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BUILDING DIVISION PER
CONTRACT�QR°tINFORMATION
BUILDING ADDRFSS�
LOS GATOS ROOFING
PERMIT"x05070176
R'S NAME:
PERMIT ISSUE DATE
SURESH SUNDARI
888 FAULSTIC14 (21
07/27/200S
NE:
SANITARY NO. CONTROL NO.
(408)298-9399
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
• I Mrcby affirm IMI I am licensed under provisions of Chapter 9 (commencing
lob Description
P n ra�
with Section 7")of Division 3oflbe Busincsand Profession, Codc,aodm license is
n n
inmllmrteandeffect. ��q D
License Clms�_�Se�� Lic.N f�/J�
wm Contractor Goc 6d7f✓ o: m
REROOF-REMOVE 2 EXIST ROOFS LNSTALliLROOFERS
SELECT FELT/SH'INGLES
ARCHITECTS CLARATION
1 understand mY yf aA ley n pts "c ranrds
_ � �/
Licensed '
OWNER BUILDER DECLARATION -
1 kraso .(Gens License law for Nc
I Sm excmpl from Nc Cimfeed..
h..
Co
following moon. (Shod,. Business and Pmfdemoli Code: Any tiny or county
on
which emismi aper, improve, demolish. ri report any suunurc
iss s re cores
I
tel,
t t
m its also requires pro applicant for such panni' m Glc signed statement
its n e. also
than LCIS licensed pSeNant hw(C
thin NC Contractor'sesand
dre,MO)
Sq. FL Floor Area
-'�'QVa1 Vti 102
7to
Cotle)or
(commencing with Sectionn of Division 3 odr)or
Division of the Business andon.
Any
than he 0 exempt thcrtfrom and Ne baso far the alleged exemption. Any vinlalion of
and deD
APN Number
Occupancy Type
Section 7031.5 by any applicant for a permit subjects to applicant to a civil penalty of
not more than five hundred dollars (53(10).
36925015. 0 0
f, az own, of Uie ryoperty, ar my employers with wages u Noir sole compcw0on,
Required Inspections
will do Ne work and the structure is out immortal or offered for sale (Sec. 7044, Business
and Professions Cod: The Conlaomrs License Law doe, not apply to an owner of
propenny who builds or improves thereon, and who does such work himself or through his
'
awn employees, Provided Nat such impmvementaart notimended,r offered forsak. if.
-
however, the building or improvement is sold within one year of compimion. Ne owner -
builder will ham IM burden of proving that he did not Wild or improve for pmpme of
sale,).
0 I, as owner of Ne property, am exclusively contracting with licensed comment, to
oonslmCl the proKn (Sec. 7044. and Raw
Wi Code:) Them
inBusiness
thtmor, nd
cense Law docs not apply b ts owner of progeny who builds or impmvv Cortrac and
o
who acts for such pmjccs with econlrazmr(sj licensed pursuant in the Convectors
License Law.
❑lam exemPl under Sec. .B&PC for this rtaon.
_._,_„___-
er Dene
_ /�T • . _ ,_
WORKER'S COMPENSATION DECLARATION
I Mrcby affirm under penalty of perjury oro of the following dedaratiam:
I hs.e and will maintain a CenNam of Consent self -insure rot Workers Compere
ration, as provided for by Section 37M of the labor Cur, for the performance of the
.... _.. . -
work for which Nis permit is issued.
❑ I have and will maintain Worker's Compensation Insurance, m required by Section
37W of Ne labor Code, for the performance of Ne work for which this permit is issued.
My Workers C.mpensadonGGlnwnntt artier end Policy numkram:
SV :7th
Cartier. Policy No.: 2,7%n'Zd/y
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Obissettion need not Mcomplewd little permit is for one hundred dollars (SIM)
or less.
1 CZm(v thm in the performance of the work for which this Permit u issued, I shall not
employ any portam in any manner so as to become subject the Workers' Compensation
Laws of California. Doc
Applicant
NOTICE TO APPLICANT: If. after making this Certificate of Exemption, you should
become s,bjen to the Worker's Compensation previsions of the labor Code, you must
forthwith comply with such provisions or this Permit shall be deemed revoked.
AGENCY
CONSmisa
C0NLENDING
I hereby affirm that is a o,nswmion I7, Cgency for Nc Performance of
eNote
the work Nur which Nu gamin is issued (Sec. 3097, Co,iv. C.
Lender'Add Name
Ie.der's Aear�
,
I cenif, than I have read Nis apidinwion and suite that Ne above let .no.Li.. is
correct. 1 agree to comply with all city and county ordmanas and sum laws misting to
building consuuction. and hereby authorize mpresmncuivcs of this City to enter upon do
abevh-mentioned property for inspection purposes
(We) agree to save, indemnify and keep harmless the City of Cupertino against
liabilities, judgments, costs and expenses which may in any way ,come against Lid City
in consequence of the gamingof this Permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE REOUL �% _
��
Re -roofs C/ ` (I
Type of Roof
V�_s!
Signature o'ApPlicanVContraclor Dam
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or furore building occupant Gore or handle hazardous material
dmOncO by the Cupertino Municipal Code, Chapter 9, 12, and the Health and Safety
NL:ndc,S p cs Yea 35533(,)? k'°
All roofs shall be inspected prior to any roofing material being installed.
IP
If a roof is installed without first obtaining an inspection, I agree to remove
Will Ne a Gcamor fulum Wzidln&
PP
cmfl hazardous air contaminants az by the Bl tax equipment or devices which JmGnod by Nc Bay Area Air Quality Management
all new materials for inspection.
Disvicl?
'
❑YCS U
Iham mail the liazandous Califon
entrarand
255 .1udentan.93ofthc
ria HalthhSafety Coda.Scctions353US 3myrsnJ35534.1
Sectios 2MS, 25533 datifup huilJing
�
to im'rnl
J,cs mol curz Oy have u mnanl, dot it is my msponsihility m nnuly the ,pant f Nc
mquimmmntawnienp„wye0pfq;O ilr,anaorauid""W' 7y. %�
(/
Signature Applicant Date
<j /z 6
of
All roof coverings to be Class "B” or better
Owner s authorized agent Da/te
r
h.
CITY OF
�UPEkTINO
0
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Building Department
JOB ADDRESS:
os -5 - 675X/7n
PERMIT #
OWNER'S NAME: N AAv AR&j
PHONE # 3re-/Z33
GENERAL CONTRACTOR: (mos
FAX #
I am not using any subcontractors: %/ 7 �Z 7 / S--
Signature
'Signature Date
Please check applicable subcontractors and complete the following information:
Owner/ Contractor Signature
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
Date
it� 3 of 3
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........ : 36925015.00
DATE ISSUED.......: 07/27/2005
RECEIPT #.........: 30541
REFERENCE ID # ...: 05070176
SITE ADDRESS .....: 10591 E ESTATES DR
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OPERATOR: suem
COPY # : 3
OWNER ............: SURESH SUNDARI
ADDRESS ..........:
CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-4507
METHOD OF PAYMENT
-----------------
CHECK
TOTAL RECEIPT :
0
AMOUNT NUMBER
____________ __________________
435.38 1615
435.38
RECEIVED FROM ....:
LOS GATOS ROOFING
.CONTRACTOR .......:
RANDY BROWN LIC
#
23481
COMPANY ..........:
LOS GATOS ROOFING
ADDRESS ..........:
888 FAULSTICH CT
CITY/STATE/ZIP ...:
SAN JOSE, CA 95112
®
TELEPHONE ........:
(408)298-9399
FEE ID
UNIT QUANTITY
AMOUNT PD -TO -DT THIS
REC
NEW BAL
BPERMFEE
VALUATION 6,102.00
137.16
0.00
137.16
0.00
BSEISMICRE
VALUATION 6,102.00
0.70
0.00
0.70
0.00
TOTAL PERMIT
__________ __________
137.86
0.00
__________
137.86
----------
0.00
METHOD OF PAYMENT
-----------------
CHECK
TOTAL RECEIPT :
0
AMOUNT NUMBER
____________ __________________
435.38 1615
435.38
•
•
CITY OF
CUPEkTINO,
CITY OF CUPERTINO
REROOF
PERMIT APPLICATION FORM
APN #
.�✓G/,_ 2s � oIS
Date:
-�
ree urou
BUILDING
BUILDING
BUILDING
BUILDING
BUILDING
ZS/as
Building Address:
/O5q/ �7.
BUILDING
Owner's Name:
31-treS�
Phone U#:
Contractor: P one #:
License #:
Contact: Phone #:
�Jr�w2
Cupertino Business License #:
�i D
� 9
X35/8/
Type of Roof Covering:
Existing:
Proposed:
❑ Built -Up Roof
j6i Asphalt Shingles
❑ Built -Up roof
>1 Asphalt Shingles
❑ Wood Shakes -
Wood Shingles
❑ Wood Shakes
Wood
E2&
Other (Specify)
❑ Shingles pp //��
`§L Other (Specify) e,!; eell-
Number of existing coverings L
To be Removed
❑ Provide LC.B.O- Report #
-)P- Provide
Mfgr. Installation Spec
I Have Read, Understand and Will Com ] With Cu ertino's Tear Off P,';-,,-
olic :
I
I b Descrip 'on:
i
esidential Commercial ❑
Fire Zone: Yes' ❑ NoWLConfirmed
with Planning Det. if
there are any restrictions: lJ
Cost of Project: /a Type of C nstrucIII
Occupanc group:
CaQ
Qty. if
Applicable
Fee TD
wee n---
Q
BPERMFEE
BENERGY... .. ........
BSEISMICRE
BSEISMICOM
BPLANCHK
� = u�r,
Bldo Permit Fees
... ......Energy ...... .. .
Seismic Fee Res
Seismic Commercial
Plan Check Fee
ree urou
BUILDING
BUILDING
BUILDING
BUILDING
BUILDING
BUSLIC
Business License
BUILDING
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CIN OF
CUPEkTIN®
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 1997 UBC Standards
and manufacturers specifications on re -roofing.
2. New roof coverings shall not be applied without fust 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. 1
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.
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:
_._.-------- __Job.Site,Address:
Roofing Company Name: 2.&!:2
A plicant's Signature:
• Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
Date: /QS