10070108 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 11003 NORTHSKY SQ CONTRACTOR:FOUR SEASONS ROOFING PERMIT NO: 10070108
OWNER'S NAME: SRINIVAS KOMIDI PO BOX 1668 DATE ISSUED:07/15/2010
VER'S PHONE: 9252308831 SAN JOSE,CA 95109 PHONE NO:(408)278-0330
LICENSEU CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r— ELECT r— PLUMB�
License Class ic. 14
T ' C I MECH RESIDENTIAL COMMERCIAL
Contractor Date T
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:RE-ROOF RMV EXSTNG CEMWOOD ROOF&INSTALL A
(commencing with Section 7000)of Division 3 of the Business&Professions NEW
Code and that my license is in full force and effect. CLASS A COMP SHINGLE.GAF GRAND CANYON
(COLOR)STONEWOOD 12SQ
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
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$4400
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is APN Number:31640002.00 Occupancy Type:
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
upon the above mentioned property for inspection purposes. (We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, PERMIT EXPIRES IF WORK IS NOT STARTED
costs,and expenses which may acc a against said City in consequence of the
granting of this pe Additio ally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR
with all non-point rce regul tion per the Cupertino Municipal Code,S ction 180 DAYS FROM LAST CALLED INSPECTION.
9.18.
(c� Lfl /
Signature Date Issued by: Date:
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS:
the following two reasons: All roofs shall be inspectedLpinito roofs aterial being installed.If a roof is
I,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaictio ,I gre o emove all new materials for
will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection. /
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: ate:
construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE
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 read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
Section 3700 of the Labor Code,for the performance of the work for which this compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Safety Code,Section 25532(a)should I store or handle hazardous material.
permit is issued. Additionally,should I use equi ment or devices which emit hazardous air
I certify that in the performance of the work for which this permit is issued,I shall contaminants as defined b e ay Area Air Quality Management District I will
not employ any person in any manner so as to become subject to the Worker's maintain co pliance wit the upertino Municipal Code,Chapter 9.12 and the
Compensation laws of Califomia. If,after making this certificate of exemption,I Health& ty Code,S ctio 25505,25533,and 25534.
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. er or uthorized a 1 S 110
ate:
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
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 I hereby affirm that there is a construction lending agency for the performance of work's
to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.)
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name
»demnify and keep harmless the City of Cupertino against liabilities,judgments,
s,and expenses which may accrue against said City in consequence of the Lender's Address
._.:nting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION
9.18.
I understand my plans shall be used as public records.
Signature Date
Licensed Professional
CITY OF CUPERTINO
2 ITEMS OF 10 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Bl.c: Lot:
APN . . . . . . . . : 31540002 . 00
DATE ISSUED. . . . . . . : 07 /15/2010
RECEIPT #. . . . . . . . . : BS )00010874
REFERENCE ID # . . . : 10 )70108
SITE ADDRESS . . . . . : 11 )03 NORTHSKY SQ
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . . CU?ERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : SRCNIVAS KOMIDI
ADDRESS . . . . . . . . . . : 11 )03 NORTHSKY SQ
CITY/STATE/ZIP . . . : CU:?ERTINO, CA 95014
RECEIVED FROM . . . . : F01JR SEASONS ROOFIN
CONTRACTOR . . . . . . . : DIAZ, ALFRED LIC # 21323
COMPANY . . . . . . . . . . : F013R SEASONS ROOFING
ADDRESS . . . . . . . . . . : PO BOX 1668
CITY/STATE/ZIP . . . : SAN JOSE, CA 95109
TELEPHONE . . . . . . . . : (408) 278-0330
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
------ ---- ------------- ---------- - --------- ---------- ---------- ----------
1BCBSC VALUATION 4, 400 . 00 1 . 00 0 .00 1. 00 0 . 00
1REROOFRES SQ FEET 12. 00 156 .00 0 . 00 156 . 00 0 . 00
- --------- ---------- ---------- ----------
TOTAL PERMIT 157 . 00 0. 00 157. 00 0 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
CITY OF CUPERTINO
FEE ESTIMATOR-- BUILDING DIVISION
ADDRESS: DATE: REVIEWED BY:
APN: BP#: *VALUATION: 1$4,400
xPERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Duplex S TOTAL APPLICATION 1R3SFDADD/REM
USE: ROOF AREA: 1,200 f TYPE:
a a
3 �
FEE ID
1REROOFFRES
FrF-1
NOTE: Thesefees are based on the prelindnary in ormation available and are only an estimate. Contact the De t or addn'l info,
FEE ITEMS (Yee Resolution 09-051 Eff' 7,.1."09) FEE QTY/FEE MISC ITEMS
1'r'` f_:
Permit Fee: $15E.00
Work Without Permit? Q Yes (E) No $0.00
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $157.50 $0.00 TOTAL FEE: $157.50
Revised: 6/30/2010
CITY OF S-7 OI
CITY OF CUPERTINO
ItEROOF
CUPERTINO PERMITAPPLICATION
Date:
APN# ` ? i �0 _(� � c)� 711 ttld
Building Address:11po3 lJorlZsx, sifi,_
Owner's Name: M� 5r ��vS.S , �n i 1 Phone #:
HOA: Yes /No ❑ If Yes, provide letter from HOA
Contractor: rr e� 62
Phone #:( )_q 7 g —v33 0
Fax#: 6e90.27,?--d333
Cupertino Business License #: Contractor License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles 3re-Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
� Other (Specify) wo o C ❑ Other (Specify)
Number of existing coverings ❑ Provide I.C.C.E.S. Report#
,va-To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description: eo ve '5,uG2N (2-C,
rC,
Ne... C qsS' `4- e- r+e✓ �C„J4s"'�( '0�`0
/a s
cc-,for)
Residential 2— - Commercial
Green Building: Please complete relevant portion of the Confirmed with-Planning Dept. if
Green Building Checklist & attach it to tt.e application or if there are any restrictions: ❑
applicable, include in plan set & the sheet index.
Valuation: � b
y L/00
I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
Signature
Revised 02/05/09
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B4O., BUILDING OFFICIAL
C U P E RT I N O 10300 TORRE AVENUE • CUPERT NO, CA 95014-3255
(408)777-3228 • FAX(408)777-33:`3 • building a0kupertino.org
PROJLCT.ADDRESS ItI00-3 /��� �, APN N
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CO,MPANYNANIE E-NAIL FAXG
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STR t: aDDRLS' CIT" STATE,Z PHONE
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I UNDERSTAND ANI► AGREE TO THE FOLLOWING:
1. The re-roof project shall comply with all applicable provisions of the 2007 California Building Code.
2. An inspection request shall be scheduled the Jay before the inspection date. Please call (408)777-
3228 between 7:30 - 3:30pm (Mon-Fri) to schedule the next day inspection,
3. Atter the roof is torn off and the nails/fasteners have been removed and all the dry-rotted wood has
been replaced, you must call for a roof inspection. A building inspector will be available with one hour.
There are special hours for the 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 ins section is required.
5. New roof coverings shall not be applied without first obtaining all inspection 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 the sheathing so a proper inspection can be performed.
6. A final inspection and approval shall be obtained from the building inspector when the re-roofing is
completed. To receive a final sign-off, the following item will be verified:
a. Flat roofs shall have a minimum of/" per fort of slope and demonstrate there is no ponding.
b. A listing from an approved testing agency shall be available on-site to review at the time of the
inspection.
c. Proper spark arrestor installation.
7. NOTE: If you call for a plywood nailing inspection and the job is not ready, you will be charged to are-
inspection fee of$126.00. The re-inspection fee shall be paid before another inspection can be
scheduled.
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 uriderd and agre,;to comply with the re-roof policy stated above.
Signature of Applicant/Agent: Date: /�
ReroofPolicy_2010.doc revised 04/14/10
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
CUPERTINO Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS:1/0t) A10k7—* PERMIT# 22-2
OWNER'S NAME: X11( A-S D M D1— PHONE# 091 -X-49 d
GENERAL CONTRACTO (/R. /V zj�j& BUSINESS LICENSE #
ADDRESS: I CITY/ZIPCODE: Z—_
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPAACY INS TION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND JALSUB TRACT S HAVE OBTAINED A CITY OF UPERTINO
BUSINESS LICENSE. .�/(�/O
I am not using any subcontractors. I
Signatu a Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINE 3S 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