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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