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11060162 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10999 MARIA ROSA WAY CONTRACTOR:BECKS ROOFING PERMIT NO: 11060162 OWNER'S NAME: YELUR SHARADA 6191 OCHO RIOS DR DATE ISSUED:06/20/2011 OW+°-'ER'S PHONE: 4088062600 SAN JOSE,CA 95123 PHONE NO:(408)365-8979 G LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB r License Class 3 /1 Lic.# 1 H 12-13 p,�/' MECH RESIDENTIAL COMMERCIAL � Contractor �� ���I'✓� Date JOB DESCRIPTION:RE-ROOF TEAR OF OSB 30LB 50YR COMP CLASS A I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business&Professions 25SQFT Code and that my license is in full force and effect. C Q 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 performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Valuation:$11000 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:35619047.00 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 to building construction,and hereby authorize representatives of this city to enter PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. � Issued b Date: C— Signature Date b� !Nhh / f, ` OWNER-BUILDER DECLARATION RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for the following two reasons: inspection. 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, Signature of Applicant: Date:6 L Business&Professions Code) I,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 and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534. not employ any person in any manner so as to become subject to the Worker's -7�! Compensation laws of California. If,after making this certificate of exemption,I Owner or rthorize ent: become subject to the Worker's Compensation provisions of the Labor Code,I must Date: forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's 1 certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.) correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address indemnify and keep harmless the City of Cupertino against liabilities,judgments, C and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION i ig of this permit.Additionally,the applicant understands and will comply wit..all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. Licensed Professional Signature Date CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 35619047. 00 DATE ISSUED. . . . . . . : 06/20/2011 RECEIPT #. . . . . . . • • : BS000013817 REFERENCE ID # . . . : 11060162 SITE ADDRESS . . . . . : 10999 MARIA ROSA WAY SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : YELUR SHARADA ADDRESS . . . . . . . . . . : 10999 MARIA ROSA WAY CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : CARL BECKS & SONS CONTRACTOR . . . . . . . : BECKS, CARL LIC # 21908 COMPANY BECKS ROOFING ADDRESS . . . . . . . . . . : 6191 OCHO RIOS DR CITY/STATE/ZIP . . . : SAN JOSE, CA 95123 TELEPHONE . . . . . . . . : (408) 365-8979 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 11, 000 .00 1. 00 0 . 00 1. 00 0 . 00 1BSEISMICR VALUATION 11, 000 . 00 1.10 0. 00 1 .10 0. 00 1REROOFRES SQ FEET 25 .00 325. 00 0 . 00 325 . 00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 327.10 0 . 00 327.10 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 327 . 10 #26865 --------------- TOTAL RECEIPT 327. 10 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 309 EXTERIOR LATH 311 SCRATCH COAT 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: PERMIT# OWNER'S NAME: PHONE# GENERAL CONTRALTO : BUSINESS LICENSE# ADDRESS: CITY/ZIPCODE: Z'3 *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 SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: � �o2b — 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 Painting /Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile kde b , � I Owner/Contractor Signature Date CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION WAPN: DDRESS: 10999 maria rosa way DATE: 06/20/2011 REVIEWED BY: bobs. BP#: "'VALUATION: Isi1,000 'PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof PRIMARY SFD or Du lex PENTAMATION 1 SFDWLROOF USE: P PERMIT TYPE: WORK tear off replace with comp shingles. SCOPE FEE ID ROOF AREA s.f. 1REROOFFRES 2,500 NOTE. Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addn'l info. FEE ITEMS (Fee.Resolution 09-051 Eff. 711`10) FEE QTY/FEE MISC ITEMS Permit Fee: $325.00 F71 Work Without Permit? 0 Yes No $0.00 Strom Motion Fee: IBSEISMICR $1.10 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: 1 $327.10 $0.00 TOTAL FEE $327.10 Revised: 04/29/2011 LMREROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPEFtTINQ (408)777-3228• FAX(408)777-3333• building(�cupertino.org PROTECT ADDRESS �/^ l APN# �1 OWNER NAME ' l PHONE O/ �&Q E-MAIL STREET ADDRESS [T� CITY, STATE,ZIP (� (/ FAX APPLICANT NAME A PHONE JS� E-MAIL STREET ADDRESS I Z. C ,STATE, ZIP FAX ITY ❑OWNER ❑ OWNER-BUILDER ❑ OWNER/A(GEENTT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME LICENSE NUMBER / LICENSE TYPE — BUS.LIC.# r COMPANY NAME / t;` E-MAIL FAX STREET ADDRESS © CITY,STATE,ZIP S PHONI /� 6 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC.# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF SFD or Duplex ❑ Multi-Family ROOF AREA: VALUATION: STRUCTURE: ❑ Commercial EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES VOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY) REMOVE/REPLACE 'YES IF NO, PLYWOOD ❑ -4" 11 _ PLYWD OSB PITCH: ROOF 11 NO #LAYERS: / THICKNESS: ❑ 5/8" TYPE: ❑ CDX '12 CLASS: A PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT# DESCRIPTION OF WORK: —T, D 7 � t I /_ L By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building co tructio .. I_authorize.representatives of Cupertino tc enter the above-identified property for inspection purposes. Signature of Applicant/Agent: TLV✓ Date: SUPPLEMENTAL INFORMATION REQUIREDMR GirrCE usE �'` Air$ _If building is associated with a Home Owner's Association,provide letter pII c> CrcE a Tinto sI7P of approval from HOA. �A EE-CQIIN-1. t BIIII.`DINGP�AN REVIEWS � _Provide Planning approval to verify if there any restrictions. ❑ EXPIiEss ❑ -BNNINGPLANRXVIEw Provide copy of Manufacturer's Installation Specifications. )� ., ❑ nPPT Q oz>RJA Provide signed copy of Cupertino's Tear-Off Policy. �. ReroofApp_2011.doc revised 03/02/11