06030073 (2) CITY OF CUPERTINO
BUILDING DIVISION PERNIIT CONTRAC"TOR INFORMATION•
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BUILDING ADDRESS: PERMIT N0.
06030073
099&NB ,AZINGWOOD AV PFRMTILZUEDATE
-'INE; SANTEARYN LNO.
ARCHRP.Cr/ NGINEER: BUILDING PERMIT INFO
BLDG EIF.CI' PLUMB MECH
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i0 LICENSEDCONTRACTORSDECLARATION JobDescri tion
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NN Sctim7")dDivision Sof thC Hudaeaxand Profeax'ns Codc, Ylcerah
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AMERICAN EAGLE PD FOR BL 3/14/06
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YOPlW•nN•EahRa-lBl bUeILuDaEdRu DECLARATION
ECLARATION FINALE®
i f I bachY.R that 1 w e.cmpl from IK Convutor'.L w ltaw for the
L O following n o.(Sation 71013,Dudreax and P t szi m Coda:Any city a county
3 which require a f rinit to a 1.alter,impmw,d.molidi,or,rt{uir MY suuctvm
print in is i—Mce..iso require ftar,,baant fm uah Notrit w Bk.Wi, danR.L
:c dalhcis1abndpwvuutooapmriaiduaNCCaur.cwr'tLi Law(CUlacr9 Sq. FL Floor Area Valuation
(.menclnywW Sectiw 70)0)d Dividon 3 of the Bin uW Pmfedmn,Cad.)a $10800
$ mad h b eacnpt theaffom anti the bah for thin adkipbd eampdon.Any nohtim of ni ARAM a IN A Afth
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S on 7013 byanyappliaw foap=ft aubjebv ftmWlient to a CIW pcmhy of APN Number 19ecupancy TI pe
not moa Can Res hwdnd down(S5m).
0 LaxowwrdWe W^Wty.a my employee with wain as lheh a4 wmpe ob,
will do Ne work.and the aboj u Is nor Ivtvtded or offend for We(Sec.7D11,9tvle.••
and Profession,Code:The CaancuW.Mesio LAw dao wt-11,to.n owma of Required Inspections
proPemy wbu badMa or boptmea thuwn,and who doe.sh work bimalf or thlmjh bis
ow.employee.VMjdcd than orcin hmptowmwu an,tet inteNd or offerM for aide If,
however,the hlldi,a rm mtcmwl agold Mrbbr ate yaxr of Coropktiora the oonxr.
bulWer w 11 b.,e th baAw of pmvint than be did m WW or hoprae for IMF.of
axle_}
❑L u owner a t pmpeny.am edmhTlY coo c t with ll cootaxeran an
comtnat Ce papa(Sec 7061.Br drtea and Profl w.Code:)The Contraanr'a 1-1-
c^"•-
lc^"•-Law doe wt imply in an owma aproperty wino milds m hoM m Jr ew,and
who aeurta for avch projem with.cobracW.)licemed pummm to the Cw� -
Lkxna
labi"=Ptubdnr Sec .B&PCTs thio ream
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WORKERS COMPENSATION DECLARATION
1 booby.ffun uMef pratlty of perjury oro 4 ttr followlne d irmatiatt:
I bare W w111 mainaln a Cenlf.t,aCaaent to aU-in,ute for Watch Coop
on,ax provldd for by Section 3700 of de Labor Code.fa the p.fonn.or the
wdtk fa esti h Ni.pmoit is iuued.
❑I late and wiU maintain Wakcr'a Comp tion I..u agimd by Sectiw
170.(0e Diner Code.for the perfarmaaoof the wort for w a thas permit 4lvaed
My Wokal Commotatiou 'a and Polity romber aa:- ,
GnSir -r - Policy No.:
- -CERTIFICATE OF EXEMPTION FROM WORKER v
COMPENSADONINSURANCE
(Tina actim tend not h ccmPlctd U de permh h fmorc horbrtd dollua($10)
ak )
1 c fy that In We pafomn a of do wort fa which this pbrmlt 4 hand,l"I tan
to Ployany penes In any tanner anal m becamesublet to thcworicnn Cdode tion
Ixwa of Ca iromia.Due
App=
NOTICE TO APPLICANT:Ir,after making Nis Cenifiaxm of Ecunpt'ue,you ahmld
bcwme aobJat to We Wto4 .Com,nanion pm,,ition,of ft Laha Code,yes mull
Z foMwith mriply wlthauch pmv4iom or this pennit Maild.dttocd tnete6
0
y CONSTRUCTION LENDING AGENCY
I hereby.(Linn that NCR h a emanucdmm Iptdint.tetcy for the Lerfonrri of
> Ca wort for which this pctmit is inw4(Sec 3IN7,CW.C.)
AL<nda's Name
z Ledeh Add ax
C) 1 certify des 1 Lave red thin appimmin tab use Nn the ii m information is
cmecb 1.tree to commy with ail City and today odirtutaa ad nor¢I.w relYin{W
building co fioa.and herebyauNoria repreaomites or 04 city to wet upw ft ahow.mentKxvH pmrp y for ltapcctim pmfroai
(Wc).y 0 axes,indemniry W keep hcmkn the City of Cupmiw ag0w
Lei Iiab104ca,IdL^en¢com aM eapw.et w hm.yln.nywayacauc.{.Imtaxid Ciy
APPLICANT UNDFRSTAnNDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date 3� `7-ce
so-!(u o(REcuyAT/11� 3-�k_Q�. Re-roofs
SifrtuAA-PPPIIIi=UCobV W Doc
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
wIB did applinrit or futmb bWldint Ccsupantuoe a handle hnudoua anterial
as defined by the Copeniw M ,Crapes 9.12, nhe Hulth ob Safety
Cnab,Smwss532(.n
All roofs shall be inspected prior to an roofingmaterial beim installed.❑Ym __ �
Will the rt,kant or fntme wildint oaepam tae equipment in tri w Ich If a roof is installed without first obtaining an inspection,I agree to remove
,It It 7abnus Wr aonamimout u def by the Bay Agra Air Quality Maori all new materials for inspection.
7
pYe o
I bate aced the hnaAom vutaiW rapirtmcm+udv Chapirn&95 of the Califs
.in Health&SWay Cod.,Ss bbt 25505.25533 ad 25531.1 imiie tarb thatlftic bulWmS
doe not curntuly h..e.was,Cat It 4 my o pwdbillty in notify tic mvp.nt of th
requitcmCnaw h- ma Pnorwiauanaeu(.Cwfaaeorac,pn Signature of Applicant Date
Q t-/y-0 6 All roof coverings to be Class "B"or better
Owns aauthoricda crit IV Doc
CITY OF CUPERTINO
1 of 1 PERMIT RECEIPT OPERATOR: suem
COPY # 3
Sec: Twp: Rng: Sub: Elk: Lot:
APN . . . . . . . . : 36917013 .00
DATE ISSUED. . . . . . . : 03/14/2006
RECEIPT #. . . . . . . . . : 33564
REFERENCE ID # . . . : 06030073
SITE ADDRESS . . . . . : 922 BLAZINGWOOD AV
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : SUMAN S SURESH KALBAG
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4619
RECEIVED FROM . . . . : AMERICAN EAGLE ROOF
CONTRACTOR . . . . . . . : LIC #
COMPANY . . . . . . . . . . :
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . .
TELEPHONE . . . . . . . . :
.EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
BPERMFEE VALUATION 11, 000.00 180.36 0.00 180.36 0.00
BSEISMICRE VALUATION 11, 000.00 1.10 0. 00 1.10 0.00
BUSLIC FLAT RATE 1.00 105.00 0. 00 105.00 0.00
TOTAL PERMIT 286.46 0.00 286.46 0.00
METHOD OF PAYMENT AMOUNT NUMBER
------------ ------------------
CHECK
_ ____CHECK 286.46 0974
TOTAL RECEIPT 286.46
•
F Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
AOF Fax(408) 777-3333
4JUPERTINO
Building Department
JOB ADDRESS: PERMIT #
O`OC /G 7t 1.4 , 00i A c:5603007 �
OWNER'S NAME: _r ;, �., PHONE # 1-/-, sr'�- b 19
GENERAL CONTRACTOR FAX #
I am not using any subcontractors: 3— /y - a�
SignatuTC Date
Please check applicable subcontractors and complete the following information
60 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
Community Development Department
c Building Division
City of Cupertino
i + 10300 Torre Avenue
• Telephone: (408) 777-3228
CITY OF Fax: (408)777-3333
CUPEkTINO
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 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.
O 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-
woofing.
Homeowner's Name:
Job Site Address: /� n _ I a 7i� c LooQ A"q
Roofing Company Name:
Applicant's Signature: �.�1 �.Le Date:
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Peper