05080060 CITY OF CUPERTINO
BUILDING DIVISION PERMIT e CIO NTRAGTOB INFORMATION
BUILDING ADDRESS: ANTHONY ROOF SERVICE PERMIT N0.05080060
20303 CARTWRIGHT WY
OWNER'S NAME: PERMIT ISSUE DATE
KAPIL BHATNAGAR 910 S MCGLINCEY LN 08/09/2005
NE: SANITARY NO. CONTROL NO.
(408) 265-5147
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
0 0 0 0
iO0 LICENSED CONTRACT'OR'S DECLARATION Job Description
�w❑ 1 hereby affirm Net 1 am licensed under provisions of Chapter 9(commencing iW with Section7010).rDm.mon Sof Ne Business mol Professore Code,and my license is
+Zsu; inf[if meamdeIf h /5 REROOF--T/O SHAKES, . RESHEET OSB
;�E L.zn cl ' - tie" REROOF PRESIDENTIAL TL
p Delc - Contractor F[[{� ry�,'� rry�a
UI understand my plansshalll he used Us public.mcn�ds I,' rr r *,3 t�
I, Licensed Professional 999 Bf3 W [iyy
OWNER-BUILDER DECLARATION
°� q 1 hereby affirm out I oro rimmed from he Contractor's License Law for the .SOQ�
p O following m `ason.(Section 703 L5,Business and Professions Code:Any city at county (l_
i m fl� which requires a permit to construct,alter,improve,demolish,or repair any amumure
°itspriorm its issunce.also nipflos theapplicam rorsuch perm;tm file.signedsuumem pp
x mathcislicenxJpursuanunheprovimonsofheCanuacwr'aLicenseaw9 S Ft.Floor Area ppp p�� VaIU fb3400
(Chapterq DING
yFG (commencing with Section 700()of Division 3 of the Business and Professions Code)or
i $
that he is exempt therefrom and Ju basis for the alleged exemption.Any violation of 4f
Section 7031.5 by airy ap,licamfor a permit subjects he.11licnt to a iml pcnahy of APN Number -Occupancy Type
not more than BK hundred dollars(S50(). 31642006 . 00
I,rsownerofhepmpcmy.mmyemployc wihwagesmheirolecomNnwtion,
will do the work and the structure is not intended or offered for sale(Sec.7064,Business
and Professions Code:The Conlnctors License Law dors not apply to an owner of Required Inspections
pmperty who builds or improves hereon,and who does such work himself or through his
own employ=&,provided that such improvements are not amended moRered for sale.It.
however,the building or improvement is sold within one year of completion.the owner,
builder will have Ne burden Of proving hal he did net build or improve for purpose of
sale.).
❑1,as owner of the property,am exclusively contracting with licensed contractors to
construct he project(Sec.7044.Business and Professions Cade:)The Contractors Li-
cense Law does not apply in an owner of progeny who builds or handum es immon,and
who contracts for such projects with a contractor(s)licensed pursuant to he Contractors
License Law.
1 am exempt under Sec. .B&P C for his recon
Owner Dau
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
_J 1 on and will maintain a Certificate of Consent to ael6;nsure for WorkersCompen-
sation,as provided for by Section 37W of he labor Code,for he performance of the
work for which his Permit is issued. .
ink
have and will maintain Worker's Compensation Insurance,as seyuimd by Section
3'/W of he Labor Code,for the performance of the work fnrwhich this Permit is issued.
My Worke%C mp nsadon lnmmnec Baric nd Policy numhcr am:
Cartier. olky,Nm.:
ER's FICATE OF EXEMPTION FROM WORK
COMPENSATION INSURANCE
(This section need not be completed if hn remit is for one hundred dollars($100)
Or leas.)
1 crrtify hm in he performance of the work for which this permit 1s;sued,I shall not
cmployanyperson in any on mer amu' mmc subjem to the Worked Compensation
Laws of Californ; p x, 1133=
Applicant
NOTICE TO APPLICANT [Myti making his Certificate of Exemption,you should
become subject in he Workers Compensnion provisions of he Labor Code,you must
.J O forthwith comply with such provisions ce this permit shall be dcemcd revoked.
Z'` CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for he performance of
[( � the work for which his permit is issued(Sec.3W7,CO.C.)
W Q Lenders Namc
Z Lenders Address
U O 1 comity Jut 1 have read his application and sum that he about indentation is '
U. correct.1 agree to comply with all city and county Ordinances and sum laws relating to
0 V building construction,and hereby audimim mpresenudives of his city to enter upon the
W above-menduned property for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
MF'.t N Babilitles,judgments.costs and expenses which may in any way see=against mid City
U z his rmit.
APPLICANT UNDERSTANDSnsecurace of the grantiOf IAND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
HAZARDOUS
Signature of Applicamor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will he applicant Or forum building uceupant more or handle haouximus material
Cdefine' he Cupino Municipal Code.Chapter 9.11,and me Health and Safety
C.
de,Sectionby.35532(ert')? All roofs shall be inspected prior to an roofing material beim
❑Yes f7Nm P P Y g g installed.
sof➢the applicant or future building t sac equipment or acme:which If a roof is installed without first obtaining an inspection,I agree to remove
DP goccupan yuipmen
mit Imoardnus air contaminants in defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes
Ihavcreaahehmardnusmamr;alsmqu;mmenuunder Chapwr6.95ordu Califor- s
nit Hcalh&Safety Code,Scctiom 25505,25533 nd 25534.1 understand Nazi!dte Wilding
Joys not curcndy h'tx a unan0 ha my rrapomihility to nntily he meupnt of Ju i
mquimm who the rtoaissuance ofaCertificate affxnpney. a Signature ofAWnt Date
owner mr mlhmrxrd ato All roof coverings to be Class"B"or better
F - Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPERTINO
Building De artment
JOB ADDRESS: PERMIT #
/-T�j / Qs`o c� OGGa
OWNER'S NAME: PHONE #
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors: �-
Sie Date
Please check applicable subcontractors and com Tete the followinginformation:
60 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
Own ontractor Signature Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
Fax: (408)777-3333
U P E IST I N O
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: %;L / 7 4r/�Ct,9CC
Job Site Address: / a
Roofing Company Name:
Applicant's Signature: ( Date:
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
1
CITY OF CUPERTINO
REROOF
2 CUPERTINO PERMIT APPLICATION FORM
APN # �! / /L 2- Date•
Building Address:
Owner's Name: Phone #:
Contract r: Phone#: License #:
Conta t: Phone #: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles Asphalt Shingles
�! Wood Shakes 9 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.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑
Job Description:
Residential Commercia F-1 _
Fire Zone: Yes ❑ No ® Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost o roject: Type of Construction: Occupancy group:
IF
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
3 ° 6 �