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10100054 CITY OF CUPERTINO :.BUILDING PERMIT BUILDING ADDRESS: 10379 KRISTA CT COPITRACTOR:T D ROOFING PERMIT NO: 10100054 OWNER'S NAME: DURGESH SRIVASTAVA 675'rULLY RD DATE ISSUED: 10/06/2010 ER'S PHONE: 4082035491 SAN JOSE,CA 95111 PHONE NO:(408)892-8872 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG F ELECT F PLUMB F License Class C� Lic.# 15 q �J 15 G MECH F RESIDENTIAL[_ COMMERCIAL Contractor Date it t /, I hereby affirm that I am licensed u6ion the provisions of Chapter 9 JOI I DESCRIPTION:RE-ROOF REMOVE WOOD INSTALL 30#FELT OSB&30YR (commencing with Section 7000)of 3 of the Business&Professions CON[P CLASS A 22SQ 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 performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance,as provided for by Sq.14 Floor Area: Valuation:$10000 Section 3700 of the Labor Code,for the performance of the work for whil� permit is issued. APr Number:34245002.00 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.,Addi'onally,the applicant understands and will comply with all non-point sour'e r lations per the Cupertino Municipal Code,Section 9.18. Co Issued - Date:��'ld 6 Signature Date — Li OWNER-BUILDER D , TION RE-ROOFS: All r)ofs 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. 1,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, Sign uture of Applicant: Date: Business&Professions Code) _ 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE I have and will maintain a Certificate of Consent to self-insure for Worker's I haie read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the Cali'ornia Health&Safety Code,Sections 25505,25533,and 25534. I will maintain performance of the work for which this permit is issued. com 3liance 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 cont aminants as defined by the Bay Area Air Quality Management District I will permit is issued. mah Main 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 Co e,Sections 25505,25533,and 25534. not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If,after making this certificate of exemption,I Owr er or au e r become subject to the Worker's Compensation provisions of the Labor Code,I must Y [ forthwith comply with such provisions or this permit shall be deemed revoked. C STRUC ION LENDING AGENCY APPLICANT CERTIFICATION I herby affirm that there is a construction lending agency for the performance of work's I 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 •mify and keep harmless the City of Cupertino against liabilities,judgments, ,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section I un(erstand my plans shall be used as public records. 9.18. Lice used Professional Signature Date CITY OF CU PERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: I HATE: REVIEWED BY: APN: BP#: *VALUATION: 1$10,000 PERMIT TYPE: Minor Building Permit PLAN CI IECK TYPE: Re-roof PRIMARY SFD or Du lex fol t „ PENTAMATION 1SFDWLR00F USE: P 1,a t>t�h �,.: d PERMIT TYPE: WORK SCOPE FEE ID ROOF AREA s.f. 1REROOFFRES 2,200 ED--t- F-1 I NOTE. Thesefees are based on the preliminary in ormation avails We and are only an estimate. Contact the De t or addn'l info. FEE ITEMS (Fee Resolution 09-051 El 7,%1.%10) FEE QTY/FEE MISC ITEMS Plea„ Chc,"k Vec: SuJp/, PC.'F'ccc f'?t�rr2h.-1Ic'c dJ. I;le Flail t`17 ck. Permit Fee: $286.00 Sapp/, Ir sp Vcc F71 f'Itrtr�h.i1l�c°h..'llc°� 1_`r�ir fc�e� l'lrarrxlz-�_11��1�.'I.lc'c� 1'crittlr't F'c°cr; Ic:f��aSt�c'crl ti�`t'tC 1� I"e't'e Work Without Permit? 0 Yes (E) No $0.00 1��litllf7fl�r I`C't';ti: f��Fa��crl�)r�c°ttarac��a�tatir,rr 1`art's'- Strong Motion Fee: IBSEISMICR $1.00 Select an Administrative Item Bldp Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $288.00 $0.00 TOTAL FEE' $288.001 Revised: 9/29/2010 CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: I,ot: APN . . . . . . . . : 34245002 .00 DATE ISSUED. . . . . . . : 10/06,2010 RECEIPT #. . . . . . . . . BS000011664 REFERENCE ID # 10100054 SITE ADDRESS . . . . . : 10379 KRISTA CT SUBDIVISION . . . . . . CITY CUPER"INO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : DURGESH SRIVASTAVA ADDRESS . . . . . . . . . . : 10379 KRISTA CT CITY/STATE/ZIP . . . : CUPER`'INO, CA 95014 RECEIVED FROM . . . . : LESLII, A HOANG CONTRACTOR . . . . . . . : LESLII's HOANG LIC # 23155 COMPANY T D ROOFING ADDRESS . . . . . . . . . . : 675 TULLY RD CITY/STATE/ZIP . . . : SAN JOSE, CA 95111 TELEPHONE . . . . . . . . : (408) 392-8872 FEE ID UNIT QUANTITY AM01JNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---- ------ ---------- ---------- ---------- 1BCBSC VALUATION 10, 000 . 00 1. 00 0 . 00 1. 00 0 . 00 1BSEISMICR VALUATION 10, 000 . 00 1 .00 0 . 00 1. 00 0 . 00 1REROOFRES SQ FEET 22 . 00 ?86 . 00 0. 00 286. 00 0 . 00 ---- ------ ---------- ---------- ---------- TOTAL PERMIT :288 . 00 0 . 00 288 . 00 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- - ------------------- CREDIT CARD 288 . 00 VISA --------------- TOTAL RECEIPT 288 . 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF REROOF TEAR-OFF POLICY COMMUNITY DEVELOPMENT DEPARTME14T•BUILDING DIVISION ALBERT SALVADOR,P.E., C.B.O., BUILDIKG OFFICIAL CUPERTINO 10300 TORRE AVENUE•CUPERTINO, CA 35014-3255 (408)777-3228• FAX(408)777-3333•buildingCcDcupertino.org PROJECT ADDRESS A f y �� C APN# OWNER NAME �LL Y-.0 S•� �� VCl. N, V E-MAIL STREET ADDRESS CITY, STATE,Z.P FAX C'ONTRACTO�IAME(Z - t1.� t �. LICENSE NUMBER _ ' LICENSELJPE�q BUS.LIC# COMPANY NAME I C, E-MAIL FAX EETp STR9r - 1` CISTATEZI PHONE � QT I,� AT I UNDERSTAND AND AGRFLE TO THE FOLLOWING: 1. The re-roof project shall comply with all applicable f rovisions of the 2007 California Building Code. 2. You must schedule all needed inspections a minimum of one day before the requested inspection date. Please schedule inspections online or call (408)777-3228 between 7:30-3:30 (Mon-Fri). . 3. Tear-off roof inspection is required. Please call fo:•tear-off inspection after the roof is torn off and all the nails/fasteners have been removed. Any and all dry-rotted wood shall be replaced prior to this inspection. A building inspector will be available wi:hin one hour. There are special hours for this service: 7:30 — 10::30am and 1:00— 3:30pm (Mon—Thurs); 7:30 — 10::30am and 1:00—2:30pm (Friday). 4. If plywood is installed, a plywood nailing inspection is required. 5. In-Progress roof inspection is required. Call for an in-progress roof inspection to verify building is weather tight after installation of approximately 25% of the roofing material. 6. New roof coverings shall not be applied without first obtaining all inspections and written approvals from the building inspector. Any roofing which is applied without first obtaining an approved inspection will require the removal of all new material down to i he sheathing so a proper inspection can be performed. 7. A final inspection and approval shall be obtained from the building inspector when the re-roofing is complete. To receive a final sign-off, the following i:ems will be verified: a. Flat roofs shall have a minimum of/4"per foot c f slope and must demonstrate there is no ponding. b. Listings from approved testing agencies for all p•e-manufactured products used shall be available on-site to review at the time of the inspection. c. Proper spark arrestor installation. 8. NOTE: If you call for a tear-off or plywood nailing nspection and the work is not complete, you will be charged a re-inspection fee of$126.00. The re-inspection fee shall be paid before another inspection can be scheduled. By my signing below, I certify each f th fo owin true: I am the property owner or authorized agent to act on the property owner's behalf. I d a 2C to comply with the re-roof policy stated above. Signature of Applicant/Agent: } ate: 77 ReroofPolicy_2010.doc revised 05/17/10 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RTI N O Fax: 408-777-3333 CONTRACTOR/ SUBI;ONTRACTOR LIST JOB ADDRESS: 10 ,3 PERMIT# OWNER'S NAME: PHONE qc s 2v 52 GENERAL CONTRACTOR: i sL BUSINESS LICENSE# ADDRESS: CITY/ZIPCODE: Sck,,r *Our municipal code req fres al usinesses working in the city to have a City of Cupertino busi ss license. NO BUILDING FINAL OR FINAL OCCUPANCIV. IVTECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCO TORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signal ure Date Please check applicable subcontractors and complete the followin i _ation: SUBCONTRACTOR BUSINESS vA 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 GIT" OF CITY OF CITPERTINO c > - RER()OF CUPERTINO PERMIT APPLICATION APN# _ _ Date: L Buildm' Address: Owner'sName: c� e_� 'I 'VI-, S hone #: HOA: Yes ❑ No If yes, provide letter from HOA Contractor: `, Phone #: 9 Y Fax#: Cupertino Business License #: Contractor License #: 5�q C) I Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof o Asphalt Shingles `-�Asphalt Shingles •Wood Shakes ❑ Wood Shakes Wood Shingles ❑ Wood Shingles ❑ Other (Specify) ❑ Other (Specify) Number of existing coverings ❑ Provide I.C.C.E.S. Report# ❑ To be Removed ❑ Provide Mfgr. Installation Specs. Job Description: a Residential - Commercial Green Building: Please complete relevant portion A the Con__flrmed aith_Planning Dept. if Green Building Checklist & attach it to the application or if there are any restrictions: ❑ applicable, include in plan set & the sheet-index. Valuation: 1 � I Have Read, Understan and ill Comply with Cupertino's Tear-Off Policy: 1 l Signature Revised 02/05/09