12120040CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7579 BARNHART PL
CONTRACTOR: K 1 ROOFING & REPAIR
PERMIT NO: 12120040
OWNER'S NAME: SHARMA NIRAJ K AND MADHU
2561 DUMONT CT
DATE ISSUED: 12/10/2012
OWNER'S PHONE: 4088028818
SAN JOSE, CA 95122
PHONE NO: (408) 625 -0565
19— " LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class L .3 C/ Lic. #
RESIDENTIAL I COMMERCIAL r
Contractor Ll Date 17— // 0 / Z
MECH
4�5_A,
I hereby affirm that I am licensed under the provisions of Chapter 9
JOB DESCRIPTION: REROOF REMOVE SHAKE INSTALL COMP 30 SQ CLASS A
(commencing with Section 7000) of Division 3 of the Business & Professions
Code and. that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self - insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
Sq. Ft Floor Area:
Valuation: $16520
performance of the work for which this permit is issued.
1 have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APN Number: 36616078.00
Occupancy Type:
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
correct. I agree to comply with all city and county ordinances and state laws relating
PERMIT EXPIRES IF WORK IS NOT STARTED
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
180 DAYS FROM LAST CALLED INSPECTION.
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point so a regulations per the Cupertino Municipal Code, Section
j 1
by: J 41Z�77 Date•` i, I t ^ 1
9.18.
Issued
Signature Date /2 /d � Z
RE- ROOFS:
❑ OWNER- BUILDER DECLARATION
All roofs shall be inspected prior to any roofing material being installed. If a roof is
Law for
installed without first obtaining inspection, I agree to remove all new materials for
I hereby affirm that I am exempt from the Contractor's License one of
the following two reasons:
inspection.
1, as owner of the property, or my employees with wages as their sole compensation,
Signature of Applicant: Date:
will do the work, and the structure is not intended or offered for sale (Sec.7044,
Business &Professions Code)
1, as owner of the property, am exclusively contracting with licensed contractors to
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
HAZARDOUS MATERIALS DISCLOSURE
declarations:
I have read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain a Certificate of Consent to self - insure for Worker's
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain
Compensation, as provided for by Section 3700 of the Labor Code, for the
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
performance of the work for which this permit is issued.
Safety Code, Section 25532(a) should I store or handle hazardous material.
I have and will maintain Worker's Compensation Insurance, as provided for by
Additionally, should I use equipment or devices which emit hazardous air
Section 3700 of the Labor Code, for the performance of the work for which this
contaminants as defined by the Bay Area Air Quality Management District I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
permit is issued.
p
Health & Safety Code, Sections 25505, 25533, and 25534.
1 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 Worker's
Owner or orVed agent:
Date:
Compensation laws of California. If, after making this certificate of exemption, I
y/d iZ
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
APPLICANT CERTIFICATION
for which this permit is issued (Sec. 3097, Civ C.)
1 certify that I have read this application and state that the above information is
Lender's Name
correct. I agree to comply with all city and county ordinances and state laws relating
to building construction, and hereby authorize representatives of this city to enter
Lender's Address
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
ARCHITECT'S DECLARATION
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
I understand my plans shall be used as public records.
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Licensed Professional
Signature Date
CUPERTINO
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014 -3255
(408) 777 -3228 - FAX (408) 777 -3333 - building0leupertino.or4
PROJECT ADDRESS
7 � � �� Y� �
rig C+ ✓'
APN #
OWNER AMA r
PHONE
E -MAIL
5 V
ST ,WADDRESS
-7 tt11!
)
J
CITY, STATE, ZIP
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I e f
FAX
CONTACT NAME
/ , -
//❑
REMOVE /REPLACE L�'YES
IfliONE `` _
E-MAIL
PLYWOOD
STREET ARDRESS
PLYWD EI OSB
PITCH:
r0 :12
CITTATE, ZIP.
❑ NO
FAX
❑ OWNER ❑ OWNER - BUILDER ❑ OWNER AGENT
CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME �h
TYPE: ❑ CDX
LICF,TI� NUMBER ,
LICENSE TYPE C
BUS. LIC. #
1 COMPANY NAME
E -MAIL I FAX
r REET ADDRESS CITYSTATE ZIP
57.2
BUS. LIC. #
1 COMPANY NAME
1 STREET ADDRESS
E -MAIL, I FAX
CITY, STATE, ZIP I PHONE
USE OF ❑ SFD Or Duplex
❑ Multi- Family
ROOF AREA:
VALUATION:
#
STRUCTURE: ❑ Commercial
5 V
(P
BUILT -UP ROOF
EXISTING ROOF TYPE:::.,_,
❑ ASPHALT SHINGLES
v WOOD SHAKES
❑ WOOD SHINGLES ❑ OTHER (SPECIFY)
//❑
REMOVE /REPLACE L�'YES
IF NO,
I
PLYWOOD
❑ %," ❑
PLYWD EI OSB
PITCH:
r0 :12
ROOF
A
❑ NO
# LAYERS:
11 5/8"
TYPE: ❑ CDX
CLASS:
PROPOSED ROOF TYPE: 11 BUILT-UP ROOF
M` ASPHALT
v ASPHALT SHINGLES
11 WOOD SHAKES
❑ WOOD SHINGLES ❑ OTHER
ICC -ES REPORT #
DESCRIPTION OF WORK:
"L
V ` '4
1-L11_41 W n /G -'�' 5 A 6bsP &A/
ReroofApp_201 1. doc revised 03116111
C.
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
FEE ID ROOF AREA
s.f.
1REROOFFRES 3,000
ADDRESS: 7579 Barnhart PI
DATE: 12110/2012
REVIEWED BY: jsg
I tt.
APN:
BP #.
"VALUATION: 1$16,520
xPERMIT TYPE: Minor Building Permit
PLAN CHECK TYPE: Re -roof
PRIMARY SFD or Duplex
USE:
I
PENTAMATION 1SFDWLR00F
I PERMIT TYPE:
WORK
Reroof, remove shake instal comp
SCOPE
suppl. Insh I ee
FEE ID ROOF AREA
s.f.
1REROOFFRES 3,000
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc ). These fees are based on the Dreliminarv, information available and are only an estimate. Contact the Deptfor addn'l info.
FEE ITEMS (Fee Resolution 11 -053 Eff 7/1!12)
k,Jl. PJata (J-io k
PFrtt d), Pk01t el,
Pkw ('hack
I tt.
f3j onxi" P m7' %`._'t':
J', trt C'. Pe:l'!7117
C)tIier Mech. Irrs'f>
Oti,_T
hl p. 1`c o:
P; ?furl
111£'f 167v, FCC,'
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc ). These fees are based on the Dreliminarv, information available and are only an estimate. Contact the Deptfor addn'l info.
FEE ITEMS (Fee Resolution 11 -053 Eff 7/1!12)
FEE
QTY /FEE
MISC ITEMS
Pleat C.'hec /G FCC.'
,Suppl. PC Fee
Permit Fee:
$450.00
suppl. Insh I ee
Plttrrab.;':1lec °lr.,'1:1c' <:
Pfunth. /.1`1ec lr.il'lc'c Permit Fees:
t,`c�rrstr-rrrtion I�r:�:
Adrninistrativet Fc c:
Work Without Permit? 0 Yes No
$0.00
,ldvane•crd Planning F(Ics:
71-in Cl 1)octrrrti ntcrtiarr
Strong Motion Fee: IBSEISMICR
$1.65
Select an Administrative Item _7
J`
t
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$452.65
$0.00 TOTAL FEE:
$4 .65
Revised: 10/01/2012
CUPERTINO
CONTRACTOR / SUBCONTRACTOR LIST
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014 -3255
Telephone: 408 - 777 -3228
Fax: 408 - 777 -3333
JOB ADDRESS: -7.
-7c%,-'
PERMIT #
OWNER'S NAME:
,'" -I ?� 1? -• r `• t- .` c
PHONE # v - r ✓�Y-
GENERAL CONTRACTOR:
BUSINESS LICENSE #
ADDRESS: //i
_-� f -�- t"
CITY /ZIPCODE: 15,, ,.,
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUB NTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE. '
I am not using any subcontractors: 2-1 lz j
Signature Date
Please check applicable subcontractors and complete the following information:
Owner / Contractor Signature
Date
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring / Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner / Contractor Signature
Date