07060106 CITY OF CUPERTINO ��tt
BUILDING DIVISION PERMIT 4 �����*'
PERMIT NO.
BUILD DD ESS:
� � EPTEMBER DR T D ROOFING 07060106
PERMIT ISSUE DATE
OWNER'S NAME:
ASHOK KUMAR 675 TULLY RD 06/13/2007
SANITARY NO. CONTROL NO.
NE:
(408) 89 -8872
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
p p LICENSED CONTRACTOR'S DECLARATION Job Description
'm P 1 hercb affirm that I am licensed under provisions of Chapter 9(commencing
'UF y EROOF—F-EMOVE WOOD SHAKE, INSTALL 50 YR PRESIDENT
Z� with Section 7000)of DivisionJ�i¢e�usirucss and Profe 'u ode.and my license is
e o. in full force an e
; z LicenscC S Lic.M 30 LB FELT 20 SQUARES.
pato Contractor
Laa A CHITECI'S DECLARATI N
i a a I understand my plans shall be used as public me r s
)yU
U.yLicensed Professional
a OWNER-BUILDER DECLARATION
3< I hereby affirm that 1 am exempt from the Contractor's License Law for the
p o following reason.(Section 703 1.5,Business and Professions Code:Any city or county
which requires a permit to construct,alter,improve,demolish,or repair any structure
ti prior to its issuance,also requires the applicant for such permit to rile a signed statemrnt Valuation
z r Ft.Floor Area $7000
that he is licensed pursuant to the provisions of Contractor's License Law(Chapter 9 �]
F (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
that he is exempt therefrom and the basis for the alleged exemption.Any violation of Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 36215024.:tl t Number
not more than five hundred dollars(5500).
❑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.7044,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 are 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
sate.).
❑1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li-
cense Taw 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 Contractors
License Law.
❑1 am exempt under Sec B dt P C for this mason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations
❑1 have and will maintain a Certificate of Consent to self-insure for Workers Compen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
rw for which this permit is issued.
I have and will maintain Workers Compensation Insurance,as required by Section
of the Labor Code,for the performance of the work for which this permit is
My Workers mpen ation inti carver d Policy number
Cj
Cartier. L obey No.:
CERTIFICATE UF 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
Oforthwith comply with such provisions or this permit shall be deemed revoked.
z " CONSTRUCTION LENDING AGENCY
(� 1 hereby affirm that there is a construction lending agency for the performance of
a.> the work for which this permit is issued(See.3097,Civ.C.)
w Q Lenders Name
Lc
z ndeesAddress
U O 1 certify that I have read this application and state that the above information is
L>.► correct.I agree to comply with all city and county ordinances and state laws relating to
Ubuilding construction,and hereby authorize representatives of this city to enter upon the
W above-mentioned property for inspection purposes.
GL (We)agree to save,indemnify and keep harmless the City of Cupertino against
H Co,) liabilities,judgments,costs an 'expenses which may in any way accrue against said City
,)
V z in consequence of the g i of this permit. Date
APPLICANT U E DS WIL PLY WITH ALL ON-POINT Issued by:
SOURCE REGU A n / '
�O Re-roofs
Signature of ontractor Date Type of R sof
HAZARDOUS MAT ER1A1S CLOSURE yl)
Will the applicant or future building occupants or handle hazardous material
as defined by the Cupertino al Code,Chap .12,and the Health and Safety
Code,Section 25532(7)? All roofs:hall be inspected prior to any roofing material being installed.
Cl Yes No
If a roof i:.installed without first obtaining an inspection,I agree to remove
Will the applicant or future 'Iding occupant use equipment or devices which
emit hazardous air contamin do tncd by the Bay Arca Air Quality Management all new materials for inspection.
District?
❑Yes ❑ o
I have mai then rdous materials requirements under Chapter 6.95 of the Califor-
nia Health&S cry Sections 25505,25533 and 25534.1 undcrstan that iC building
does.not cu tly vc IC that it is my responsibility to motif the oceu t of the
requrements hi m mel p to issuance of a Cerirt�e n Signature of Applicant Date
�j All roof coverings to be Class 'B or better
Owner or authorixcd agent pato
CITY OF CUPERTINO
2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: suew
COPY # 1
Sec: Twp: Rng: Sub: Blk Lot:
APN . . . . . . . . : 362:_5024 . 00
DATE ISSUED. . . . . . . : 06/:_3/2007
RECEIPT #. . . . • • • . . : BS000001646
REFERENCE ID # . . . : 07060106
SITE ADDRESS . . . . . : 998 SEPTEMBER DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUP:ERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : ASHOK KUMAR
ADDRESS . . . . . . . . . . .
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4141
RECEIVED FROM ASHDK KUMAR
CONTRACTOR LESLIE HOANG LIC # 23155
COMPANY T D ROOFING
ADDRESS 675 TULLY RD
CITY/STATE/ZIP SAN JOSE, CA 95111
TELEPHONE (408) 892-8872
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ---------- ----
BPERMFEE VALUATION 7, 000 .00 137.16 0 .00 137 .16 0. 00
BSEISMICRE VALUATION 7, 000 .00 0 .70 0. 00 0 . 70 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 137. 86 0 . 00 137 .86 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- -------
CREDIT CARD 137.86 VISA
---------------
TOTAL RECEIPT 137. 86
CITY OF C'UPERTINO
REROOF
CUPERTINO PERMIT APPLICATION FORM
r-Build;ing
N Date:ddress: II�
S C
Owner's Name: Phone
Contractor: icense#: S C) 1
r 120 � j� c
Contact: Cupertino Business License#:
f
ype of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof QBuilt-Up roof
L Asphalt Shingles X
Asphalt Shingles
LJWood Shakes Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report#
XTo be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read,Understand and Will Comply With Cu iertino's Tear Off Policy:
Job Description: [ e S C,,' �; `'C
Jc LAG-u�l S�1c.
Residential VQ Commercial ❑
Fire Zone: Yes ❑ No Confirmed with Planning Det. if
there are any restrictions: LJ
Cost of Project: 1 Type of Construction: Occupancy group:
Qty. if
Applicable Fee ID Fee Description Fee Group
TBPERMFEE 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
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 1997 UBC Standards
and manufacturers specifications on re- oofing.
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 irspection 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 t to job site at the time on inspection.
I understand and will comply with the above stated policy on re-roofing.
Homeowner's Name: A L g.)_,,-,\
Job Site Address: �� J i> gin'► < �'
Roofing Company Name: T/ c0 C) i Z
Applicant's Signature: Date: �^ I C '
Greg Casteel
Building Official
111 11/2/04
Community Development
w:. 10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY Of Fax(408)777-3333
-.UPEkTINO
Buildin De artment
JOB PERMIT MIT #
cr � � CY,, 6c<- A 070 0100
Ir
OWNER'S NAME: A j 1io Lk--,-)>�X PHONE # �{v
GENERAL CONTRACTOR L1 C FAX #
I am not using any subcontractors:
Signature � Date
Please check applicable subcontractors and complete the followin 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 Date