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11010153 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 11786 PINE BROOK CT CONTRACTOR:CASTILLO'S ROOFING PERMIT NO: 110 10 153 OWNER'S NAME: REDDY VENKAT AND GOWDER SUJATHA B 1703 CATHAY DR DATE ISSUED:01/28/2011 OWNER'S PHONE: 4089140989 SAN JOSE,CA 95122 PHONE NO:(408)251-3565 LICENSED CONTRACT R'S DECLARATION 7 C� 3o BUILDING PERMIT INFO: BLDG r ELECT f— PLUMBF License Class �✓ + Lie.# , MECH r RESIDENTIAL r COMMERCIAL Con Date I hereby affirm at I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:TEAR OFF WOOD SHAKES,INSTALL#30LB FELT, (commencing with Section 7000)of Division 3 of the Business&Professions INSTALL Code and that my license is in full force and effect. GAF GRAND CANYON,CLASS A,19 SQUARES 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 is Sq.Ft Floor Area: Valuation:$9000 permit is issued. APPLICANT CERTIFICATION APN Number:36604050.00 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. Signatu . Date o?� // Issued by: Date OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shROOFS: all be inspected prior to anyy rrooofing 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: 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: I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE 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. permit is issued. Additionally,should I use equipment or devices which emit hazardous air 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 become subject to the Worker's Compensation provisions of the Labor Code,I mus Ow r arized agent: ut forthwith comply with such provisions or this permit shall be deemed revoked. Date:/A2??-/// ate: �o??' // APPLICANT CERTIFICATION _CONSTRUCTION LENDING AGENCY 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 --,ts,and expenses which may accrue against said City in consequence of the ;ting of this permit.Additionally,the applicant understands and will comply ..,.h all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION 9.18. I understand my plans shall be used as public records. Signature Date Licensed Professional Building Department City Of Cupertino 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: 78' PERMIT# OWNER'S NAME: ;F'.0 PHONE# �slo S GENERAL CONTRACTOR: BUSINESS LICENSE# ADDRESS: / ,rj C CITY/ZIPCODE:cS n Sf' 0.4 9_5 9- *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY F CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: X77` 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 Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile ,2Vl�/ Owner/ContractorSignature Date CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 11786 pine brook ct DATE: 01/28/2011 REVIEWED BY: b APN: (p ,0s i4 900* R*PERMITTYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof PRIMARY SFD or Duplex PENTAMATION 1 SFDWLROOF USE: I I PERMIT TYPE: WORK tear off shakes install new shingles. SCOPE FEE ID ROOF AREA s.f. 1 REROOFFRES 1,900 W,h, Plcm(`h,:(k PL.w /W("" Ll�»:it. Peau I'r T 1 t,rzh. Pc rmil F Lc: 1"C' Oilier,tach, Insr). 0!hcr Pbir b Ir r>- Ll Other Ii CITY OF CITY OF CUPERTINO REROOF C U P E RTI N O PERMIT APPLICATION 11 APN Date: LO g. r)LlIf residential, is house an Eichler? Yes No If yes, needs planning approval. Building Address: I � -i u, -- T>i e-- C . Owner's Name: ven f (j�et4d Phone #. A �� HOA: Yes ❑ No If yes, provide etter from HOA Contractor: Phone#: Fax#: Cupertino Business License #: Contractor License #: Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑_,Asphalt Shingles o�sphalt Shingles d Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other(Specify) ❑ Other (Specify) Nujnber of existing coverings ❑ Provide I.C.C.E.S. Report# o be Removed ❑ Provide Mfgr. Installation Specs. Job Description: Ta;AW-ZF)P— Wbe Tn 91i 'P rar��C�q� 6� Com. Residential Commercial ❑ Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if Green Building Checklist & attach it to the application or if there are any restrictions: ❑ applicable, include in plan set & the sheet index. Valuation: , ' Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy: