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10090240
CITY OF CUPERT][NO BUILDING PERMIT BUILDING ADDRESS: 10091 SANTA CLARA AVE CONTRACTOR:PRINCIPLE ROOFING& PERMIT NO: 10090240 OWNER'S NAME: RAMAKRISHNA VENGALASETTI 10160 STERN AVE DATE ISSUED:09/27/2010 NER'S PHONE: 4082521396 CUPERTINO,CA 95014 PHONE NO:(408)898-7298 D✓ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r— PLUMB r License Class_i C 3°) Lie.# S 1 6391— — �" MECH RESIDENTIAL COMMERCIAL Contractor Date 0612_)PL11CJ I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: RE-ROOF-REMOVE EXISTING COMPOSITION SHINGLE, (commencing with Section 7000)of Division 3 of the Business&Professions INSTALL 30YR COMPOSITION SHINGLE,CLASS A 13SQ 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.Ft Floor Area: Valuation:$3900 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION x/ APN Number:32625006.00 Occupancy Type: 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. h Issued b . Date: Sienature Date ❑ 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 oinstalled 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, Signature of Applicant: Date: Business&Professions Code) I,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 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. 1 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 permit is issued. 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 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 Compensation laws of California. If,after making this certificate of exemption,I Owner or uthorized agent: become subject to the Worker's Compensation provisions of the Labor Code,I mus: 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 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 -,n the above mentioned property for inspection purposes.(We)agree to save Lender's Address ;mnify and keep harmless the City of Cupertino against liabilities,judgments, ,,osts,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION with 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 FEE ESTIMATOR- BUILDING DIVISION ADDRESS: DATE: REVIEWED BY: APN: BP#: *VALUATION: $3,000 -� *PERMIT TYPE: Minor Building Permit PLA V CHECK TYPE: Re-roof PRIMARY ft)7 L [PE_NTAMATIONMITT_ 1SFDWLROOF USE: SFD or Duplex t>r� :F�, r ERMIT TYPE: WORK SCOPE FEE ID ROOF AREA (S.f. 1 REROOFFRES 1,;300 irc L`lilt_ ;,c�. 0;',Y f" SiIC't., ry, r., Li Cir 1-'!t rY,, !> Ot'i_.'! ... If1 . NOTE. Theseees are based on the relimina in ormation<<vailable and are onlyan estimate. Contact the De t or addn'l info. FEE ITEMS (Fee Resolution 09-051 Elf.T"b'10) FEE QTY/FEE MISC ITEMS Pltlr. (_l c(tll 1'CC MtI17 Permit Fee: $161.00 P/11110- llce 11. Eh'(: I air I c. Plrrrfrft.:1ICt fr.il;lc c Pea�rrtrt I'CC: ('On,57riwfion Ta,v Work Without Permit? 0 Yes E) No $0.00 Plannin" V'vS' TI-o cel L)r>�t;ttte°pttcrtir>r' f'c� . : Strong Motion Fee: IBSEISMICR $).50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $17).50 $0.00 TOTAL FEE.] $170.50 Revised: 9/22/2010 CITY CF CUPERTINO 3 ITEMS OF 3 PERN,IT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 32625006 .00 DATE ISSUED. . . . . . . : 09/27/2010 RECEIPT #. . . . . . . . . : B3000011561 REFERENCE ID # 1)090240 SITE ADDRESS 1 )091 SANTA CLARA AVE SUBDIVISION . . . . . . : CITY CUPERTINO IMPACT AREA . . . . . . OWNER RiUMAKRISHNA VENGALASETTI ADDRESS 10091 SANTA CLARA AVE CITY/STATE/ZIP CUPERTINO, CA 95014 RECEIVED FROM . . . . : DERECK LOI CONTRACTOR DERECK LOI LIC # 27564 COMPANY PRINCIPLE ROOFING & ADDRESS . . . . . . . . . . : 1C160 STERN AVE CITY/STATE/ZIP CUPERTINO, CA 95014 TELEPHONE . . . . . . . . : (908) 898-7298 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---- ---------- ---------- ______ ---------- ---------- 1BCBSC VALUATION 3, 900 . 00 1. 00 0. 00 1. 00 0 . 00 1BSEISMICR VALUATION 3, 900. 00 0.50 0. 00 0 .50 0 . 00 1REROOFRES SQ FEET 13 . 00 169.00 0.00 169. 00 0 . 00 ---------- ---------- TOTAL PERMIT : ---------- ---------- 170 .50 0 .00 170.50 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER --------------- -------------------- CREDIT CARD 170 .50 VISA --------------- TOTAL RECEIPT 170 .50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION --------------- --- ---------------- ------------ 1 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF CITY OF CITY OF CUPERTINOIM REROOF CUPERTINO PERMIT ��PPLICATION APN # U � Date: 0-9/23//v Building Address: � GD � S�%�Trat GG�►� Owner's Name: �S,yN,�r Vt�,'6. LA.S,z-rrl* Phone #: L 46V l 2 5-Z- 13 HOA: Yes ❑ No �If yes, provide letter from HOA Contractor: �7rLii.rG; �� fi+moi` , c ✓5� Phone -;z 09 Fax#: Cupertino Business License #: Contractor License #: fi/ E3 d� Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof t"Asphalt Shingles ©/Ksphalt 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: /2u✓�c,✓ > � ,-s T,°�✓�i � s;ty .,....isd .gyp Residential - Commercial Green Building: Please complete relevant portion of the Cor)-finned 34�ith_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: I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy: Signature Revised 02/05/09