07100181 CITY OF CUPERTINO ` ` `
BUfLDING D�VIS10iV PERMIT �Gfi3�T� ��flR 1��'�?R�1�T�QN.: '
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,
PERMIT IJO.
BUILDI �� ass �DERLAND DR DADDARIO ROOFING 07100181 .
ER'S NAME: PERMIT L55UE DATE
RAHUL SHINKRE 1734 WILLA WAY � 10/25/2007
PHONE: SANITARY NO. CONTROL NO.
(831)476-9109
ARCHITECT/ENGINEER: BU[LDING PERMI'I' MFO
BLDG ELECT PLUMB MECH
� � 0 0
i O p L(CENSED CONTRACTOR'S DECLARATION
� V� I hcrcby aflirm ihat I am licenscd undcr provisions of Chaptcr 9(commencing Job Description
; z� wi�h Scction 7000) of Division 3 of thc Business and ProCcssions Codc, and my license is RE - ROOF � 5 � YR C OMPO S I T �. S. B/ TEAR OF F SHAKE , 3 6
�� y in full Corcc and cffect
��? I.icensc Class ��� G( �ic. #�-3 d�� '3 '� S Q C LA S S A
; F � Datc le .— �f� '�o '� Con�ractar J h
ARCHTTECI'S DECLARATION
i a a t undcrstanJ my plans shall bc used as pubiic rccnrds
>yU
' 4. N Licenscd Pcufcssional
� y � OW NER-BUILDER DECLARATION
j a� I Acrcby aCf rm Ihat 1 am ezcmpt from ihc Conuactors Liccnsc Law Cor the
: p o foilowing rcuon. (Scction 7031.5, Business and Profcssions Codc: Any city or counry
e,°, � which rcquires a pccmit to conswct, aher, improvc, dcmolixh, nr �epair any suuctmc
� Z y prior tn iLt issuancc, alsu rcquires �hc applicant for such pertnit to filc a signcd s�alcmen�
� z < tha� hc is Iiccnscd pursuant to thc pmvisions o[ Uu Convactur's Liccnsc Law (puptcr 9 � q. Ft. Floor Area Valuation
u t• �(commcncing wiih Scctian 7U00) of Division 3 of Ihc Busincss and Profcssinns Cadc) or $16 4 5 0
,, �.. U�at he is ezempt thcrctrom and the basis Cor the allegcd ezempdon. Any violation of
Secuon 7031.5 by any applicant for a permit subjecu �he applicant W a civil penalry of Number Oceupaney Type
not more ihan five hundred dollars (5500� 3 6 2110 3 3'
❑ I, ss owncr oC tt�e pmperty, or my employcu with wages u the'v solc compensauoo,
wiU do the work and tde suunuce is not intended or offeced for sale (Sec. 7044, Buarcss Re u ired In s ections
and Professions Code: The Cantncwr's License Law does no[ apply w an owner of Q P
property who builds or improves �hercon, and who does such arort himulf or �hmagd his
own employcr_c, providcd that such improvemen�s arc not imm�ded or otte�ed Cor sale. If,
however, the building or improvement is sotd wi�hin one year of comple6on. �he owrcr-
builder will have ihe burden of proving �at he did not build or improvc for purpoae of
sale.).
❑ 1, as owner of the property, am acelusively conttaciing with licenud rnntractors m
construct the projen (Sec. 7044. Businas and Protessions CodeJ The Coouanars Li-
ccnse Law docs not apply to an owner of propeny who builds or improves the�ea�, and ,
who conuac�s far such projects with a convactor(s) liansed pursuant to �he Convxtofs
License Law.
� am uempt under Sec. . B dc P C for ihis reasnn
.ier Date
WORKER'S COMPENSAT[ON DECLARAT[ON - '
I demby �mi under penaity o[ perjury one of the (olbwing declaratians:
❑ I hsre and will maintain a Certi6cam of Consent to sclf-insure for Workcr's Compen-
sation, u provided fw by Section 3700 aC the Labor Cade, for �he perfortnancc of �he
wark for which Wis permit is issued.
❑ I havc and will maintain Workefs Compensation Insuranu, u �cquired by Scctim
3700 oC thc Labor Codc. Cor thc performance of �he work for w6ich this permit is issued. '
My Workefs CompensaGon Insurance carticr and Policy number are:
Carrier. �C•�-n�.-� I— � Poliry No.: B DO 29 2q — LC'�
CERTIFiC TE OF EMPITON FROM WORKERS'
COMPENSATlON INSURANCE
('ihis sectian need not be completed if the permit is for onc hundrcd dollars (S I00)
or Icss.) .
1 cenity ihas in thc performancc of thc work for which �his permit is issucd ! shatl aa
employ any person in any manncr so u to bcrnmc subject to the Workers' CompensaGon
Laws of Califomia. Da�c
Applicant
NO'CICE TO APPLICANT: If, aftcr makin� �his CeniGca�c of Excmption, you shauld
bccome subjcct to the Workcr's CompensaUon provisions of ihc Labor Code, you muu
� O CaMwith comply with such provisions or this permit shall bc dccmcd �cvoked.
z "' CONSTRUCI'ION LFNDING AGENCY
.�
E-r ►—� I hc�cAy atlirm ihat thcre is a consuuctina knding agc�rcy for ihc performanoe oC
Fi � �hc wurk for which this permi� is issucd (Scc. 3097, Civ. C.) '
W� Q Lendcr's Namc .
a z Lender's Address
V � I certify �hat 1 have rcad �his applieation and siaic �hat �he abovc inCormation is
w � cortccG I agrce �o comply with all city and county ordinances and su�e laws relaung to
Q U building conswction, and hesby authome tcpresemativcs of Nis city to cmer upon thc �
� a ahovc-mcntiuncd property for inspccdon purposes.
(Wc) agrce to save, indcm�ify and kecp harmless ihc City of Cupertino agains�
�� liabilitiu, judgmcnes, cos�s and expenscs which may in any way accruc against said �ry
V z in conuquencc oC thc granting aC �his permiG -� /�
�" APPLICAM UNDERSTANDS AND W1LL COMPLY WITH ALL NON-POIKf Issued by: Date j�'' ��" ���
SOURCE REGULATIONS.
�a — �= d Re-roofs ��-�
S' re af A can tor Dafc
H OUS MATERIALS D[SCLOSURE Type of Ro� �f
Will �hc applicant or future buitding accupant storc or handlc hmardous matcrial
:fined by thc Cupertino Municipal Codc. Chaptcr 9.12, and �hc Hca1N and Safety
�c. SccUon 25532(a)? � AlI roofs sFall be inspeeted prior to any roofing material being installed.
❑ Ycs
w��i m� a������� o� r�w� n���a;� «�u �� � o� ���� .Yn�b If a roof is nstalled without first obtaining an inspection, I agree to remove -
emit hai.ardous air contaminants as ckfincd by the Bay Area Air Quali�y Managcment all new+ mat erials for inspecr.ion.
nistricc?
o Y� e�,+�
I havc rcad ihe hvardaus matcrials rcquircmcnts unJcrChap�cr6.95 of thc Calilw-
nia Hcalih & Safcty Codc. Scctions 25505. 25533 and Z5534. I undcrstand that if the 6uilding
dors noi curtcn�y havc a �cnan6 it is my responsiAility m no�l'y ihc occupanc of �he
rcyuircmcn�s which must bc to issuancc af a Ccnifica�c of Occupancy. Signature o.' Applieant Date
'' �—� All roof coverings to be Class "B" or better
Ow auth td agc Darc
- ��1�� ��1
CITY OF t�UPERTINO
' "` RE�ZOOF
CuPE�Tt�[t� . PERMIT APPL�ICATION FORM
3�a �3 , O
Date:
� q'� � � U, ✓1 2 r' �- /C� -- c �- � �
Building Address:
� � ' Y�
wne 's ame: Phone #:
Ct �(JC�f i0 - �t ,'� c �53 I ._ Q'( � c
Con ractor: License #:
, ,� �- � y^ �^ p � , � _ �
Contact: Cupertino Business License #:
� a �-f-s
Type of R�of Covering:
E'sting: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ �sphalt Shingles �''�phalt Shingles
�Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other (Specify) ❑ Other (Specify)
Nuinber of existing coverings ❑ Provide I.C.B.O. Report #
❑ To be Removed , 0 Provide Mfgr. Installation Specs. �_
� C' �, � ��� �S
�O c.�.— cc. J s,' .1 a� L, . � � � c� �; k� � c�
I Have Read, Understand and Will Comply With ��ertino's Tear Off Policy: ❑
Job Description:
Residential Commercial ❑
Fire Zone: Yes ❑ No �/ Confirmed with Planning De�t. if
there are any restrictions: U
Cost of Project: � Type of Construction: Occupancy roup:
b �G �'.�-_ 1.�0 ►' �l c � \�- - ` J
Qry. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE �;ldg Permit Fees BUILDING
BENERGY Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
- . , Community Development Department
, Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408) 777-3228
Fax: (408) 777-3333
Building l�epartment
Subject: Re-roofing policy for the (;ity of Cupertino
1. Prior to permit issuance, you must agrE e to comply with 1997 UBC Standards
and manufacturers specifications on re- roofing.
2. New roof coverings shall not be applieci without first obtaining all inspection
and written approval from the buildin€; inspector. A final inspection and
approval shall be obtained from the bulding 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 apprcval.
2) In-progress inspection approval.
3) Final inspection approval.
a) Spark arrester installation.
5. if plywood is installed, a plywood nail :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 t1e job site at the time on inspection.
I understand and will comply with the above stated policy on re-roofing.
Homeowner's Name: �CCt {1W � S ��; �, (�re
Job Site Address: � �-j' f (� � �� � � � .�c Y - � 0. � t � � �---�
Roofing Company Name: ' iJa � ��_ i�00'F�'�7 ct
Applicant's Signature: G Date: �0 -'� -o `�
Greg Casteel
Building Official
Revisec.11 / 2/ 04
CITY OF CUPERTINO
2 ITEMS OF 2 PERMI`� RECEIPT OPER.ATOR: patg
COPY # : 1
Sec: Twp: Rng: Sub: Bl]c: Lot:
APN ........ 36:?11033.00
DATE ISSUED.......: 10,'25/2007
RECEIPT #.......... BS�)00003082
REFERENCE ID # ...: 07:�00181
SITE ADDRESS .....: 79:36 SUNDERLAND DR
SUBDIVISION ......:
CITY .............. CU:?ERTINO
IMPACT AREA .......
OWNER ............. RAIiUL SHINKRE
ADDRESS ..........: 79'�6 SiTNDERLAND DR
CITY/STATE/ZIP ...: CU:?ERTINO CA 95014
RECEIVED FROM ....: DA]�DARIO ROOFING CO
CONTRACTOR .......: ED��AR MONTOYA LIC # 26245
COMPANY ..........: DA]�DARIO ROOFING
ADDRESS ..........: 17:34 WILLA WAY
CITY/STATE/ZIP ...: SA]JTA CRUZ, CA 95062
TELEPHONE ........: (8.31)476
FEE ID UNIT QUANTITY :�MOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 16,450.00 245.16 0.00 245.16 0.00
BSEISMICRE VALUATION 16,450.00 1.70 0.00 1.70 0.00
---------- ---------- ---------- ----------
TOTAL PERMIT : 246.86 0.00 246.86 0.00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 246.86 #21959
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TOTAL RECEIPT : 246.86
� � : F : Community Development
10300 Torre Avenue
'� ��.t ` Cupertino CA 95014
Telephone (408) 777-3228
CITY OF Fax (408) 777-3333
CUPEI�TINO �
Buildin De artment
JOB ADDRESS: PERMIT #
r 7 �e - �v �.�,.-- c;�-�. � ' o � ' /
OWNER'S NAME: �.e � S ` , � � PHONE # - 7 , ,
GENERAL CONTRACTOR: �' r , � . FAX # �.. q � G
I am not using any subcontractors: �� (c3 —�:,`'— � 7
�;na e Date
Please check a licable subcontractors and com �lete the followin information:
SUBCONTRACTOR BUSIr1ESS 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
_- fU ^ ` S' c' �Z
er Contractor Signature Date