06020132 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT ; CONTRACTOR INFORMATION
BUILDING ADDRESS: R J BEAN ROOFING PERMIT NO.0602013
11502 SEVEN SPRINGS LN
OWNER'S NAME: PERMIT ISSUE DATE
SANJAY GUPTA 6355 COTTLE RD 02/22/2006
NE: SANITARY NO, CONTROL NO.
(408) 358-4028
ARCHITECIPENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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X00 LICENSED CONTRACTOR'S DECLARATION Job Description
Y
U 1Wmbyafrifm NalIem ft he Bu underprovivons of mChapmr9my license is P
W with Section]gYJ)of Division Sof the Business and Profrssioas Code,and my license is
n�a inmumreeand lL REROOF--T/O SHAKE, INSTALL SHINGLES
;'q= ucc",rata" -0 �M ' FIX DRYROTT, APPLY 1/2 �(j� B F-,oE
-^o Dam_ _ Contractor ''�11
eS� ARCHITECTS DECLARATIO 40YR. ELK COMP.
e W u I understand my plans shall W used As public records
sA.A.o G Licensed Professional D.
S OWNER-BUILDER DECLARATION M
<y I hereby aRexempt rm Nal I am exemfroa
m the Canuam's License Law AR(or the AR
0 0 fullnwing mason.(Section 7031.5,Business and Professions Code:Any city or county 7
which requires a permit o construct,alar,improve, immulish,or repair any structure
Z i prior H its issuance.Alan requires the applicant for such Permit to rile a signed statement ifts ft..
< Nat heis licensed pursuanuothe prevision offContactursLicense Law(Chapter 9 Sq.Ft.Floor Area I 0
YFG (commencing with Section 7")of Division 3 of NC Business and Professions Code)or �tl ql7 �+,�9000
y e5$ Nat he u exempt t emfrotn And He basis for the alleged eremption.Any violation of a AAA ���777 3r'
Section 7031.5 by Any appli.,for A permit subjects the Applicant o A civil pcnJty of APN Number Occas arc T
not more Nan Five hundred dollars(5500). P Y yPe
0 1,m owner of the pmpcny,or my employcu with wagu m umir sole compenuuon,
will do the work.and the swctua is not immndcd oroRered(ornate(Sec.7064,Business 26652033
and professions Code:The Contractors License Law does trot apply N an owner of Required Inspections
property who builda or improve Hereon.and who does such work himselfor 0umugh his
own employees,provided that such improvements are not invndcd oolfered for Axis.If.
however,One building or improvement is sold within one year of completion,Ne owner.
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
0 h as Owner of He progeny,am exclmiwly contracting with licensed contractors to
construct Ne project(Sec.7044,Business and Profusions Code:)The Contractors Li-
cense Law docs not pply to an owner of property who Wilda or improv thereon.And
who contracts for such projects with a contractor(s)licensed pursuant in the Contractors
License Law.
0r'am exempt under Sec. ,B k P C for this reason
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby affirm under petal ty of perjury one of the following decimations:
I hove and will maintain a Certificate of Consent to self-insure for Workers Compen-
sation,As Provided for by Saturn 3700 of the Labor Code,for ton,performance of the
work for which this permit is issued.
0 1 have And will maintain Workers Compensation Insurance,as required by Section
3700 of NC Labor Code.for He performanee of the work four which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number art:
Cartier. Z:5(Q?�' Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu section reed not be completed if tie Permit is for one hundred dollars(5100)
or max)
I ccnify him in thc perfomtanec of the work for which this permit is issued,1 shall Out
employ any person in anymanna �LpZr?.Yubbcl to the Workcrs Compensation
LAws of califomia,p Z
Applicant If
NOTICE TO APPPL CART:If.after making this Cenificam of EacmPUW.you Huuld
become subject m the workers Compensation provisions of the Labor Code,you muss
.,O fmMwith comply with such provisions or His Permit shall W deemed revoked. -
z y CONSTRUCTION LENDING AGENCY
[-+4 I Wrathy alrirm that there is a construction lendingape cy for the Performance of
G'7 the work for which this permit is issued(Sec.3097,Civ.C.)
[y A Lendcr's Nene '
kL
z Underi Addrecs
7
IJ Q I certify that I have read His application and sum that theabove informationu
ter. building I agar m comply with all airy and county ordinances andrad cum laws relastingg to
0(') abovengcotioned mNrLyWmbyauNorimaprtsenmisrs of this city mcnmr upon the
,tea above-(We)a ed property for dcmnify An Imcp hs.
(Wc)agmc ro ave,indemnify and keep may
in m IW City of see=
against
F'Zt,l inconses.qu consequence
of the Standing ofPcnsecmit. may in any way accrue againslsvd City
C)xZ, A APPLICANT
of the Standing of this permit.
^a APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURC LA NS.
o
G Re-roofs _5� �.
Stgneturc tf icanUContrecm, -Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding occupant store or handle haarduus mamrial
as defined by the Cupertino Municipal Code.Chapter 9.12,and t1m Health and Safety
Schon 25533(4)? All roofs shall be inspected prior to an roofing material beim
❑� H�ty% 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 W,ardrus air conumiwtn as defined by the Bay Area Air Quality Management all new materials for Inspection.
District?
0Ycs �
I have mad He hararduus--'let'requne-AMA a rum,Chapmr 6.95 of the Calimr-
ria HnaW&Sultry Code Sccuonshatiti2MyrespAnd 25534,1 understand thetifNe Wilding
Jou not currently have a censor,Nm it u my responsibility to nosily the occupant of Ne �Zf/Y�-/ �j C��'
mqui nmwhic munbemetprio,missnanamracertifimamofampancy. Signatu of Applicant Date
2'L2-oe
owne o, ornedagent Dom All roof coverings to be Class"B"or better
�..�, - Community Development
�j 10300 Torre Avenue
ry"'�' Cupertino CA 95014
Telephone(408)777-3228
� CITY OF Fax(408)777-3333
UPEI�TINO
Building De artment
JOB ADDRESS:S : PERMIT #
OWNER'S NAME: PHONE #
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors: - 2--ZZ-DL
Signature Date
Please check applicable subcontractors ancom tete the following information:
66 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
Owne ontractor Signature Date
�l
Community Development Department
�,. Building Division
4%1#tt P
_ Ci of Cupertino
10300 Torre Avenue
OCITY OF Telephone: (408)777-3228
UPEkTINO 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. 1
2) In-prFinal gress inspection approval.approval. Z�
3) Final inspection approval.
a) Spark arrester installation. .3
5. If plywood is installed, a plywood nail inspection is required.Z
• 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:: SAW \4Q , ciiwaa
Job Site Address: I (77 d�yAA WA J 'Qvi
nA(j'��
Roofing Company Name:
Applicant's Signature: Date:x-06
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN # �L
Building Address:
11501 S Ql.rn
Owner's Name: ^ Phoile\: I
v1 -51
Conttor: Phone#: License#:
,� �Oo iu Eb- N15 —I S03 D2
Contact: D'�" Phone#: Cupertino Business License#:
Desi o I 0
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles BKAsphalt Shingles
a' Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings�_ ❑ Provide I.C.B.O.Report#
.[Y To be Removed ❑ Provide Mfgr. Installation Specs. r,(�q
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Mob Description:
Residential 12r- I Com'merciar ❑
Fire Zone: Yes, } No ff Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project: T e of Construction: Occupancy gyp:
r
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
3 33
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