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09060123 CITY OF CUPERTINO BUILDING DIVISION PERNIITQRt Z � YP BUILDING ADDRESS: PERMIT NO. OWNER'S NAME: PERMIT ISSUE DATE CONTROL NO. ARCHrMCTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH p C LICENSED CONTRACTOR'S DECLARATION U I hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description Z with Section 7000)of Division 3 of the Business and Professions Code,and my license is !may in full force andettect 7�Q S RE—RF APPLY NEW TPO RF, OVR EXTNG FOAM ROOF CLS A t n Z Licensc CI_pss �i^r—t Lic.S n r— Date —L 2—Q 4 Contractor 00 t 11 SQ ARCHrIECrS DECLARATION , c 1 understand my plans shall be used as public records a I&y Licensed Professional rn l OWNER-BUILDER DECLARATION 1<2 I hereby affirm that I am exempt from the Contractor's License Law for the :❑O following reason.(Section 7031.5,Business and Professions Code:Any city or county o('z which requires a permit to construct,alter,improve,dcmolLch,or repair any structure Z y prior to its issuance,also requires the applicant for such permit to file a signed statement ;Z G that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft Floor Area Valuation (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 S6000 Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APT d Number Occupancy Type not more than five hundred dollars(5500) ❑1,ss owner of the property,or my employees with wages as their sole compensation, 31630136 . 00 will do the work,and the structure is not intended or offered for sale(Sec.7044,Business and Professions Code:The Contractor's License Law dots 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.). ❑I,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. ccnse Law 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 Contractor's License Law. ❑I am exempt under See. B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's Compen- ..ion,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑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(+CQ1rop_e on In er and Policy number are: Cartier s `A Policy No.: 60,Z—=2z S\ CERTIFICATE OF 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 O forthwith comply with such provisions or this permit shall be deemed revoked. N 'c CONSTRUCTION LENDING AGENCY ►� 1 hereby affirm that there is a construction lending agency for the performance of Yr> the work for which this permit is issued(Sec.3097,Civ.C.) ALender's Name ]z Lender's Address C) I certify that I have read this application and stale that the above information is corm.I 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 w W above-mentioned property for inspection purposes. y a (We)agree to save,indemnify and keep harmless the City of Cupertino against rA liabilities•judgments,costs and expenses which may in any way accrue against said City Z in consequence of the granting of this permit. ' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOUR LATIONS. Re-roofs Signature of ApplicanUContractor Dale 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)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes 1�No Will the applicant or future building occupant use equipment or devices which If a roof is instal ed without first obtaining an inspection,I agree to remove it hazardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection. ,trict? ❑Yes �No I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building does not currently have a tenant•that it is my responsibility to notify the occupant of the requi rats which must be met prior to issuance of certificate of Occupancy. Signature of Applicant Date cVw�ner or authorized agent 6 -2? All roof coverings to be Class'A"'or better Datc CITY OF CUPERTINO A K".1REROOF Of CUPERTINO PERMIT APPLICATION APN # 0 Date: Building Address: I `l � Owner's Name: S�,.� ;\ � �� Phone #: x-108 - ?LILA- tis 7? HOA: Yes S No ❑ If Yes, provide letter from HOA Contractor: Phone #: 00$- 84L1 -y 5 77 Fax #: q16 - - P02 ( Cupertino Business License #: Contractor License #: °� 32 8S7 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) T 'PO Number of existing coverings ❑ Provide I.C.C.E.S. Report# ❑ To be Removed -�L Provide Mfgr. Installation Specs. Job Description: TPC> Roo _ o eh �� ,,►.� t ooh \o'_SA 1 � 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: ❑ app licable, include in plan set & the sheet index. Valuation: I Have Read, Understand and Will Comply with Cufertino's Tear-Off Policy: Signature Revised 02/05/09 CITY OF CUPERTINO ` REROOF a, CUPEkT1NO FEE SCHEDULE Number of Fee ID Fee Description Fee Permit Type Squares Group 1REROOFCOM Re-roof Commercial B 1COMMLROOF IBCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICO Seismic Comme-cial B I 1 1RER00FRES Re-roof Residen-:ial B 1SFDWLR00F IBCBSC Cal Bldg Standa:-ds B ALL PERMIT TYPES Commission Fee / 1BSEISMICRE Seismic Residential B 1 REROOFMRES Re-roof Multi-Family B 1MFDWLROOF IBCBSC Cal Bldg Standa:•ds B ALL PERMIT TYPES Commission Fee 1BSEISMICRE Seismic Residential B 1BUSLIC Business License. B 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-:o comply with 2007 IBC Standards and manufacturers specifications on re-rcofing.All roofs are Class "A"per Cupertino municipal code 16.04.080. 2. New roof coverings shall not be applied vAthout 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 materiel 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 45176.18. The re-inspection fee must be paid before another inspection can be scheduled. IMPORTANT: 1. Flat roofs must have a minimum of 1/ "pe::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 sta:ed policy on re-roofing. Homeowner's Name: ��a h; A� Job Site Address: Iz V'AaM W 1 Roofing Company Name: !`� L" Applicant's Signature: � Date: --2 cq Greg Casteel Building Official Revised 07/30/08 May 22, 2009 To Whom It May Concern: The Beekman Place Homeowner' s Association Board has approved all the necessar-• documents for Swapnil Laddha to install a new roof on his property at 19917 Beekman Place. The Board has approved the materials selected and given the approval to proceed. Please contact myself• or Chris Butcher at 255-0642 if there are any further questions. Sincerely JoAnn Correia Beekman Place Board President Community Development - 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CIV OF Fax(408)777-3333 rUPEkTINO Buil din ; Department JOB ADDRESS: PERMIT# to Z-3 qe Ck,Ma,.. OWNER'S NAME: S L-c PHONE # GENERAL CONTRACTOR: ' FAX # qt& -9 41 -kl(? I I am not using any subcontractors: -22-oq Signat ire Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINES 3 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