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CITY OF CUPERTINO
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BUILDING DIVISION pERiy(jT'
_kCONCRAC,TOR`�I1Y.FRMAT701V
BUILDING ADDRESS:
PERMIT NO.
1
OWNER'S NAME:
PERMIT ISSUE DATE
A CONTROL NO.
ARCHITEC (eNGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
Job Description
1 Malty affim that I w limnsxd under provtdmu of Chapter, 9 (Comms ming
Busimss fiofnmrs Code.andmylice�is
s-'7-�y
RE -RF RMV SHK SHNGLS PLC W 7/16" OSB 30YR GAF/ELK
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Gmmctar
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COMP CLS A 41SQ- QUALITY FIRST HOME IMPRVMENT INC
CI'S DECLARATION
daspublic rec.ds
PD FOR BUS LIC
rsdo
NER-BUILDER DECLARATION
1 krtbo a0im that 1 exempt from d Consumes Law for um
1. r onsCo: My
following maven. (Section 701.5. IS, Buiocu and Cour: My city m rounry
va. daroow
with require pmmit an construct, atmL improve, dcmal W, ore sir any smcaure
permit m 011 a signed sWemrnl
prim m its n also requima tk applicant a
iepand
Sq. Ft. Floor Area
Valuation
l p the Contractor
pScWan m We provisions of the Conuacmr'e License Law (Chapmr9
(commencing withherefro 7000) of Division J of tic Business, d Code) of
(commencing wi
Any
ecaam on. vi
That k u eumpt Ikmfmm and the bark for tk atkgcd essmpUoa Any violation of
'
APN Number
Occupancy Type
Sectim 7011.5 by an,r applicant far apmark wbjCCU Wn applicant m a Civil pmuky of
not morn Wan five hutalred dollars (S500).
32643032.00
❑ 4 25 owntrr of the praputy,. mY wploycn with wages u tkir sole coat romauon.
Required Inspections
will do the work and tan, structure u not imemind.affered for said (Sec. 1044, Bushman
and Prornstiav Code Tic Conuamars Lbome Law don ma apply a an ow. of
progeny who builds m improwa tkreon, and who docs such work himselfor although his
awn emplaycn, provided that such imprnvemenes are not transect aro@red fmsaln lL
hwewr. We building or imprnwmmt is mid within am war of CamPlomn. We owner -
builder will haw the buNen of proving that he did not Mid or improve for puryme of
'
sal.j.
❑ 1. u Daum of rk yrnpeny. w m bsivnly com mi, with licensed commands m
mowaruca the projca (Sec. 7061. Bud. and Pofessiom Code:) M Cmtracam's Li -
Crowe law does r. apply m an war of property who builds or impmm Wersm, and,
who ronmcts fm such projects with a conmctot(s) licensed puramnt to We CantranMs
Licmve Law.
❑ lamesempaundm See .BAPCrmilthteamn
Owns Dam
WORKERS COMPENSATION DECLARATION
I hereby affirm ander mmily of perjury ore of Ik following declantiow
haw and will maintain a Cenifmam of Consent m self -insure f. WarlessCoupon-
lim. as provided far by section 37W of Ne Labor Code. far the perfumanon of Ne
wart for which this permit is isocd.
haw and will maintain Worker's Comp msadon lowumnCr, u required by Section
J of the labor Coda, f. arm puformame of the wart forwhich this permit k imued.
'
My Wcrjy�l� Coupe /w/�1d1m1 InvtnoaLy��.vaM Policy nuclaram:
Grtier, LlLi 70 1.W Z 1l all z1CY No.: '14 2- 707'3
CERTIFICATE OF EXEMPr10N FROM WORKERS'
COMPENSATION INSURANCE
(ThissacUon mN makcmnplemd if flue permit is furore hundred dollars ($100)
nr kss)
1 certify that in WC p.romame or We work for which this permit Is [sand. I shill no,
coploy any perms in any manmr so as a koome subject m tk Wortrn' Compeowetion
Laws of California Dam
Applicw
NOTICE TO APPLICANT: If, afar making this Certificate of Exemption. you should
bocome subject m the WorWs Compensation provisions of M Labor Code you most
comply with such provisions or this permit shall k dccmed revoked.
CONSTRUCTION LENDING AGENCY
Ikreby afTim that there k a comarman kndingagenc, fnr the rmfornaan of
the work for which this permit k im cd (Sec. 3097. Civ. C)
LendCs Nem.
Lc=Address
-
I Crnify that 1 Mw and thk application oral soon that tk abow information is
comLt 1 agrm m comply with all city and county Ordinances and sum laws muting m
Wilding Construction, and hereby mahmire mpresenuuves of Nis city to Cnmr upon We
show -normo. s property for inspection purposes
(We) agree to saw, indemnify and Feep harmless the City of Cupenina against
k= harmlessCityof Caftan
liabiliti(We)gamto emu andexpcmend any std Cry
ranting a( iLWILL
COMPLY WITH ALL NON- OIssued
by: Date
�CmulacincnU
Re -roofs
neturn of ApplianVConser a
HAZA OUS MATERIALS DISCLOSURE
Type of Roof
Will We applicant or fuarn building aceupant sac Or b mik haaAms mamriat
-
as deBmd by the Cuparfirm Municipal Code, Charm, 9.1], and the Hn1W aM Safety
Cade. Sskm 25532(07
All roofs shall be inspected prior to any roofing material being installed.
❑Yes
If a roof is installed without firs[ obtaining an inspection, I agree to remove
Will the applicant or fuum building occupant use equipment or devioa which
hmardom air cmantrinants as defined by We Bay Arta Air Quality Management
all new materials for inspect
anict7
❑Yes Ptlu
I have haudows andsools nyuirememsumkr C'Aaper6,95afdeCahl.-
maHcalth m 'au ie . and25534.I mcaCmdaboifde building
. '""1 2
clues ret ren w an at' mL ponibiliry m ratify We occupant of un
G J
.qui y t 'rmi 6i11LCaf.CCnlRmmof(kNp
%ignature n Date
l'. a
All roof coverings to be Class 'j�" Orbetter
wncr or wWufiacd D
�3 ITEMS OF 3
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN .......... 32643032.00
DATE ISSUED.......: 12/03/2008
RECEIPT #.........: BS000006740
REFERENCE ID # ...: 08120031
SITE ADDRESS .....: 10690 CASTINE AVE
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OPERATOR: patg
COPY # : 1
OWNER ............: PRADEEP BHOJ
ADDRESS ..........: 10690 CASTINE AVE
CITY/STATE/ZIP ...: CUPERTINO CA, 95014-1313
RECEIVED FROM ....: QUALITY FIRST HOME
CONTRACTOR .......: TBD - TO BE DETERMINED LIC # 00096
COMPANY ..........: TBD - TO BE DETERMINED
ADDRESS ..........:
CITY/STATE/ZIP ....
TELEPHONE ........:
• FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL
1BSEISMICR VALUATION 30,669.00 3.10 0.00 3.10 0.00
1BUSLIC FLAT RATE 1.00 114.00 0.00 114.00 0.00
1REROOFRES SQ FEET 41.00 533.00 0.00 533.00 0.00
TOTAL PERMIT : 650.10 0.00 650.10 0.00
METHOD OF PAYMENT
-----------------
CHECK
TOTAL RECEIPT :
AMOUNT
---------------
650.10
---------------
650.10
VOICE ID DESCRIPTION
-------- ----------------------------
601 ROOF TEAR OFF
604 ROOF IN -PROGRESS
0
REFERENCE NUMBER
--------------------
#9129
VOICE ID DESCRIPTION
- ----------------------------
602
------ -------- -
602 ROOF PLYWOOD NAIL
605 FINAL REROOF
Community Development Department
Building Division
City of Cupertino
• 10300 Torre Avenue
Telephone: (408) 777-3228
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 2007 IBC Standards
and manufacturers specifications on re -roofing. All roofs are Class "A" per Cupertino
municipal code 16.04.080.
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 Naz
job Site Address:
Roofing Company
Applicant's Signat
• Greg Casteel
Building Official
Revised 07/30/08
CITY OF CUPERTINO d p (z 003 /
REROOF
PERMIT APPLICATION
APN #
Ll -3.,-), a (3
Date:
Building Address:
16Pfv Casnv4 Ave
-
Owner's Name:Trr�jeee Bbw,�
Phone #&oy)2y2,-2_3s(,
10!940 CAsflve Ave
Cu^it f,rw cw 7014
Contractor: Qa&(jr H,aSr f o e
Phone #: (4078P- Z9z!
%Gb Como4,erte i4ve fl'C
U0M,/ C - 3r&75>
Fax #:
Cupertino Business License #:
Contractor License #:
S7 772
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
❑ Provide Mfgr. Installation Specs.
Job Description: per,,,a✓C 151toybej,
Q,ePlaee G,)/*c -71(t, oSb, .3oytt (pp e-Lh
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: P6 f
Comply with Cupertino's Tear -Off Policy:
Revised 6/16/08
eDd
CI OF
CUPEkTINO
CITY OF CUPERTINO
REROOF
FEE SCHEDULE •
Number of
Squares
Fee ID
Fee Description
Fee
Group
Permit Type
1RER00FC0M
Re -roof Commercial
B
1COMMLROOF
1BSEISMICO
Seismic Commercial
B
Y/
1RER00FRES '
Re -roof Residential
B
1SFDWLR00F
l
1BSEISMICRE
Seismic Residential
B
1REROOFMRES
Re -roof Multi -Family
B
1MFDWLROOF
1BSEISMICRE
Seismic Residential
B
1BUSLIC
Business License
B
Revised 6/16/08