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06060068 (2) CITY OF CUPERTINOF BUILDINC.DIVISION PERMIT ..00NTRr1CTOR INFORMATION Vis, BUILDING ADDRESS: , ABOVE ALL ROOFING PERMIT No.06060068 19928 TWILIGHT CT OWNER'SNAME: PERMIT L%UE GATE MANISHA PURANIK 700 NORTHRUP ST 06/08/2006 E: SANITARY NO. CONTROL NO. (408) 292-4188 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH p o LICENSED CONTRACTOR'S DECLARATION mE I hereby affirm Jut 1 am lixcnced under provisions or Chapter 9(mmmexing `��'f r� p .�kJoPPPb frDeescription �ir� with Scnion7IXIU)afDivisianQ3ofthe Business and Pra(ex iom Code,and mylicens is (�f ry10, g7 04 in full forc7e�and�effi tPf`��p 1'�h'W9yNl(lT�/•/ �'�ffa��f"'��� �„ -� t TEAR OFF IN 6 B 30LB FELT, 50 YEAR Iqz Li"nm Lie.g CLASS A COM k-� Dom Cantracmr ARCHITECTS as public Ano i a I uMmu cnJ my plans shall he used as public rtmrds JUN ZZ-2006 tyU :Wt; Licensed Pmfcssional g OWNER-BUILDER DECLARATION r� q a, P I hcroby alirre Nal I".exempt from site contractors License Law for the t1,aalgS:)(ll1)1s CtNgtj IlLrlllb IIILLLJJJ--- //i .❑O following reason.(Section 1031.5.Business and mon,&ons Code:Any city s county 1.9 which require a permit ro construct alcor.improve,dmnlhsh.m rtpair any structure -iy prior ta its issuance.also requires the applicant for such permit to file a signed statement 6 that be is licensed pursuant to the provisions ofthe Contractor's LicenWLaw Chapter 9 Sq.Ft. Floor Area Value` 4000 iii-C (commencing with Section 710W)of Division 3 of the Business and Professioru Code)., $ Out he is exempt themfmm atM the basis for On alleged exemption.Any violation of Section 7031.5 by any applicant far a Permit subjects Jm applicam in a civil penalty of Number Occupancy Type not mare d mr five boMmd dollen(551X)l 316 310 31 . 00 0 1,u ownsr of Ile property,or my employcn with wagn u Nebsolc compeuadon, will ed thcwork.andthc he Comtsnms License Law ed s not apply in an Business Required Inspections and Property he u Cade:The Committees License law den not apply in,t owner of q p pmpcnywhobuilds provided improvech Imp,andwho daaswhwmkhimselrar through hu awnrve,On buiing., thmsnehimprorcmentsare not intendedocoRemA forsale.Ir however,Nebuildingorden f nvatusold within man year ofmproeforNeownv- buildr will Wve the burden of proving Jut he did rot build w improve for purynse Or ' Sate.). i]1,as owner of the property w coclusively conurm ing with licensed mmruwrs to construct the project(See.7014,Business and Professions Cede:)The Com uwrs U. cense law don net apply in an owns,of property be builds or improves thereon,and. who contracts for such projects with a cemossor(s)licensed patterns,to the Contractors Llcens Law. ❑lamncmptundcrsv. ,Bh PCfwthisrtamn Owner Dau WORKERS COMPENSATION DECLARATION 1 hereby of irre under pecalty of perjury one of the following declarations: 1 ham and will maintain a CeniOeam of Consent to self-iuum for Workw'sCompcn- soom.u provided for by Section 37M of the Utime Code.for the pedo..of Use work for which Nu permit is issued. ❑1 have and will maintain Workers Compensation Insa .,as required by Semon 3700 of de Labour Cod,far the pcd..of Oc work for which this permit u issued. ' My War s ampfew—bo/II.e...a or and Policy number am: t Cartier. s T'C. n\ t//'/� Polity No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section..door be c0mplered if on,permit is farmer hundred dollen(SIM) or less) I cenifv Nat in the perfarmancc of dm warn for which this Permit is issued.I shall not employ anyperwn in try mennerso as m become subject m the Worlmrs'Compensation Laws of California.Dam Applicant NOTICE TO APPLICANT:If.are,making this Certificate of Eaempti m.you should become subject m On Workw's Compensation provisions of the Labor Code you most .,z forthwith comply wish such provisions or this permit shall W domed revoked. OCONSTRUCTION LENDING AGENCY f" I hereby affirm nor ft.is.mnstroction lending agency fw the pcsfwmarec of aOn woris k for which this permit is issued(Sec.3097,Civ.C.) CQ lora Name . z lentils Addreas U0 I certify Nat I have read this applmatium and sum Jul tM above information is 1, f'" coronet.1 agree w comply with all city and county ordinances and sum laws relating to OC) building construction.and hereby autherive re,creutives of this city to enter upon the W allow-mentioned property for inspection purposes. CL (We)agree to sarc,indemnify and keep harmless the City of CupeNno against tF—t r/1 liabilitamjudgmcnts.costs and apenees which may in try way scans against said City ras (J z =H�DOUS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date i j �ZL S Re-roofs MATERIALS DISCLOSURE 'Do./ Type of Roof Will the appliant 0r future Wilding oaupwt Lae or handle hsrard0u material u defined by one Cupertino Municipal Cadc,Chapter 9.12,end the Health and Safety Code,Seen..25532(x)? /rYs{n All roofs shall be inspected prior to any roofing material being installed. T Will the, scant or future bei din occupant cox If a roof is installed without first obtainingan inspection,I agree to remove Ire C p Wuipmept or devices which g emit heyallou air conuminanu u ned by she Bay Am Air Quality Management all n materials for inspection. District? I-]Y. 11m.rewlthehoa rw materials reyvimments under Chapmrh.95 ofthe Califon doesnitur Safety Cade,pawns at Ili myrspo25534.1 tM bodily tkmifthebuilding /' Jon not currently M1avc a tenons Nat Iles my responsibility m notify Um occupant of the 6 nts mbcetprior uancfaCrifmofOca Oryate pplcaDat au orcrcda cnmumAll roof coverings to be Class"B"or better ,.w. Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 WUPERTINO Building Department JOB ADDRESS: PERMIT# l�lQ2� �-w ` C / , 1 1,-)�5 a aoc� OWNER'S NAME: ,� �` /l/f PHONE A qeVG 6 2 GENERAL CONTRACTOR: e AX # I am not using any subcontractors: G ©� 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 f • f Owner/Contrctor Signature 6ate CITY OF CUPERTINO !m 1 of 1 PERMIT RECEIPT OPERATOR: amyw COPY # 2 Sec : Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 31631031 . 00 DATE ISSUED. . . . . . . : 06/08/2006 RECEIPT # . . . . . . . . . : 34752 REFERENCE ID # . . . : 06060068 SITE ADDRESS . . . . . : 19928 TWILIGHT CT SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : MANISHA PURANIK ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : , 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 �EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ------ --- ---------- ---------- ---------- BPERMFEE VALUATION 12, 000 . 00 191 . 16 0 . 00 191 . 16 0 . 00 BSEISMICRE VALUATION 12, 000 . 00 1. 20 0 . 00 1 . 20 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 192 . 36 0 . 00 192 . 36 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ ------------------ CHECK 192 . 36 12366 TOTAL RECEIPT 192 . 36 CITY OF CUPERTINO4 REROOF CITY• CUPEI�TINO PERMIT APPLICATION FORM APN# 31 l.Y/ n 2I Date: tJ BuiAdi g �es� _ C Ow er's Nam % �A h,0 f-cznC actor: License#: C act: d. one • Cupertino Business License#: ahh s' .S D- ype of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles ❑ Asphalt Shingles / Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other(Specify) 91 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: Jqb Descrip ' ar %F i� l /d C�5 �D -tn So r. Residential Commerci 1 ❑ Fire Zone: Yes ❑ No Confirmed with Planning Det. if there are nnv restrictions: Ll Cost of Project: Type of Const tion: Occupancy group: r v�© Qty. if A licable Fee ID Fee Description Fee Group BPERMFEE Bldg Permit Fees BUILDING BENERGY EnerRv BUILDING BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING