08100070CITY OF CUPERTINO�-,.a'"-a
Btj"INE DIVs1ON' PERNIIT
*, QN%T= dt'6RkINFQRMATIIQN� r
BUILDING ADDRESS:
PERMIT NO.
10881 S BLANEY AVE
DINYARI INCORPORATED
08100070
OWNER'S NAME:
PERMIT ISSUE DATE
STEVE CASERZA
500 PHELAN AVE
10/14/2008
NE:
SANITARY NO. CONTROL NO.
(408)289-5400
ARCHf1ECf/ENGINEER:
-
BUILDING PERMIT INFO
BLDG EIECf PLUMB MECH
LICENSED CONTRACTIDR'S DECLARATIOv
lob Description
,¢.eby affirm that lam licensed under rovlsions of Cha ter 9 (rommenein g
with Sodm 70fo)clD]vmon 3ofthe Business and professions Cosh. and my licenseis
RE-RF CLSA 189SQ OVRLY EXT RF W/45-MIL WHITE THCKin '
deffm.,�j(,e
a Slr(.1➢yW
o
Lienm Lk.Y
av
THEMOPLSTIC TPO MEMBRN BY CARLISLE SYNTEC
Dam �D/ contractor ill^ rm
ARCHITECTS DECLARATION
I understand my Plans shall W used as Public records
Licensed Pmfmssional
OWNER-BUILDER DECLARATION
I hereby vRrm that I am "Ohopt from it. Contrmofs License Law for the
following ¢anon. (Section NO 13, Business and ProfeNiuns Cade: Any city or county
which requires a permit or cmmnm4 she. improv. dcred W, Or repair any Structure
prior to its issuance. also requires the applicant for such Permit to file a signed statement
than he is licensed pursuant to the provieons of the Contractor', U.. U.(Chapter 9
Sq. Ft. Floor Area
Valuation
(commencing with Section 7000) of Division 3 of the Business Shut Profusions Code) or
$33208 .
that he is exempt themrrom and the basis for time e0cgcd exemption. Any v(olelan of
pp Number
3 6 9 3 4 0 5 2
- Occupancy Type
Section 7031.5 by any appliant fm a Permit ubjecu the aPIrkart to a civil Pcoslty of
not mom man fire hundred "Ran (gsoo).
❑ 1. u swear of dm pmputy, m mY emPloym tout wages u me'vule campewdm,
Required Inspections
mil da the wok and the sWemR la nalNmnded m nBCmd for Nle (See.71344. BYLnn(a
Add Professions Code: The Comdctofs License Law does rot apply to an owner or
progeny .1m builds or improv, thdcon, and who does such work hivuelf o through his
own employees• provided tiatuch improw:menu art not intended orolfcred fm Nle. If.
bower. the building or improvment I. mid widen one year ofeempleaon, the owner-
builder will ham the bmdnn of poring mat he did not bald or improve for purpou of
Nle.).
Q 1. as nano of tic property. am exclusively, contracting with limned cormuaeton to
consmcl the prgnct (Sec. 7014. Busidess and Professions code:) The Corractors U.
eco m Law does not apply to an mou of property who builds or improv merman• tad,
who contracts for soh projects with a contrtabods) licensed Formed to the Commo's
Liceme Law.
❑ lamescmP1.duSee .BAPcfmthisrtasm
Own. Dam
WORKERS COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following decleradons:
hav me Wll maims], a Certificate ofeomenl to self-Insure for WoAer'sComper-
radon• as provided for by Schon 3700 of the labor Code, for the performance of the
wok for which this Permit is Oman.
1 ban and will maintain Workse. Compensation Inswnmtt. as mquird by Section
3700 M the labor Code. fear the performance of the wok forwbich this permit is ihued
My Workerrls Compensmon Inunnce anion and Policy number am:
'
t}
Cartier. lvNOf(fh vhwA(.(�(3, Policy NO.: 3�(00";Iloq—KI
CERIIFl�OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(ThisscNma need ml he complemd irons pemitls for one hundred dodars ($10(f)
or less)
1 ocrol that in mm penformomce or the work for which this Permit is issued. I shill not
employ any nomad In any m=mrw N An become subject to the Worl{cn Gomp.Whon
Lave or California. Dam
Appicun
NOTICE TO APPLICANT.- If. ,fur making this Certificate of Esemprion. you should
become ¢inject to e the Won a CmensiNebor
npt m prorralons of LaCode, you muss
fawith comply with Such provisions or mu permit shall be domed mated.
M
]
cONSf ucnoN LENDING AGENCY
I hereby affirm con mere is • construction lending agency for the performance of
the work for which this pcmut is memd (Sec. 3097. Civ. C.)
Leddeh NShm
1
Lendda Address
i 1 cen]fy Nat I hav mud this applicad. and sate this use earn intennadm IS
'
' comm 1 agree mo comply wion all city and county onlinanm and sora laws relating to
Wilding consuucdon. and hereby authorise rtprtaenuuv of this city to motor upon the
.
abon-mcruvomd property for inspection purposes.
j
(We) agree to an, indemnify and keep harmless lin City of Cupertino against
] Ilabllltles,judgmena.ea,a NdexpemN which may In my way mea agalml Nld Chy
inconsequencoofthegretingafthispermit.
l'
q APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT
Issued by: Date
SOURCE REGUTIO
Re-roofs
Type of Roof
v � /° /
Sigwurt of Appli -trmtor monH DOU ATERIALS DISCLOSURE
Wlllthr or alous al
_
Mureip[Cgmcvpanlsmse r9.i2. ditHndle
as deRned ndS&cty
the Cupertino MurciW I COM. Chapter 9.11 and tle Hnith utl Safety
Cupunot
Code. Dyes:sslz(.)7
Section
❑Y. sutno
All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building Occupant use equipment m devices which
If a roof is installed ry}thout first obtaining an inspection, I agree to remove
Wed.. air icoumimmas as defined by the Bay Ara An QualilY Maragemed
all new materials O TOS ct10
.m7
❑Yu WNm
I havrealtheha wsmmeriabrequimmenuunder Chapw6.95ofthc Califm
/L�/O�
nix HealmhSafctyCode,S//ovau 25505.25533out7S536.l undersand thrllthe Wilding(/
lD
dos Out comnlly a WNL II is my R,Podlblllty m noury, me 0.TupNl of the
d�
rmgmimmm/�j dor to ig<nan. Ora cwBcam OFO copy f�
Signature/of'Aoicant Date
/
A roof coverings to be Class 'n" or better
"coda Dao
ownmr g cm
o6a6t
• 2 ITEMS OF 2
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN .......... 36934052.00
DATE ISSUED.......: 10/14/2008
RECEIPT #.........: BS000006336
REFERENCE ID # ...: 08100070
SITE ADDRESS .....: 10881 S BLANEY AVE
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OWNER ............: STEVE CASERZA
ADDRESS ..........: 10881 S BLANEY AVE
CITY/STATE/ZIP ...: CUPERTINO, CA 95014
OPERATOR: patg
COPY # : 1
RECEIVED FROM ....: MARTIN 0 URETA
CONTRACTOR .......: FARBOD DINYARI LIC # 24367
COMPANY ..........: DINYARI INCORPORATED
ADDRESS ..........: 500 PHELAN AVE
CITY/STATE/ZIP ...: SAN JOSE, CA 95112
TELEPHONE ........: (408)289-5400
• FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL
-------------------------------------------------------------------------
1BSEISMICR VALUATION 33,208.00 3.40 0.00 3.40 0.00
1REROOFRES SQ FEET 189.00 2457.00 0.00 2457.00 0.00
• lIlmnl=Wxlll# isAlll1w_A0=Wxlllfl
METHOD OF PAYMENT
-----------------
CREDIT CARD
CREDIT CARD
CREDIT CARD
TOTAL RECEIPT
AMOUNT
1,000.00
730.20
730.20
---------------
2,460.40
VOICE ID DESCRIPTION
-------- ----------------------------
601 ROOF TEAR OFF
604 ROOF IN -PROGRESS
r 1
U
REFERENCE NUMBER
--------------------
VISA
VS
VSA
VOICE IO DESCRIPTION
-------- ----------------------------
602 ROOF PLYWOOD NAIL
605 FINAL REROOF
Ll
•
•
SO( -
CITY OF
CUPERTINO
CITY OF-CUPERTINO
REROOF
PERMIT APPLICATION
APN #.y 2
Building Address:
10881 S alone P}ve cu no
G} 06004
Owner's Name:
Phone #:
S+"e. CQ5er--q
408 --2.55 - t-11io 3
Contractor: (S00 Phelan ke
Phone#: 408_2%9_Sq=
D11(Ipm TYIG SpSe �(/I- 9Sll2)
Fax#: 40S-2$9-SS910
Cupertino Business License #:
Contractor License #:
2y lob-
Slel�Sby
Type of Roof Covering:
�p
y/�
Existing: l J " �' `
Proposed:
❑ Built -Up Roof
❑ Built -Up roof
❑ Asphalt Shingles
❑ Asphalt Shingles
❑ Wood Shakes
❑ Wood Shakes
❑ Wood Shingles
❑ Wood Shingles
Other (Specify) Tga- —
x Other (Specify) yS _Mil ►PO
Number of existing coveringssii
❑ Provide JAB$ -Report # l:Sp, -1403
❑ ToT ved
Provide Mfgr. Installation Specs.
'nN -7l K S%Xt-MW f_ 4 -
Job Description: 431, .M 18,905
"CODI Izoof-„
Ovslcq e)nsih ►w -f- Wlklk 4S—n-61. WinAp
b C.w ; s
' Irl A.
Residential ❑
Commercial
Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if
Green Building Checklist & attach it to the application
or if there are any restrictions: ❑
applicable, include in plan set & the sheet index.
Valuation: 33, 20`a•OO
I Have Read, Understand and Will Comply with Cupertino's Tear-6�ff olicy:
Revised 6/16/08