07030078 CITY OF CUPERTINO
BUILDING DIVISION PERMITo 'I'JK�C 'o�INP`oRMTION•;
BUILDING ADDRESS: PERMIT NO.
10415 N BLANEY AV TBD - TO BE DETERMINED 07030078
OW NER's NAME: PERMIT ISSUE DATE
SURESH BABU CHANNALATH 03/12/2007
..BONE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0
o C LICENSED CONTRACTOR'S DECLARATION
u FI hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description
.Z� with Section 70()U)af Division3of the Business and Professions Code,and myliccnsc is RE—ROOF. SHAKE CONVERSION TO COMPOSITION 1/2" OSB
? N in full force and cfferA_
7 Z License Class Lic.8 f[1� D Y 23 SQUARES 30# FELT
F w Date Contractor
ARCHITECTS DECLARATION
U I understand my plans shall be used as public records
uJ
,a
o Licensed Professional
ur OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
t]O following reason.(Section 7031.5,Business and Professions Code:Any city or county
<m which requires a permit to construct,alter,improve,demolish,or repair any structure
?Z y prior to its issuance,also requires the applicant for such permit to file a signed statement
_< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.)"t.Floor Area Valuation
uF (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $7000
L 3• 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 of3 Number Occupancy Type
not more than eve hundred dollars(M). 31633114 `� anC�01 p y yp
❑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 sad(Sec.7044,Business
and Professions Code:The Contractor's License Law docs not apply to an owner of Required Inspections
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
sale.).
❑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 Law does not apply to an owner of property who builds or improves thereon,and.
who contracts for such projects with a contractors)licensed pursuant to the Contractor's
License Law.
❑1 am exempt under Sea 4&P C for this reason
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 Workces Compcn-
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 Worke/es Compensation Insurance carrier and Policy nuunb ram:
Carrier. LDM1RS 7Gf 5 - Policy No.: 0-7-
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not he 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
(- I hereby affirm that there is a construction lending agency for the performance of
the work for which this permit is issued(See.3097,Civ.C.)
aQ Lender's Name
Z Lender's Address
U 0 1 certify that I have read this application and slate that the above information is
�-" correct.1 agree to comply with all city and county ordinances and state laws relating to
Vbuilding construction,and hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes.
a (We)agree to save,indemnify and keep harmless the City of Cupertino against
rA liabilities,judgments,casts and expenses which may in any way accrue against said City
U vZ in consequence of the granting of this permit.
r— APPLICANT DERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOU E U ATTONS.
03 Re-roofs J
Signatu o Applicant/Contractor Dao v
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
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)?
❑Yes ) All roofs shall be inspected prior to any roofing material being installed.
RI No
Will the applicant or future building occupant use equipment or devices which If a roof is instilled without first obtaining an inspection,I agree to remove
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materia Lls for inspection.
District?
❑Yes �(No
1 have acct the hazardous smaterials555, requirements under Chapter that if the Calling
nia Health&SafctyCodc,Sections 25505,25533 and 25534.1 understand thaziCthe building .\J ^Z
does.not currently have a tenant,that it is my responsibility o notify the occupant of the _3
requre n=ichbe met prior o issuance of a Certificate Occupanc. Signatu Of Applicant Date
41 03
Owner or a t orized agent atc-
All roof coverings to be Class"B"or better
CITY OF CUPERTINO 0-1-0 300
REROOF
CUPEkT`INO PERMIT APPLIICATION FORM
APN# 3 1(0 -
Building Address: ,
S C
Owner's Name: Pho e#:
Contractor:'1Gk) / License -
,67
9(/
Contact: Cupertino Business License#:
�a 6 �� ; y 5 7.2o101
Type of Rooi'Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ,W10' Asphalt Shingles
Wood ShakesWood Shakes
ElWood Shingles 04�rWood'Shingles
❑ Other(Specify) ❑ 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 C '
u ertinos Tear Off Policy:
y:
Job Descrip 'on
ke- __ 0oA) uers1,& -i an S_ Ile 0!Sd _50-94,4�17
Residential)�T ommercial ❑
Fire Zone: Yes ❑ No Confirmed with Planning Det. if
there are any restrictions: LJ
Cost of Proj ct: u Type of C ns rtiort: Occupancy group:
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plar.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-roc fing.
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 materia l down to the sheathing,
so a proper City inspection can be performed`.
7. NOTE: If you call for a plywood nail inspE ction 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 11;cheduled.
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: c p,
Job Site Address: //1t//,5
Roofing Company Name: 'L,G�J
Applicant's Signature:
Greg Casteel
Building Official
Revised 11/2/04
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: kiersaw
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . . 3163=114 . 00
DATE ISSUED. . . . . . . : 03/12/2007
RECEIPT #. . . . . . . . . : BS00(1000666
REFERENCE ID # . . . : 0703(078
SITE ADDRESS . . . . . : 1041E N BLANEY AV
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . . .
OWNER SURElcH BABU CHANNALATH
ADDRESS . . . . . . . . . .
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2333
RECEIVED FROM . . . . : RECEIPT INTERFACE
CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096
COMPANY . . . . . . . . . . : TBD - TO BE DETERMINED
ADDRESS . . . . . . . . . .
CITY/STATE/ZIP . . . : ,
TELEPHONE
FEE ID UNIT QUANTITY AMCUNT 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
BUSLIC FLAT RATE 1.00 107 . 00 0 . 00 107 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 244 . 86 0 . 00 244 . 86 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 244 . 86 VISA
---------------
TOTAL RECEIPT 244 . 86