06100144 CITY OF CUPERTINO ACL TR CTaR. tow
i
Y;UILDING DIVISION PERMIT
BUILDING ADDRESS: T D ROOFING PERMIT NO. 06100144
10657 LARRY W PERMIT ISSUE DATE
OWNER'S NAME:
KISHORE KASANSEHY 675 TULLY SANITARY NO. CONTROL NO.
NE:
(4 0 8) 8 92-8 8 72 BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
99z LICENSED CONTRACTOR'S DECLARATION Job Description
tVP 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing
z� with Section 7000)of Division 3 of the Business and Profe'ions Code,and mI license is
!o y in full force and effe�t 'J,G ) REMOVE WOOD SHAKE, REPLACE W/ TL COMP
t ? License Cl Ltc•
t p Dam C Contractor
m RCHITECTS DECLARATION nn
i e l understand my plans shall be used as public records U
t0.0
to H Licensed Professional
y OWNER-BUILDER DECLARATION
>• 1 hereby affirm that 1 am exempt from the Contractor's License Law for the
p�o following reason.(Section 7031.5,Business and Professions Code:Any city or county
%m which requires a permit to construct,alter,improve,demolish,or repair any structure
H prior w its issuance,also requires the applicant for such permit to file a signed statement S Ft.Floor Area Valuation
?< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 �l
t= (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of AMR [ 00 Occupancy Type
not more than rive hundred dollars(5500).
❑1,as owner of the property,or my employees with wages az their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections
and Professions Code:The Contractor's License Law docs not apply to an owner of
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for sale.If,
however,the building or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044.Business and Professions Code:)The Contractor's U-
cense Law does not apply to an owner of property who builds or improves thereon,and
who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's
License Law.
❑1 am exempt under Sec B&P C for this reason
Owner Dare
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
LJ 1 have and will maintain a Certificate of Consent to self-insure for Worker's Compen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
h and will maintain Worker's Compensation Insurance,as required by Section
the Labor Code,for the performance of the work for which this permit is issued.
My Workers Co peas ion I carric land Policy number ares
Carrier. Ll L t licy NO.: 15 C1
CERTIFICATE Op EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars($I00)
or less.)
I certify that in the performance of the work for which this permit is issued,1 shall not
employ any person in any manner so as to become subject to the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
,J z forthwith comply with such provisions or this permit shall be deemed revoked.
Z, CONSTRUCTION LENDING AGENCY
(~.t►-. 1 hereby affirm that there is a construction lending agency for the performance of
Q!
the work for which this permit is issued(Sec.3097,Civ.C.)
W Q Lendces Name
Q. Lender's Address
U C) 1 certify that I have read this application and state that the above information is
L>. F correct.I agree to comply with all city and county ordinances and state laws relating to
O U building construction.and hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes.
�-4 OW. (We)agree to save,indcmni(y and keep harmless the City of Cupertino against
liabilities,judgmentsWAng
costs and expenses which may in any way accrue against said City /
V Z in consequence f tof this permit. Date '61 r/
APPLICANT NDS AND WILL COMPLY WITH AL NON-P INT Issued by:
SOURCEREG L
<<= 1 1 Re-roofs
Signature of Applicant/Con to Dare T of Roof
HAZARDOUS MATERItLISCLOSURE ypeWill the applicant or future building ocre orhandle hazardous material
as defined by the Cupertin untcipal Code.Chapter 9.12,and the Health and Safety
Code,Section 25532(a). All roofs shall be inspected prior to any roofing material being installed.
❑Yes
If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use equipment or devices which
emit hazardous air conramiripts p-deNcd by the Bay Area Air Quality Management all new materials for inspection.
�G� r
District?
❑Yes ❑No
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- 1 f v
nia Hcalth&S et C ,Sections 25505.25533 and 25534.1 understand that if the building i
does not curie tl h a tenant,that it is my responsibility to notify the upant of the Date
rr rcments t' l rior to issuance of a Cerdfic of Occ ancy. Signature of Applicant
U All roof cove ' gs to be Class"B"or better
rl Owner or authori-red agent Date
Community Development
So, 10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CIT$OF Fax(408)777-3333
'-UPEkTINO
Building Department
JOB ADDRESS: CA V PERMIT #
OWNER'S NAME: i,�L s h 9- 01 S A- 0 e 1 HONE # Ci SI5 I �I 1�1 Q)
GENERAL CONTRACTOR: D ' �� #
I am not using any subcontractors:
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
Owner/Contractor Signature Date
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 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 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: i S 11 U ��J Ck S 1'l %�1
job Site Address: i 0 (o S
Roofing Company Name: �� 0'
Applicant's Signature: �' Date: PG I 9C L
Greg Casteel
Building Official
Revised 11/2/04
CITY OF CUPERTINO
�m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 31602011 . 00
DATE ISSUED. . . . . . . : 10/19/2006
RECEIPT # . . . . . . . . . : 36493
REFERENCE ID # . . . : 06100144
SITE ADDRESS . . . . . : 10657 LARRY WY
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : KISHORE KASANSEHY
ADDRESS . . . . . . . . .
CITY/STATE/ZIP . . . : ,
RECEIVED FROM TD ROOFING
CONTRACTOR . . . . . . . : LESLIE HOANG LIC # 23155
COMPANY . . . . . . . . . . : T D ROOFING
ADDRESS . . . . . . . . . . : 675 TULLY RD
CITY/STATE/ZIP . . . : SAN JOSE, CA 95111
TELEPHONE . . . . . . . . : (408) 892-8872
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
- - - ---- - -- - - -------- -- - ---------- ---- ---- - - ---------- - ---- ----- ----------
BPERMFEE VALUATION 9, 000 . 00 158 . 76 0 . 00 158 . 76 0 . 00
BSEISMICRE VALUATION 91000 - 000 . 90 0 . 00 0 . 90 0 . 00
---- ------ ---------- ---------- ------- ---
TOTAL PERMIT 159 . 66 0 . 00 159 . 66 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
- - - --- - --- - - ---- - - ------- ---- ------------------
OTHER 159 . 66 VISA
TOTAL RECEIPT 159 . 66
bt��oo i44
CITY OF CUPERTINO
RE R�➢OF
CUPEkTINO PERMIT APPLICATION FORM
Date: I o
APN# 31Co-Oa " 01 1
Building Address:
I O S cl t 4
Owner's Name: P one#: _ ,
K , S l 1 cL S C-1 1'1 S C1-t- �� (o p
Contractor: License#: 5__
Contacts ( l'4 os 1 �J q p S�� Cupertino Business License #:
l' J D
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles � Asphalt Shingles
Wood Shakes ❑ Wood Shakes
Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
J�lpmber of existing coverings ❑ Provide I.C.B.O.Report#
1�r/►C To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read, Understand and Will Comply With Cupertino's Tear Off Policy:
Job Description: f
7LL-s))0")C "VU O�A S l i Ck -&- � C� "k
Residential XCommercial ❑ C C1�>S
Fire Zone: Yes ❑ No Confirmed with Planning Deft. if
there are any restrictions: LJ
Cost of Project: Type of Construction: Occupancy group:
g5 OD U -13
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