06080059 F
TY OF CUPERTINODuILDtkb DIVIGION PERMIT aCOAt,,jUCTORWIN'FORMA'TION' '-,h`DING ADDRESS: MDC ROOFING P°`M�NO'06080059
0222 BARBnUt7t TA
ERS NAME: PFRhfff patIEDATE
BAXI HIMANSHU 1612 TRIES
ONE SMM "
NO. CONTROL NO.
(408) 271-9548
ARCHf1F.Cr/FI3GRIEER: BUILDING PERMIT INFO
BLDG ELECT PWMB MECH
0
OOp LICENSED CONIRACMS DECLARATION Job Description
U 1 hachy'Tbco Jut I am ®a
11d.t provivwu or C.".9(mmnaclnL P
N Secdut 7000)of DivLdm 3 or Nc Butinctoand PmfeW=Code,attl my&cccc u
m full fma.ttd of REMOVE WOOD SHAKE & SHINGLES, INSTALL 7/16" PLY
'g� ` 6 uc.11,
Cvmncwr AND ROOF, 50 YEAR CLASS A
F Mr^
AR HDECLARATION
ltotderuutJ mlw tW11 y pO k be usdu public tawM
� U
t� Li cri¢d PmfemorW
OWNER-BNLDPA DECLARATION
:C C 1 tc uirm Nu I em a<td f too t!r CarmaceCO IJeaue Iry fm Ne
:p o It nc ai=l. u' 71131.5,Bvdtcsso, Pofe`o` CtWe:Aoy ehy w cwmty
9�+ ic, ivi it...
a P. to cormrtct.ober.11L f me demaOW.w tepoh.ny oUco,c e
liy priormptitlutrcc.aBom9uJottrtpplinntfwtechperoitmBh.ilLrcdsuctmm
Ft. Floor Area Valua$TB000
< Nu he h lkcnwd purmml to the pmvicwo of Nc Ctnuacteft liamc Lar l(b.Pa9 Sq.
(cutnmatclnL wlN Salim 7000)+1 D yWoo 3 Nthc Budttc Prorcuiom Codc)w
_ Jut he 17 eaavpt tbmfr®aM Ne huh fa Jn JWLed eaampUan Any vbWltm of
Sedco 70315 by atq aPpllam I.a petted mbjcca Ne-Wham to a li 0 P icy of APN Number - Occupancy Type
ow ooe Otto 0w Modred dalhn(550(1). 35912020 . 0 0
❑1,u avow of tic ptoputy,Otto,wpb5w wbh v�La u tdctr tdc aanpmuJm,
w Ooft.arlr, thorn, unot"'eeded'aficclW"lelsoc- ",B,oti— Required Inspections
eoO Pof==Cede:The C.1=1r);m7amIJ Lav don em aP*m N w of
VWMy vbo WM w impow Jame,and who d Auchwork hlmtelfa 1hot4b his
aw emfdoyat.P(Wlded that t hpproemmu ue vat Wtet aolfertd fat U. .
hawetv.thehtyc tho o&oof ovinh mid dW meyeu Niotp, fWto,the aw of
Evildv wW Lw tis hrtdett of govinL tW he did rot mik ar traprove fm WtPou of
❑L tl awta of the ptopmy.w eulmlvely coatrtj w'vh I3mucd motramaa to /
cantuttct t c project(Sec.7 .Buinen and Pefetnma Code:)The Coau.txtft LI.
nate Lew datl out apply m ao ower a proputy wbo buim W Improto tberem,
who cm"uo fw mch ptojecu witb.c.ocr tr(8)li—,d Pumant m Ne Coovuteh F, �IZ=yl .�
❑Iw cvmptuMC See ,B&P C fo,
OvmrDate
OR
AdL
WKERSC PENSTMONIDECI.V1AT10N
I hemby+Euro under penalty of perjtuy ole of the folbwinL't"�
l]I N.e and w0l maieuio a CatiE•*•o(Cwvicet to teU-Ittmm farW ftesConpm-
tatim,u pmvitlN for by saGan 3700 a the LAbvr Code.for the perftcmm¢a(the
wort fw which Nit pvott Lt imcl
❑I Mw uW will muwin WuryeYt Camtpemulan Itutana,u tcquimA by Sccdoo /
37(D of the Mbar Cook.for the pctforot.of the vol fa which Nu Permit h luueE. j
My Worhe2s C.afnpevwlm tnm`uoce a�rtai/a�W Policy own am: '�
Cam'cr. lcy No.:
OF ON FR OFUU3t
COMPENSATION WSUI CE
rat,maimted oat W complo"Uthe permit Al fame hcod doll—(SIM)
w low)
I t=u v Jot W Nc Pofomaoa of tb�v fm which this P ib h iatcd.I t l not
..ploy airy .in,ny vtaorcratl n baamemb*t m the Wo 'Cempoauim
IJwa of cAifamia_Due
Appl
NCrCCEeTO A"LICA ..If.after mati.j Nit CauOate a(E Pmo.you t w
hccc oe sa)=to tic wch s Compentotlan ft rima a Ne utb Cade,"nmtt
., to do O faMwi,b mmply with toed provltiwo m erm
this Pit th. W dmttN tl
z N CONSIRL3CfION LENDING AGENCY
'r+^ Ibcmby Nie that thele ht conttmdm koN.L+Rory fw Jc pcfornortmuf .
CL> the w (w which this permit h issued(Sec 3097,Civ.C-)
QIle IName
a z Lcodcr.Add..^
U O 1¢nify dot 1 hate t Nit appliotim and twc Nu the above Ofott wo h
D. F' corm+I M=to aropiy with til city W county a itt.M..td tote Ito tOwnt to
O[) WiWieL cmwuction,arq hereby mN oc mprmrncti a this city to cna upon tit
W .hove-rocndanN n,o,cny foe in cvm nttrpmesCL .
(We)+g.to ave,indemnify W t<cp hu the City M C.Perurto.picot
rZ Ilabilidn.JudLm(to,cmtt3.9 eapr"+•which may any way a amc.ji.said City
UZ in eamequence of the Jnt a7N Date F
^ APPLICANT nD A3f�s .`t L cony Y w ALL[ON INr Issued by: 0 �«
SOUR axVs. /
Re-roofs
SI API H CATIARDOUS MATvuA DIS RE D Type of Roof
t appliovt w force bWldinp a¢vpmtnwe m huWlc hanNom tnSa tid
u by t the Cvpmim MUMCIpJ Cede.Csapa 9.12,atW the HCJN ae4 Wny,
Coee.Salm 25532(+)7 All roofs shall be inspected prior to any roofing material being installed.
❑y.
Will the aPPlicvuw ftmvc Wildinf aavyrtt.'oi'o adM whim If a roof is installed without first obtaining an inspection,I agree to remove
cmlt haiardwu W,cmhmiw tl defucd by the Bay Arta Air Qwllty M Cctoeot all new materials for inspection.
Dhvicti
❑Y. Na --�dt
I have mid the rttuen.1t,.FImnao underCtaPp+h.95 of Jc Cahfw- "an
(/ (� /tdaHolth§'. ]5503.35533 ux1 .11fdcnund W INe bowing a 7. 6eutte m t,Joe I my ily to notify tic t f New�' of S gat a Date
owncw nacmt D,tn O All roof cover gs to be Class"B"or better
CITY OF CUPERTINO
em 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . 1 . : 35912020 . 00
DATE ISSUED. . . . . . . : 08/09/2006
RECEIPT # . . . . . . . . . : 35565
REFERENCE ID # . . . 06080059
SITE ADDRESS . . . . . : 10222 BARBARA LA
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : BAXI HIMANSHU
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : MDC ROOFING
CONTRACTOR . . . . . . . : MARTIN DE LA CRUZ LIC # 24875
COMPANY . . . . . . . . . . : MDC ROOFING
ADDRESS . . . . . . . . . . : 1612 TRIESTE CT
CITY/STATE/ZIP . . . : SAN JOSE, CA 95122
TELEPHONE . . . . . . . . : (408) 271-9548
•FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
- -- ------- ----- - ------- ----- - ---- - ------- -- --- - - -- ----- ---
BPERMFEE VALUATION 13 , 000 . 00 201 . 96 0 . 00 201 . 96 0 . 00
BSEISMICRE VALUATION 13 , 000 . 00 1 . 30 0 . 00 1 . 30 0 . 00
TOTAL PERMIT 203 . 26 0 . 00 203 . 26 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
- - - - - ---- - - - - - --- ------ ----
CHECK 203 . 26 2157
------------
TOTAL RECEIPT 203 . 26
•
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 1997 UBC Standards
and manufacturers specifications on re-roofing.
2. New roof coverings shall not be applied without first obtaining altinspection
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 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: WI(k XT FN kU Zb ( (
Job Site Address: 10 ZL &J'(La'yCl L,
Roofing Company Name: r2og> , n
Applicant's Signature: Date:k (o —
i
Greg Casteel
Building Official
Revised 11/2/04
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408) 777-3333
�UPEI�TINO
Building De artment
JOB ADDRESS: PERMIT #
OWNER'S NAME: PHONE #
GENERAL CONTRACTOR AX #
I am not using any subcontractors:
90
Signature Date
Please check applicable subcontractors and complete the foll 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
Owner/Contractor Signature Date
CITY OF CUPERTINO
REROOF
• CUPEKTINO PERMIT APPLICATION FORM
APN# 3t�q_ 12 M Date:
/ O
Building Address:
,
Owner's Name: Phone#:
Contractor: License#: r
Contact: Cupertino Business License #:
D C_k-
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles Ar Asphalt Shingles
W Wood Shakes ❑ Wood Shakes
4' Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other (Specify)_
Number of existing coverings X Provide I.C.B.O. Report#
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: 5D
or�
Residential I Commercial eieamA
Fire Zone: Yes ❑ No J Confirmed with Planning Det. if
there are any restrictions: LJ
Cost of Project: Type of Construction: Occupancy group:
(Loo , Vn
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING