06100220 CITY OF CUPERTINO
BUILDING DIVISION PERMITRAQ I ( MTIf�l�t'
v
BUILDING ADDRESS: MANA GENERAL CONTRACTOR PERMIT No.0 610 0 2 2 0
1079 NOVEMBER
PERMIT ISSUE DATE
OWNER'S NAME:
GAJRAJ & HIMANI SINGH 1839 TAMPA. WAY 101Z31 /2006
SANITARY NO. CONTROL NO.
)NE:
(408) 375-4288
BUILDING PERMIT INFO
ARCHITECT/ENGINEER:
BLDG ELECT PLUMB MECH
p ZO LICENSED CONTRACTOR'S DECLARATION Job Description
V I hereby affirm that I am licensed under provisions of Chapter 9(commencing
Z with Section 70(10)of Division 3 of the Business and Professions Code,and my license is
I,< in full force and c L REROOF- REMOVE EXISTING, APPLY NEW PLYWOOD,
;�? License Lam. LC AND ASPHALT SHINGLES 19 SQUARES CLASS A
t—� Date Contractor ~
.t
ARCHITECTS DECLARATION'
A 1 N r ,
i a< I understand my plans shall he used as public records
)qU
'
U.F Licensed Professional
y
OWNER-BUILDER DECLARATION
> 1 hereby affirm that 1 am exempt from the Contractor's License Law for the
3 a0 following reason.(Section 7031.5,Business and Professions Code:Any city or county
which requires a permit to construct,alter,improve,demolish,or repair any structure
?Z y prior ht its issuance,also requires the applicant for such permit to file a signed statement Valuati$15 5 0 0
=G that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft. Floor Area
E $ (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
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not more than five hundred dollars($500). 36216019 . 00
0 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 Cade:The Contractors License Law does trot apply to an owner of q p
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.).
L as owner of the property,am exclusively contracting with licensed contractors to
nstruct the project(Sec.7044,Business and Professions Code:)The Contractor's Li.
cense Law docs 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 Contractor's
License Law.
0 1 am exempt under Sec. B&P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
Cl 1 have and will maintain a Certificate of Consent to self-insure for Workces Compen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
0 I 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 Worker's Compensation Insurance carrier and Policy number arc:
Cartier.SATE R 01D Policy No.�O U 24e+'4.*
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars($100)
or less.)
1 certify that in the performance of the work for which this permit is issued.I shall not
employ any person in any min ap�Jo ore subject to the Workers'Compensation
Laws of mna. ate min
9J ��yV 1J��
Applicant 4
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
,J O forthwith 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
a the work for which this permit is issued(Sec.3097,Civ.C.)
W Q Lender's Name
aZ Lender's Address
IJ 0 1 certify that I have read this application and state that the above information is
L>. t--' correct.1 agree to comply with all city and county ordinances and state laws relating to
C U building construction,and hereby authorize representatives of this city to enter upon the
a above-mentioned property for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
liabR-Aclv_";�J
' gments,toss and expenses which may in any way accrue against said City
U Z in cccanting of this permit. G
►-m APSTANDS ANDMPLY WITH ALL NON-POINT Issued by: Date 0- 3/�/
SoNS.
Re-roofs
Signatu HAZARDOUS MATERIALS DISCLOSURE D to 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
Cade,Section 25532(x)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes pfIo
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
0 Yes Wo
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Safe Code,Sections 25505,25533 and 25534.1 understand that if the building
d #, ,
n y a tenant that it ism possibility ro notify the occupant of the
uiw is ust be met prior to iss cc of a Ccrtificatc of Deco ry. Signature of Applicant Date
All roof coverings to be Class"B"or better
Ownhorized agent Datc
CITY OF CUPERTINO
=em 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 36216019 . 00
DATE ISSUED. . . . . . . : 10/31/2006
RECEIPT # . . . . . . . . . : 36624
REFERENCE ID # . . . : 06100220
SITE ADDRESS . . . . . : 1079 NOVEMBER DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : GAJRAJ & HIMANI SINGH
ADDRESS . . . . . . . . .
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : CARLOS ORELLANA
CONTRACTOR . . . . . . . : CARLOS ORELLANA LIC # 27468
COMPANY . . . . . . . . . . : MANA GENERAL CONTRACTOR
ADDRESS . . . . . . . . . . : 1839 TAMPA WAY
CITY/STATE/ZIP . . . : SAN JOSE, CA 95122
TELEPHONE . . . . . . . . : (408) 375-4288
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
- - - - - --- - - --- ---- -- ---- - ------ --- - ----- ---- ---------- --- ---- --- - - ----- -- -
BPERMFEE VALUATION 6 , 000 . 00 126 . 36 0 . 00 126 . 36 0 . 00
BSEISMICRE VALUATION 6 , 000 . 00 0 . 60 0 . 00 0 . 60 0 . 00
---------- ---------- - -------- - ----------
TOTAL PERMIT 126 . 96 0 . 00 126 . 96 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
- - - - -- - - ---- - - -- - - - -- ----- --- --- - ---- ----- - ----
OTHER 126 . 96 VISA
TOTAL RECEIPT 126 . 96
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-roofing.
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
mply with the above stated policy on re-roofing.
Homeowner's Name: leu
Job Site Address: d TG 00 k>''\612
Roofing Company Name:
Applicant's Signature: C�f t 0, Date:
Greg Casteel
Building Official
Revised 11/2/04
Community Development
' 10300 Torre Avenue
s. . Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
''UPEI�TINO
Building Department
JOB ADDRESS: PERMIT #
OWNER'S NAME: PHONE # Y ' 3 7 4 2-
GENERAL
GENERAL CONTRACTOR: tMQ N vt e iu, - FAX #
I am not using any subcontractors: Ock(to) 04 � t�w� to Zo
Signature Date
Please check applicable subcontractors and complete the following 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
OW) ocp_�_10
att,
CITY OF CUPERTINO
REI:OOF
CUPEkTINO PERMIT APPLICATION FORM
APN# �� _ Date:ViI�lZo-,1
Buildin Address:
10 o o em 6,e
Owner's Name: Phone#:
r S n� h ��an ' a --33 31
Co act : License#:
yv1 v\ rte. �Q � � 4 fcc 40�' 1 1A 10
tntact: ) v Cupertino Business License #:
f- oS ce 1 PICA- 3�� Z-do
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles )A Asphalt Shingles
)k 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.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description:
Residential �g Commercial j�,1� /cox
Fire Zone: Yes ❑ No Confirmed with Planning Deft. if
there are any restrictions: LJ
Cost of Project: Type of Construction: Occupancy roup:
5,500 �
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 Plan Check Fee BUILDING
BUSLIC Business License BUILDING