06020028 CITY OF CUPERTINO (�^}•L• "°F1fZ�Z1°7f'1;��%��yy°ya�y,��+'�vrag'��,"g••//��
BUILDING DIVISION PERMIT �aCCSNTReCTUR T21l�AM�11V�'
BUILDING ADDRESS: PERMff N0.0 6 0 2 0 02 8
19639
Its NAME: PERMIT ISSUE DATE
MR & MRS VAKSHAN 12/09/20 6
PHONE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACTOWSDECLARATION JobDescription
1 hcmby affirm Net I am licensed under provisions of Chapter 9(commencing
withS.0 7")uIDI visio Sof the Busintasand C dm nd ycense is
M mmnranandARecL�J Lug REROOF-T/O (E) -INSP COMP SHINGLE CLASS A
?�z_ Lmenec _ NO SHEATHING-VA TOIQ RSO AN6 •P�llt,(YR BL 2/6/6
q Dem Contrulor ttso ��
W s Mill bCTS DECLARATION !fid1)
U 1 ubocrwnd my Ptans Mall be usod u public rtcorOs
to(�• Licensed Professional
5^03 OWNER-BUILDER DECLARATION FEB tl-2006
gm I hereby Hirm that I Am exempt from the Contractor's License LAW for the
0 0 following rtason.(Section 7031.5,Business and Professions Cale:Any city Of County
$fL which requires a permit to construct,cher,improve.demolish,or repair any mumu p ♦ M
_Zto prior u its issuance.also requires tiro applicant for such Permit m rile a signed statement p � �n
� Ihat he la lleelleCJ pu1e110m In NC pmYIelON of UM Caamctor'a Llt1'mC IJw(CMplef9 Sq.Ft.Floor Area V� (3V8iltl,n, aluati$18500
Er,zC (eanmencing with Sttlion700o)of DivAkm3 of Ne Bushuxuand ProfessionsCodc)a till V
g 3$ Nat he is exempt therefrom aM 0n but,for the alleged exemption.Any vlolallon of
Section 7031.5 by scy applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not Come M.five hundred dollars($500). 31635002 . 00
0 1,as owner of the property,or my employes with wain u Nem sure compensation,
will do the work and Neaworum I not intended aonued image(Sm.7044,Business Required Inspections
and Protections Cade:The Contrast's License LAW does oat apply of an aWIKr of q P
p reperty who builds or Improv thereon,arm wha doss such work Mmsr3f or through his
ownemployces,provided that such Improvements are not Mounded oroffered for ale.If,
however.Am builNni a imp.mat is sold within oro year of completion.the aWeer-
buildear Will have M,burdu of proving that he did nm Wild or Improve far purpose of
sale.).
0 1.As maw of the property,am exclusively contracting with licensed untreno s u
construct the project(Sec.7044,Business and Profession Cade:)The Conuuuls U.
retie Law data not apply N an owner of property who builds or improm dureon,and,
who contracts for such pmjecta with a eonmemr(0 licensed pursuant in the Contractor's
License Law.
O l em exempt under See .B At P C for this recon
Dau
WORKER'S COMPENSATION—DECLARATION
I hereby affirm under penury of perjury one of the following decimations:
0 1 have and wfll maintain aCersificueof Co sent N self-loom ferWorker's Compen-
Wien,As provided for by Section 3700 of the later Code,for the p uformance of the
Work for which this permit is issued.
0 I hove and will maimain Water's Compensation Insurance,u required by Section
3700 of On labor Code,fa me performance of the work for Which this permit u loud. /
My We 9 Insurmrtecamimand Polity a br
Gorier T Polley No
•RTIFl
C C OF N FROM WORKERS
COMPENSATION INSURANCE
cmis rection Amur act hccompleted If tic Permit isfarone hundreddollas($100)
or lea)
1 canHy that In the perfnmsuco of the work for which Nie permit is laved,l Mall not
employ any person in any manner an u to become object to Me Wo lews'Compensmon
Law of Coffomig Dau
Applicant
NOTICE TO APPLICANT:IL after making this Certificate of Exemption.you Mould
become subject in 0s Worker's Compemedan provisions of the labor Code.you muss
0z forthwith Comply with such provisioro or this Perron"I W deemed revek6
ZO CONSTRUCTION LENDING AGENCY
(.w I hereby affirm des there is a Construction lending agency for the performance of
C'sem+ the wok fa which this Permit is issued(Sac.3091,Civ.C.) '
WM Q Lendm3 Name
Z Lender'.Address
U Q 1 certUy,that I have mad this application and sus that the Move information it
U. (r amrtecL I Agree m comply with all city And county oremarms and etas laws relating to
0 building construction,and hereby authorbe reprtseusam of Nis city to Conte!upon the
CTt above-mendonW property far Inspection purposes.
G (We)agree to an.indemnify and keep hinnmv the City of Cupertino against
rat liabilities,judgments,cam and expenses which may in try way accrue sgalnstWd City
V Z in consequence of the$noun$of this permh.
"-' APPLICANT UNDERSTAN ND WIL PLY WITH ALL NOWPOINf Issued by; Date Z• 1-z;�4
SOURCE L D
Re-roofs
Signatme of ApplicansContnc Dau
HA2AR9&U§MATERIALS DISCLOSURE Type of Roof
Will the applicant or forum building occupant sum or handle haardou material
defined by the Cupertino Municipal Code,Chapter 9.I2,and the Health and Safety
m, es 255324)?255324)? ❑Na
C] at YAll roofs shall be inspected prior to any roofing material being installed.
❑
Will Nc applicant or future building occupe t,use equipment or devise which If a roof is installed without first obtaining an inspection,I agree to remove
emit henrdou.ir conuminata as deRncd by the Bay Area Air Quality Management all new materials for inspection.
DI.niet7
13 yo, []No
I have mad the h' dnusmammalsrequimme ser Chapter 695 of the Glifor.
ole Health$:Sefcty Code,SCotiou25503,2133 s34.iandastval Nmuthc building
don am cam ¢ace L that It u nsponsthility u notify ties occupant of the
mgvlremcn whi bcma Ance.I.certir aLarom p -to Signature of Applicant Date
Owner ser auhansrd.gOm Dare All roof coverings to be Class"Bic or better
CITY OF CUPERTINO
I• 1 of 1 PERMIT RECEIPT OPERATOR: suem
COPY # 3
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 31635002.00
DATE ISSUED. . . . . . . : 02/06/2006
RECEIPT #. . . . . . . . . : 33086
REFERENCE ID # . . . : 06020028
SITE ADDRESS . . . . . : 19639 MERRITT DR
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : MR & MRS VAKSHAN
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
RECEIVED FROM . . . . : VA TONG ROOFING CO
CONTRACTOR . . . . . . . : LIC #
COMPANY . . . . . . . . . . :
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
• TELEPHONE . . . . . . . . :
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
__________ __________
BPERMFEE VALUATION 10,000.00 169.56 0.00 169.56 0.00
BSEISMICRE VALUATION 10,000.00 1.00 0.00 1.00 0.00
BUSLIC FLAT RATE 1.00 105.00 0.00 105.00 0.00
---------- ---------- ---------- ----------
TOTAL PERMIT 275.56 0.00 275.56 0.00
METHOD OF PAYMENT AMOUNT NUMBER
_________________ ------------ _________-----_---
CHECK 275.56 3153
TOTAL RECEIPT 275.56
Community Development
10300 Torre Avenue
• Cupertino CA 95014
Telephone(408)777-3228
aC101 Fax(408)777-3333
CUPERTINO
Building Department
JOB ADD ' 3 � PERMIT #
OWNER' NAME: PHONE # < j",�Z C�
GENERAL CONTRACTORFAX#
I am not using any subcontractors:
Signapifa Date
Please check applicable subcontractors and com lete a 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
j 10300 Torre Avenue
• CITY OF Telephone: (40088;� 3228
CUPEkTINO
333
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$176.15. 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: /mr V MI-5
Job Site Address: ! / /�7G�"� ,air�l
Roofing Company Name:
Applicants Signature: a
• Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINO
'WC REROOF
`UEIkTINO PERMIT APPLICATION FORM
APN# s �a Dat '
Building Address•6 3
Owner's Name: o e
Contractor: Phone# icense#:
OyC-- >iGG //� G S3 z �3 0
Contact: Phone#• Cupertino Business License#:
�G i Z
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
-W.Asphalt ShinglesAsphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report#
❑ To be Removed ❑ Provide Mfgr.Installation Specs.
Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
ob Des 'ption:
S/S / �
/l �-
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning D
there are any restrictions: Eept. if
Cost of P jec�t. n� Type of Construction: Occupancy group:
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