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09080353 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20374 CLIFDEN WAY C:)NTRACTOR:K H ROOFING PERMIT NO:09080353 OWNER'S NAME: MULKA RAVI V-56 LITTLE ORCHARD ST DATE ISSUED:08/25/2009 .R'S PHONE: 4086878888 S.UN JOSE,CA 95110 PHONE NO:(408)293-2754 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# MECH F RESIDENTIAL COMMERCIAL f Contractor < y 'r, � j�17 Date �r I hereby affirm that I am licensed under the provisions of Chapter 9 J 3B DESCRIPTION:RE-ROOF TEAR OFF WOOD SHAKE BUILD DECK (commencing with Section 7000)of Division 3 of the Business&Professions 1 OSB Code and that my license is in full force and effect. PLYWOOD,THE FLATROOF WE USE THE METAL DARK BRONZE COLOR,THE PITCH WE USE 40 YEAR COMP,CLS A 30SQ I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 1 have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area: Valuation:$10000 permit is issued. APPLICANT CERTIFICATION O,PN Number:36936020.00 Occupancy Type: I certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Issuedb� Date: Signature Date 1 .� CI OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that 1 am exempt from the Contractor's License Law for one of ,Ul roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for I,as owner of the property,or my employees with wages as their sole compensation, i nspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, - - Business&Professions Code) :signature of Applicant: Date: I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE I have and will maintain a Certificate of Consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the l have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain I have and will maintain Worker's Compensation Insurance,as provided for by -ompliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Safety Code,Section 25532(a)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534. Compensation laws of California. If,after making this certificate of exemption,I C become subject to the Worker's Compensation provisions of the Labor Code,I must Owner or authorized agent: ^� forthwith comply with such provisions or this permit shall be deemed revoked. ,i i Date: CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save it �ify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address CIL and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. 1 understand my plans shall be used as public records. _ c , Signature Date - f Licensed Professional I- . CITY OF C UPE� RTINO REROOF CIT'of PERMIT APPLICATION CUPEkT1NO Date: APN # Building Address. FPhe#: Owner's Name: HOA: Yes ❑ No ❑ If yes, provide letter from HOA r Phone #: Contractor: - ; Fax#: Business License #: Contractor License #: Cupertino 9 Type of Roof Covering: FExisfing- Proposed: ❑ Built-Up roof ilt-Up Roof Ld Asphalt Shingles sphalt Shingles ❑ Wood Shakes ood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other (Specify) ❑ Other (Specify) ❑ Provide I.C.C.E.S. Report# Number of existing coverings ❑ Provide Mfgr. Installation Specs. ❑ To be Removed Job Description: Commercial ❑ Residential Q • Please complete relevant portion of the Confirmed with Planning Dept. if Green Building. P ❑ Green Building Checklist & attach it to the a,�plication or if there are any restrictions: applicable, include in lan set & the sheet ine.ex. Valuation: t I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy: Signature Revised 02/05/09 i CITY OF 41UPERTINO REIROOF CUPEkTINO FEE SCHEDULE Number of Fee ID Fee Description Fee Permit Type Squares Group 1REROOFCOM Re-roof Commercial B 1COMMLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1 BSEISMICO Seismic C:)mmercial B 1REROOFRES Re-roof Ro.sidential B 1SFDWLR00F 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee / 1BSEISMICRE Seismic R,;sidential B 1 REROOFMRES Re-roof Multi-Family B 1MFDWLROOF 1 BCBSC Cal Bldg !E_tandards B ALL PERMIT TYPES Commission Fee 1BSEISMICRE Seismic Rosidential B 1 BUSLIC Business License B 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 2007 IBC Standards and manufacturers specifications on re-roofing.All roofs are Class "A"per Cupertino municipal code 16.04.080. 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 nz<il inspection is required. 6. Any roofing which is applied withov.t 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 nai l 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 cim be scheduled. IMPORTANT: 1. Flat roofs must have a minimum of lei "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: Job Site Address: _ Roofing Company Name: !� ' Applicant's Signature: Date. Greg Casteel Building Official Rev:sed 07/30/08 Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 XPEkTINO Building Department JOB ADDRESS: ' ., PERMIT�0 OWNER'S NAME: PHONE # GENERAL CONTRACTOR - FAX # I am not using any subcontractors: Y 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