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07100100 CITY OF CUPERTINO �- ` ' 7 ` BUIL DIVI�ION PERMIT 4'�� ; � ,, ,.: .:: PERMIT NQ. BUfL �9 q p R LILAC WAY C& C R�OFING 07100100 . OW NER'S NAME: PERMIT ISSUE DATE K PODIBANDA M AND 89 S 21 ST 10/15/2007 jQN�f.TTT1T D T SANITARY NO. CONTROL NO. (408)293-1868 ARCHiT'ECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH n 0 � 0 i p � LICENSED CONTRACTOR'S DECLARATION JOb DCSCflpt10T1 %� C t hcrcby affirm that I am licenscd unJcr provisions oC Chaptcr 9(cammcncing ; Z� wi�h Sccdon 7000) of Division 3 of thc Busincss and Profcssians Code and my licensc is RE - R00 F; REMV EX S TNG S HAK E S & I N S T L 1/ 2 C DX >>y infullCorccandeffeG{. l Z � pLYWOOD & RE-ROOF W/COMP 23 SQ� CLASS A. j v� i[,icensc Clazs Lic. N : F � Datc - � Conuac��l��" d6� : I IV �' � ^ ARCHITEC['S DECLARATION 7 o�C a 1 undcrswnd my plans shall be uscd az public records )yU ' n. y Liccnsed Profcssional � y � OWNER-BUILDER DECLARATION ! hcrcby alTirm ihat 1 am excmpt Crom ihc Con�ractor's Liccnsc Law for �hc � p o following rcuon. (Scction 7031.5, Busincss and Profccsions Ca1c: Any city or county �,°, ,�c, which requires a pcmiit w conswct, altcr, improvc, dcmolish, or rep�ir any swctu�c ° Z y prior ui i�s issuancc, alsu rcquires thc applicant for such permil to filc a signcd stalemcnt �< that hc is liccnacd pursuanl lo thc pmvisions of thc Cnnuacwr's Liccnsc Law (Chaptcr 9 ; iq. Ft. Floor Area Valuation � I �(commcncing wiih Scction 7000) of Division 3 of �hc Busincss and Profcssions Codc) ar $1012 5 i�� that 6e is exemp� chccefrom and t�e buis Cor Ne alleged eumpdon. Any violaGon of Section 7031.5 by arry applicant (or a peimit subjects ihe applicant to a civil penalty af Number Oeeupaney Type not mare than five 6undred dollacs (5500). 3 r J 9 � 4 � � 3�� ❑ I, u owncr oC ttie property. or my employces with wages az their sate compensadon, will do thc wark and the stcvauce is noe intended or of[aed (or salc (Sec. 7044, Business Re uired Ins ecti ons and Pmfessions Code: The Conuacwr's License Law dors not spply m an owixr ot Q � propeny who builds a improves thercon, and who does such work himsel[ or through Ais own employces, providcd ihat such improvements are not imended or o[tered for sala I[, however, the building or improvement is sold within one year of comptetion, ihe ownu- builder will have U�e burden o[ proving that hc did not build or improve (w pmpose of saleJ. ❑ I, as owner o( Ihe property, am ezdusivaly conlracting wilh licensed rnnvactors w rnnstmct �he pivjm (Sec. 7044. Business and PraCcssions Code:) The Conuactors Li- cense Law docs oot apply to an owner of propeny who builds ar improves Ihe�eon, and . who conuacts Car such pmjects wich a conuanorts) licensed pursuant to the Convactor's License Law. Q► am ezempt under Sec . B dc P C for �his rcason Owner Date _ . _ WORKER'S COMPENSAT[ON DECLARATION 1 hereby afCirm under penalty o( perjury one of the folbwing declarations: ❑ I hsre and will maintain a Certificate of Consent to self-insure for Workers Compen- sation, as provided for by Section 3700 of the Labar Code, (or �he performance of Uie work for which this pertnit is issucd. ❑ I havc and will maintain Workels Compensatian Insuronce, as required hy Scction 3700 of thc Labor Codc, Car thc pcdormancc of �he work far which this permit is issued. My Worke��mpensation Insuance carrier and Policy number aze: � I '7 Cartier. S�� ' U 11� � Policy No: ' �— CERTIFICATE OF EXEMPIIOIV FROM W RKERS' COMPENSATtON [NSURANCE ' (ihis scction need not bc complc�ed if the permit is for onc hundred dollars (S1Q0) or Icss.) , I cenify thxt in the performanee af the work for which Ihis permi� is issued, t shall not enploy any person in any manncr so as to bccome wbject io Uie Worlccrs' Compcnsadon Laws o( Cali(omia. Datc Applicant NOTICE 7'O APPC.ICAM; If, aftcr making t�is Ccrtificau of E�ccmptian, you should become subject to ihe Worker's Compensation provisions of iAc Labor Code, you muu , O forthwi�h comply with such provisions or this pecmil shall be deemed revoked. z "" CONStRUCT10N LENDMG AGENCY E � t hcrehy a(iirtn �hat thcro is a conswetinn Icnding agcncy for thc perfurmancc u( p�., .� �hc work Cur which this pertnit is issucd (Sce. 3097. Civ. CJ � A Lendcr's Namc " a � L.ender's Address U � 1 certify that 1 havc rcad ihis applieation and siatc that thc abovc informauon is w � correct. I agrce to comply with all city and county onlinances and sute laws relating w � U building conswction, and hcrcby authori�e represcntativcs of ihis city to cntcr upnn thc � W abovc-mcn�ioncd property for inspcction purposes. a (Wc) agrce to save, indcmnify and kecp harmlcss �hc City oC Cupertino against „�„� � liabiliuu, judgmcn�s, costs and expcnsc: which may in any way accruc against said City U z in consequcncc aC Wc granting of �his pertnit. Date ' �'+ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOU REGULATIONS. „r ' G � ""� = Re-roofs /'°�� Signaturc of ApplianUComractor �a� Type of R�of HAZARDOUS MATERIALS DISC[.OSURE Will lhe applicant or futurc building occupant storc or handlc haiardous matcrial az dcfincd by the Cupenino Municipal Codc. Chaptcr 9.12, snd the Hcal�h and SaCcty c� Scction 25532(a)? All roofs :�hall be inspected prior to any roofing material being installed. ❑ Y� r� If a roof i:; installed without first obtaining an inspection, I agree to remove - Will thc applicant or fuwrc building occupant usc cyuipmrn� or deviccs which cmii harardous air conuminan�s az dcfined by the Bay Arca Air Quality Managcment all new m aterials for inspeccion. Dis�rict? - . . ❑ Ycs �Nu t havc rcaJ the hvardous matcrials requircmcn�t undcrChap�cr 6.95 of �hc Cali(o � �' /> /% � nia Hcalth & Safcry Codc. Sections 25505, 25533 and 25534. f uncicrstand thu iCihc buildin // / ��._`L �(�.� dces no� curtently havc a tcnan4 wat it is my rcsponsibility to noufy thc oecupant af Nc /r/ O�e f rcy y cn�s which must bc met pnor ��u ora c�r�a� or o��p��r. Signature of Applicant 11 Date !/��r��*j �� --�-= �G "� �" v � All roof coverings to be Class "B or better Owncr or au�horizcd agcnt Datc C�`]lc�� o � CITY OF (�UPERTINO ' �;.� REIZOOF CU��T1�o PERMIT APPL ICATION FORM APN # Date: �� d8� o � �-- rs�-�� Building Address: � �� L ( L ✓a w ,� � �� Owner's Name: Phone #: � �Z�- ` Z Contractor: License #: �- 2 • � �- ' 9 Z � 2 Contact: Cupertino Business License #: U.Z 7 /'C Type of Roof Covering: Eacisting: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles d� Asphalt Shingles Q� Wood Shakes ❑ Wood Shakes ❑ Wood Shingles 0 Wood Shingles ❑ Other (Specify) ❑ Other (Specify) Nuinber of existing coverings ❑ Provide I.C.B.O. Report # ❑ To be Removed ❑ Provide Mfgr. Installation Specs. I Have Read, Understand and Will Com ly With Cu��ertino's Tear Off Policy: ❑ Job Description: � i/ti � E� i/G' � r 1 iw L- lL c S JVS � L� �7 C I�X L W � f'1/� Residential ,� Commercial ❑ �� S Fire Zone: Yes ❑ No � Confirmed with Planning Dept. if there are any restrictions: LJ , Cost of Project: Type of Construc:tion: Occupancy group: �o. �: Uv �� Cr�vo�' s F Qty. if Applicable Fee ID Fee Description Fee Group BPERIVIFEE 131dg Permit Fees BLJILDING BENERGY Energy BLTILDING BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BLTILDING Community Development Department � Building Division City of Cupertino 10300 Torre Avenue Telephone: (408) 777-3228 Fax: (408) 777-3333 Building I)epartment Subject: Re-roofing policy for the C'ity of Cupertino 1. Prior to permit issuance, you must agre � to comply with 1997 UBC Standards and manufacturers specifications on re-roofing. 2. New roof coverings shall not be appliec. without first obtaining all inspection and written approval from the building inspector. A final inspection and approval shall be obtained from the buitding 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 i nspection is required. 6. Any roofing which is applied without f: rst obtaining an inspection, will require the removal of all new mat� �rial down to the sheathing, so a proper City inspection can be perfc rmed. 7. NOTE: If you call for a plywood nail ir.spection and the job is not ready, you will be charged a re-inspection fee ��f $176.18. The re-inspection fee must be paid 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: �4 /� 1 �C V 2 l. ��(/ Job Site Address: � �� L/ L/� C t-� �- % Roofing Company Name: � F �(� U 0 � � n/ �- Applicant's Signature: �� ...,� �c� Date: �� - l � ' � � Greg Casteel Building Official Revise i 11/2/04 CITY OF CUPERTINO 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: Bl}:: Lot: APN ...... 35��04008.00 DATE ISSUED.......: 10�15/2007 RECEIPT #.........: BS(�00002987 REFERENCE ID # ...: 07�.00100 SITE ADDRESS .....: 77"'5 LILAC WAY SUBDIVISION ....... CITY .............. CUI'ERTINO IMPACT AREA ....... OWNER ............: KiJF:UPPU PODIBANDA M AND INDIRA ADDRESS ..........: 77''5 LILAC WY CITY/STATE/ZIP ...: CUI'ERTINO CA, 95014-4208 RECEIVED FROM ....: C�LND C ROOFING CONTRACTOR .......: OS�'ALDO CAMARA LIC # 22982 COMPANY ..........: C F_• C ROOFING ADDRESS ........... 89 S 21 ST CITY/STATE/ZIP ...: SA21 JOSE, CA 95116 TELEPHONE ........: (4()8)298 FEE ID UNIT QUANTITY E�NlOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ----------- ---------- ---------- ---------- BPERMFEE VALUATION 10,125.00 180.36 0.00 180.36 0.00 BSEISMICRE VALUATION 10,125.00 1.10 0.00 1.10 0.00 ----------- ---------- ---------- ---------- TOTAL PERMIT : 181.46 0.00 181.46 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 181.46 VISA --------------- TOTAL RECEIPT : 181.46 Community Development `�` °°.�, • 10300 Torre Avenue ; �. � ;� � �� Cupertino CA 95014 Telephone (408) 777-3228 CITY OF Fax (408) 777-3333 ':UPEf�TINO Buildi:n De artment JOB ADDRESS: PERMIT�� D O( O� r L / � C �-�- .-� i OWNER'S NAME: 6 f k P PHONE # y -� Y 6 Z GENERAL CONTRACTOR: �' -� 2 ';ti G. FAX # I am not using any subcontractors: � /i�� 3--�. �G -/ 5 =� 2 Si� mature Date Please check a licable subcontractors and com �lete the followin information: SUBCONTRACTOR BUSIrfESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing IIectrical Excavation Fencing Flooring: Carpeting Linoleum / Wood Glass / Glazing Heatin.g Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile �� lr �� , �. �. .�.� _ �� - ��-� � Owner/Contractor Signature Date