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09090039 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 11557 FALLCREEK SPRIN CT CONTRACTOR:WESTSHORE ROOFING PERMIT NO:09090039 INC `vNER'S NAME: PRASAD VENUGOPAL 2245-A FORTUNE DR DATE ISSUED:09/09/2009 %. vNER'S PHONE: 4088882958 SAN JOSE,CA 95131 PHONE NO:(408)694-0060 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT r- PLUMB F License Class Lic.# r MECH RESIDENTIAL COMMERCIAL Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:RE-ROOF 18SQS CLASS A;GAF/ELK (commencing with Section 7000)of Division 3 of the Business&Professions TIMBERLINE COMP Code and that my license is in full force and effect. ROOF 1 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:$6500 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:36651016.00 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 by: Date: S;-nature 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 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 stricture is not intended or offered for sale(Sec.7044, Signature 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 1 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. 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 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 Compensation laws of California. If,after making this certificate of exemption,I Owner or authorized agent: 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 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 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, costs,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 1 understand my plans shall be used as public records. 9.18. Licensed Professional Signature Date CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 11557 FALLCREEK SPRIN CT CONTRACTOR:WESTSHORE ROOFING PERMIT NO:09090039 INC ' "NER'S NAME: HUANG JANET H 2245-A FORTUNE DR DATE ISSUED:09/09/2009 u,rNER'S PHONE: 4088882958 SAN JOSE,CA 95131 PHONE NO:(408X694-0060 Iii LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class C- 5c,( L".# S L ` MECH f— RESIDENTIAL COMMERCIAL Contractor V -p S t 5}]c>✓O- (2wfi�l Date JOB DESCRIPTION:*NO CONDITIONS I hereby affirm that I am licensed under the provisions of Chapter 9 (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:$6500 performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance,as provided for by APN Number:36651016.00 Occupancy Type: Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the Date: granting of this permit. Additionally,the applicant understands and will comply Issued with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Date C RE-ROOFS: _ All roofs shall be inspected prior to any roofing material being installed.If a roof is installed without first obtaining an inspection,I agree to remove all new materials for ❑ OWNER-BUILDER DECLARATION inspection. /� I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applican��?' ` Date: 1`Z`en the following two reasons: 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, ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). HAZARDOUS MATERIALS DISCLOSURE I hereby affirm under penalty of perjury one of the following three I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Safety Code,Section 25532(a)should I store or handle hazardous material. Compensation,as provided for by Section 3700 of the Labor Code,for the Additionally,should I use equipment or devices which emit hazardous air performance of the work for which this permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I have and will maintain Worker's Compensation Insurance,as provided for by maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Section 3700 of the Labor Code,for the performance of the work for which this Health&Safety Code,Sections 25505,25533,and 25534. permit is issued. I certify that in the performance of the work for which this permit is issued,I shall Owper/orr aut��Vd,agent: Date: G not employ any person in any manner so as to become subject to the Worker's d'S � Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must CONSTRUCTION LENDING AGENCY forthwith comply with such provisions or this permit shall be deemed revoked. I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued(Sec.3097,Civ C.) APPLICANT CERTIFICATION Lender's Name I certify that 1 have read this application and state that the above information is Lender's Address 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 ARCHITECT'S DECLARATION the above mentioned property for inspection purposes.(We)agree to save mify and keep harmless the City of Cupertino against liabilities,judgments, I understand m plans shall be used as public records. costs,and expenses which may accrue against said City in consequence of the y p granting of this permit.Additionally,the applicant understands and will comply Licensed Professional with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Signature Date CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg COPY ## 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 36651016 .00 DATE ISSUED. . . . . . . : 09/09/2009 RECEIPT #. . . . . . . . . BS000008623 REFERENCE ID # . . . : 09090039 SITE ADDRESS . . . . . : 11557 FALLCREEK SPRIN CT SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER PRASAD VENUGOPAL ADDRESS 11557 FALLCREEK SPRING CT CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5118 RECEIVED FROM . . . . : BEN FOWLER CONTRACTOR . . . . . . . : PAUL FOWLER LIC # 21417 COMPANY WESTSHORE ROOFING INC ADDRESS 2245-A FORTUNE DR CITY/STATE/ZIP . . . : SAN JOSE, CA 95131 TELEPHONE . . . . . . . . : (408) 694-0060 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 6, 500 . 00 1 . 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 6, 500 . 00 0 .70 0 . 00 0 . 70 0 . 00 1REROOFRES SQ FEET 18 . 00 234 . 00 0 . 00 234 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 235.70 0 . 00 235. 70 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 235 .70 MC --------------- TOTAL RECEIPT 235 .70 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF ° CITY OF CUPERTINO REROOF Cin�F PERMIT APPLICATION CUPEi�T1NO APN # Date: � � � � � v \ �. � v Building Address: S S u (� C V,e e _ Phone #: �� - 2`T 5 Owner's Name: � �- U SA a U � �� HOA: Yes ❑ No If es, provide letter from HOA y -6 `� Z 6o Phone#: Contractor: Fax #: Contractor License #: 7? 7 Z Z � Cupertino Business License #: Type of Roof Covering: Proposed: Existing: ❑ Built-Up roof ❑ Built-Up Roof ' Asphalt Shingles Asphalt Shingles T❑' Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other (Specify) ❑ Other (Specify) ❑ Provide I.C.C.E.S. Report# Number of existing coverings ❑ Provide Mfgr. Installation Specs. To be Removed l'� e Job Description: C �t S 5 �� '''� �� `M ✓ 1 r Commercial ❑ Residential Confirmed with Planning Dept. if Green Building: Please complete relevant portion f t applicationorif there are any restrictions: Green Building Checklist & attach it to the app a li cable, include in Ian set & the sheet index. .Valuation: 5-00 r � I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy: Signature Revised 02/05/09 i CITY OF CUPERTINO REROOF CUPERTINO FEE SCHEDULE Number of Fee ID Fee Description Fee Permit Type Squares Group 1 REROOFCOM Re-roof Commercial B 1COMMLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1 BSEISMICO Seismic Commercial B 1REROOFRES Re-roof Residential B 1SFDWLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICRE Seismic Residential B 1 REROOFMRES Re-roof Multi-Family B 1MFDWLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICRE Seismic Residential B 1BUSLIC Business License B Community Development Department Building Division City of Cupertino 10300 Torre Avenue Telephone: (408)777-3228 Fax: (408)777-3333 Building Department Subject: Re-roofing policy for the City of Cupertino 1. Prior to permit issuance,you must agree to comply with 2007 IBC Standards and manufacturers specifications on re-roofing.All roofs are Class "A"per Cupertino municipal code 16.04.080. 2. New roof coverings shall not be applied without first obtaining all inspection and written approval from the building inspector. A final inspection and approval shall be obtained from the building inspector when the re-roofing is completed. 3. All roofs shall be inspected prior to any roofing installation. 4. To receive a final sign off from the City,the following steps are required: 1) Pre-inspection and/or tear off approval. 2) In-progress inspection approval. 3) Final inspection approval. a) Spark arrester installation. 5. If plywood is installed,a plywood nail inspection is required. 6. Any roofing which is applied without first obtaining an inspection, will require the removal of all new material down to the sheathing, so a proper City inspection can be performed. 7. NOTE: If you call for a plywood nail inspection and the job is not ready, you will be charged a re-inspection fee of$176.18. The re-inspection fee must be Raid before another inspection can be scheduled. IMPORTANT: 1. Flat roofs must have a minimum of 1/4 "per foot slope and demonstrate that there is no ponding. 2. An I.C.B.O.report is required to be on the job site at the time on inspection. I understand and will comply with the above stated policy on re-roofing. Homeowner's Name: job Site Address: Roofing Company Name: G� `�S l�° 00 n hC Date: w l Applicant's Signature: Greg Casteel Building Official Revised 07/30/08 Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 -UPEkTIN0 BuildinDe artment JOB ADDRESS: PERMIT # i Sr5 �- 'Fu 11 c re e, 5��'�►3 G O 02 OWNER'S NAME: u'u S 0Ld PHONE # U -Z- GENERAL GENERAL CONTRACTOR: Vl/C S o�v cr' ,h FAX # VS-6 –O-Z-33 I am not using any subcontractors:— _ U 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 Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile D to Owner/Contractor Signature