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12120088 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1025 CRANBERRY DR CONTRACTOR:CASTILLO'S ROOFING PERMIT NO: 12120088 OWNER'S NAME: CHANDRASEKAR KRISHNAMURTHY 1703 CATHAY DR DATE ISSUED: 12/17/2012 OWNER'S PHONE: 4085075013 SAN JOSE,CA 95122 PHONE NO:(408)251-3565 LICENSED CONTRACTOR'S DECLARATION _ G�f BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class C� Lic.# L�L ✓�� MECH J_ RESIDENTIAL COMMERCIAL Contractor Date % AA- I hereby affirm t t I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:TEAR OFF EXISTING ROOF INSTALL 30#FELT,INSTALL (commencing with Section 7000)of Division 3 of the Business&Professions NEW GAF GRAND SEQUOIA COMP SHINGLES 25 SQFT CLASS A Code and that my license is in full force and effect. 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. I 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:$6400 permit is issued. APPLICANT CERTIFICATION APN Number:36203016.00 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. Issued Date:� ��f- Signature L Date` l 7 ❑ OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All 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, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Signature of Applicant: Date: 1,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 I 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. I will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material. 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 1 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 become subject to the Worker's Compensation provisions of the Labor Code,I must Own r utA rized agent. forthwith comply with such provisions or this permit shall be deemed revoked. 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 indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address costs,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. I understand my plans shall be used as public records. Signature Date Licensed Professional REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333•buildinoancuperlino.org PROJECT ADDRESS ;, APN# I- OWNER NAME ii l l'Y ' } m� PHONE E-MAIL STREET ADDRESS CITY% TATE,ZIP I c j CONTACT NAME �' ^� PHONE 7 E-MAIL STREET ADDRESS ^ ` - CITY,STATE,ZIP ^ '. FAX ❑ OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTORNAME � r / ( LICENSE NUMBER % ;_ 'j LICENSE TYPFir? _�J BUS.LIC.# COMPANY NAME E-MAIL FAX 4' STREET ADDRESSi CITY,STATE,ZIP " f PHONE' 1 y y ARCHITECT/ENGINEERNAME LICENSE NUMBER BUS.LIC.# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ,Ej'SFD or Duplex ❑ Multi-Family ROOF AREA: ) VALUATION: STRUCTURE: ❑ Commercial . )/ •`jam �~�' C' EXISTING ROOF TYPE: ❑BUILT-UP ROOF ZrASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY) REMOVE/REPLACE.F<S IF NO, c., PLYWOOD ❑ -w, ❑ PLYWD ❑OSB PITCH: f ROOF ❑ NO #LAYERS. THICKNESS: ❑ 5/8" TYPE: ❑CDX , 12 CLASS: A PROPOSED ROOF TYPE: ❑BUILT-UP ROOFASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT# DESCRIPTION OF WORK:.._- - - L, :Clc lr � IV By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agre to complywith all applicable local ordinances and state laws relating to building coo d�ruction. a orize representatives of to enter the above-i{d rr pro o spection purposes. Signature of Appli anVAgent: _ Date: 6 ( fl SUPPLEMENTAL 1NRMATION REQUIRED OFFICE USE ONLY _ Prov buildirig is associated with a Ho a Owners Association,provide letter PLAN CHECK TYPE ROUTING LIP-- proal from HOA. THE COUNTER B DI REVIEW PP vide Planning approval to verify if there any restrictions. ❑ EXPRESS D PLANNING PLAN REVIEW `Provide copy of Manufacturer's Installation Specifications. ❑ STANDARD FIREDEPT t,41'rovide signed copy of Cupertino's Tear-Off Policy. ❑ oTIIEA , ReroofApp_2011.doc revised 03/16/11 CITY OF CUPERTINO FEE ESTIMATOR— BUILDING DIVISION ADDRESS: 1025 cranberry dr. DATE: 12/17/2012 REVIEWED BY: bobs. APN: BP#: *VALUATION: 1$6,400 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex PENTAMATION 1 SFDWLROOF USE: PERMIT TYPE: WORK SCOPE I fc(,h. K7 r'druttt>.1"rrrr CIrcci; f7<c I';4ar (.'faxk rl.hc.i. P'rtt7t Iter: 1'/urrrlr. F'zr,rtT�°e: lit'fc P.Irn>;f;°e Li 017f c,. Li NOTE.This estimate does not include fees due to other Departments(i.e.Planning,Public Works, Fire,Sanitary Sewer District,School District,etc). Thesefees are based on the prelimina information available and are only an estimate. Contact the De t or addn7 info. FEE ITEMS(Fee Resolution 11-053 Eff 7./1%122 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 2,500 s.f. Re-roof __jSuppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 $375.00 1REROOFRES PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee Q Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 C�uiistrririiOlt 1'tM": Adinbiisfrati�,(,Fee: Work Without Permit? 0 Yes No $0.00 Advanced Planning Fee: $0.00 Select a Non-Residential Building or Structure 0 E1-ovel 0o ionctitcrtit>ri !ccs. Strong Motion Fee: 1BSEISMICR $0.64 Select an Administrative Item Bldy,Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $1.64 $375.00 TOTAL FEE: $376.64 Revised: 10/01/2012 Building Department City Of Cupertino La 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: ('•. -; '-r"f" PERMIT# 22 a� OWNER'S NAME: ( � 6 r '� r' v 1 f�U-io,i,t , •j►,' PHONE# GENERAL CONTRACTOR: �� "S`1? C�`> £''i - "��e_ BUSINESS LICENSE# ADDRESS: ( �• ' ' .,,_ c - CITY/ZIPCODE: � o'' Cl� 1 ` *Our municipal code requires all busine ses working in the city to have a City of Cupertino bVkiness license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using an subcontraete :R- Y rs Signature Date Please check applicable subcontractors an complete the following information: V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring/Carpeting Linoleum/Wood Glass /Glazing Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile ` t Owner/Contractor Signature Date