
10300 Torre Avenue
CITY()F Telephone: (408)777-3228
U P E IST I N O 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.
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:
Job Site Address: 2l0YJ Rct.',vn b, lcy'.
Roofing Company Name: G1 vk o v S
Applicant's Signature: Date: _L Zi S
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINO os) ao►�3
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN # 3��- ate_ O o'15 Date: 12-
Building Address: p
Owner's Name: J� Phone#:
�-; e e(oLV 3 -IS(>
Contractor: Phone#: License#:
Wqs Inc 510-Vtf7 -6c)&V `ll Cl
Contact: 11 Phone#: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up RoofL3Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
�?S Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) 5 Other(Specify)Com f SL; gt,%
Number of existing coverings C1 Provide I.C.B.O.Report#
❑ To be Removed El Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑
JrI�o�b Description:
evhovI lozq O� 5k,kp c�, lr,g 3Y, Co.,. 6 'o
Residential _C35' Commercial ❑
Fire Zone: Yes P No ❑ Confirmed with Planning Dept. if
there are any restrictions: LJ
C�pst of Project: Type of Construction: Occupancy�group:
aYto, 731- ge- kooP I
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