07090133 77777 : gi.
777777
CITY OF CUPERTINO
BOILDING DWISION PERMIT
PERMIT NO.
BUILL�T6a. REskALNUT SPRING CT LOS GATOS ROOFING 07090133
l l b / PERMTT ISSUE DATE
OWNER'S NAME:
PARSANNA SRINIVAS P 0 BOA: 1726 09/20/2007
SANITARY NO. CONTROL NO.
)NE:
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: RMV EXTNG SHAKE RF; INSTL BLDG ELECT PLUMB MECH
C, C] O O O
p 0 LICENSED CONTRACTOR'S DECLARATION ___� „,_ _ __ __T__ bola Description
P 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing
U U with Section 7000)of Division 3 of the Business and Professions Code,and my license is
t=y in full force and effect.
Licen —Lam
lass •
p Datc Conlrsc^•-D- S
F ARCHITECTS DECLARATION
i a< I understand my plans shall be used as public records
)yU
m H Licensed Professional
<
OWNER-BUILDER DECLARATION
,�.
I hereby affirm that 1 am exempt from the Contractor's License Law for the
"00 following reason.(Section 7031.5,Business and Professions Code:Any city or county
which requires a permit to construct,alter,improve,demolish,or repair any structure
rn prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation
z a that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 3q.Ft.Floor Area
Z F (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
Q that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not more than five hundred dollars($500).
❑I,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.70",Business Required Inspections
and Professions Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements am not intended or offered for sale.If.
however,the building or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Contractoes U-
cense Law does not apply to an owner of property who builds or improves thereon.and.
who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's
License Law.
❑I am exempt under Sec B&P C for this reason
Owner Date -
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑I have and will maintain a Certificate of Consent to self-insure Car Worker's Compen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Worker's Compensatiipnsurailce carrier and Policy number ar%;
'SteCartier: e Policy No.: a c 0 ao
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars($100)
or less.)
I certify that in the performance of the work for which this permit is issued.I shall not
employ any person in any manner so as to become subject to the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
Z forthwith comply with such provisions or this permit shall be deemed revoked.
Z O CONSTRUCTION LENDING AGENCY
[~.t`A I hereby affirm that there is a construction lending agency for the performance of
a> the work for which this permit is issued(Sec.3097,Civ.C.)
W Q
Lender's Name
Z Lender's Address
U 0 1 certify that I have read this application and state that the above information is
Lt, correct.I agree to comply with all city and county ordinances and state laws relating to
U building construction,and hereby authorise representatives of this city to enter upon the
W above-mentioned property for inspection purposes.
a (We)agree to save,indemnify and keep harmless the City of Cupertino against
liabilities,judgments,costs and expenses which may in any way accrue against said City
U Z in consequence of the granting of this permit. Date
�.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued b):
'-
SOU 'REGULATIONS.
y✓ ze D Re-roofs4
Signatu of Applicant/Comractor Dare Type Of Roof
MATERIALS DISCLOSURE yP
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes CJ No
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
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new r.)aterials for inspection.
District? —�
❑Yes L +cr
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building �O�
does not currently have a tenant.that it is my responsibility to notify the occupant of flit
rcq i nts which must et prior to issuance of a Certificate of Occu ancy. Signatu E;of Applicant Date
All roof coverings to be Class "B" or better
Owner r authorized agent Date
(Lo 7oy o%-3
CITY OF CUPERTINO
CITY OF' REROOF
CUPEkTINO PERMIT APPLICATION FORM
APN# _S� �/ � Date:
Building Address:
Owner's Name: Phone#:
4 r arm/2Sr�n i ves� �?_ 2 - D
Contractor: Phon(.#: 0cy License#:
a� /f& 2IS- 9,399 k60 Y0
Contact: `�-- Phone #: Cupertino Business License#:
sa,177)(!?� .9V 3
Type 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) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report# `
To be Removed ,�J X Provide Mfo-r. nstallation Specs. .S
"IX4 /?OOP olcq s 1/
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
besc ption:
Residential Commercial El
Fire Zone: Yes ❑ No Confirmed with Planning Deft.
there are any restrictions: LLJJ
Cost of Pr t: ��O _� Typeo Cons�Dcti Occupancy group: k
�.-�
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Energy BUILDING
- B3EISMICRE_- _ . ---Sesmic_Fee.Res . - _, __ .B-UILDING-
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
CITY OF CUPERTINO
2 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Bll:: Lot:
APN . . . . . . . . . 36E54118. 00
DATE ISSUED. . . . . . . : 09/20/2007
RECEIPT #. . . . . . . . . : BS000002701
REFERENCE ID # . . . : 07090133
SITE ADDRESS 11E75 WALNUT SPRING CT
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER PARSANNA SRINIVAS
ADDRESS 11675 WALNUT SPRING CT
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : LOS) GATOS ROOFING
CONTRACTOR . . . . . . . : RANDY BROWN LIC # 23481
COMPANY . . . . . . . . . . : LOS) GATOS ROOFING
ADDRESS . . . . . . . . . . : P 0 BOX 1726
CITY/STATE/ZIP . . . : LO.'i GATOS, CA 95031
TELEPHONE . . . . . . . . : (408)298-9399
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- - --------- ---------- ---------- ----
BPERMFEE VALUATION 6, 630. 00 137 .16 0. 00 137 .16 0. 00
BSEISMICRE VALUATION 6, 630. 00 0.70 0. 00 0.70 0. 00
- --------- ---------- ---------- ----------
TOTAL PERMIT 137 .86 0. 00 137 .86 0. 00
Community Development Department
Building Division
g City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
CUPED1 Fax: (408)777-3333
INO
Building" Department
Subject: Re-roofing policy for the City of Cupertino
1. Prior to permit issuance,you must af;ree 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 withou t first obtaining an inspection,
will require the removal of all new material down to the sheathing,
so a proper City inspection can be pe,-formed.
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: - 'V'A/
.. - - - - -- --
Roofing Company Name: �r Q
A plicant's Signature: 4>-e' Date:
Greg teel
Building Official
ReviE ed 1/30/03
Printed c,7 Recycled Paper
Community Development
- 10300 Torre Avenue
�.�
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
CUPEkTINO
Buildi_n De artment
JOB ADDRESS: // � (��/� PERMIT # �
OWNER'S NAME: PHONE # U -54S
GENERAL CONTRACTOR &eC o 5 c. FAX # 93 - 1
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
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 gDat