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06100001 CITY OF CUPERTINO BUILDING DIVISION PERMIT T � 1 }IIMAIQI�'. BUILDING ADDRESS: TARA HOMES PERMIT N0.0 6 10 0 0 0 1 0640 JOHANSEN DR PERMR ISSUE DATE OWNER'S NAME: 20200 LUCILLE AVE APT 41 10/02/2006 SANITARY NO. CONTROL NO. ONE: (408) 253-7828 BUILDING PERMR INFO ARCHITECTIENGINEER: BLDG ELECT PLUMB MECH l O p LICENSED CONTRACTOR'S DECLARATION Job Description U p l hereby affirm that I am licensed under provisions of Chapter 9(commencing .Z w with Section 7000)of Division 3 of the Business and Professions Code,and my license is =y in full force and effect REMOVE EXISTING ROOF & BUILD A NEW ROOF z License Class Lic.a 2 . 5 SQUARES F 0 Date Contractor ••,t ARCHITECTS DECLARATION 2 cd" 1 understand my plans shall be used as public records �aU u H Licensed Professional y.tea OWNER-BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the C OO following reason.(Section 7031.5•Business and Professions Code:Any city or county < which requires a permit to construct,alter,improve,demolish,or repair any structure Z} prior to its issuance,also requires the applicant for such permit to file a signed statement $ Ft.Floor Area Valuad%6 0 0 0 _< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 fl (commencing with Section 7000)of Division 3 of the Business and Professions Code)or y that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type not more than five hundred dollars($500). 37536009 . 00 ❑I,as owner of the property,or my employees with wages as their sole compensation, will do the work and the structure is not intended or offered for sale(Sec.7044.Business Required Inspections and Professions Code:The Contractor's License Law docs not apply to an owner of property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for sale.If, however,the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044.Business and Professions Code:)The Contractor's Li- cense Law does not apply to an owner of property who builds or improves thereon,and. who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law. ❑I am exempt under Sec. B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: LJ I have and will maintain a Certificate of Consent to self-insure for Worker's Compen- sation,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 required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number are: Cartier. Polity No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars(S 100) or less.) I certify that in the performance of the work for which this permit is issued,I shall not employ an n in any manner so as to be c 'c orkers'Compensation Laws of C ifo ia. tc Applicant NOTICE P :If,after mak g this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must O forthwith comply with such provisions or this permit shall be deemed revoked. Z 2CONSTRUCTION LENDING AGENCY CA[�►. 1 hereby affirm that there is a construction lending agency for the performance of p( > the work for which this permit is issued(Sec.3097,Civ.C.) W A Lender's Name tL Lender's Address U C) I certify that I have read this application and state that the above information is LL H correct.I agree to comply with all city and county ordinances and state laws relating to 0U building construction,and hereby authorize representatives of this city to enter upon the W above-mentioned property for inspection purposes. a (We)agree to save,indemnify and keep harmless the City of Cupertino against ,_q 1Z liabilities,judgments,costs and expenses which may in any way accrue against said City V Z in consequence of the granting of this permit UT NDate " APPLIC UNDERSTANDS A D W L COMPLY WITH ALL NON-POINT Issued by: SOU S. __/ (D XOLi Re-roofs Signature of Applicant/Contractor tate Type of Roof HAZARDOUS MATERIALS DISCLOSURE yp Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety code.Section 25532(a)? ,,,,,, All roofs shall be inspected prior to any roofing material being installed. ❑Yes ty"o \ If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes No I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building docs inertly have a tcnan4 Utat it' my responsibility to notify the occupant of the -T rc rem is which st be et prior ssuance of a Ccnificate of a upancy, Signature of Applicant Date All roof coverings to be Class"B"or better ner or authorized agent tc CITY OF CUPERTINO �m 1 of 1 PERMIT RECEIPT OPERATOR: kiersaw COPY # 3 Sec: Twp: Rng: Sub: Blk: Lot: APN 37536009.00 DATE ISSUED. . . . . . . : 10/02/2006 RECEIPT #. . . . . . . . . 36269 REFERENCE ID # . . . : 06100001 SITE ADDRESS 10640 JOHANSEN DR SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : , RECEIVED FROM SUBRO KOLLA CONTRACTOR PADMAJA MANDAVA LIC # 25310 COMPANY TARA HOMES ADDRESS 20200 LUCILLE AVE, APT#41 CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 TELEPHONE (408) 253-7828 _EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- --------- --- ---------- ---------- ---------- ---------- BPERMFEE VALUATION 5, 000.00 115.56 0.00 115.56 0.00 BSEISMICRE VALUATION 5, 000.00 0.50 0.00 0.50 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT 116.06 0.00 116.06 0.00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ ------------------ OTHER 116.06 VISA TOTAL RECEIPT 116.06 Community Development Department Building Division City of Cupertino L, 10300 Torre Avenue Telephone: (408)777-3228 CITY OF Fax: (408)777-3333 CUPEkTINO 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: 1 Doti Site Address: Roofing Company Name: Applicant's Signature: Date: Greg Casteel Building Official Revised 11/2/04 Printed on Recycled Paper CITY OF CUPERTINO REROOF CUPEkTINO PERMIT APPLICATION FORM APN # �, � pl 001 Date: 3 Building Address: I O/ O -AN� tj DR. C V n3 o CA 9-501 Owner's Name: Sv 3 Q O �oL_L-A Pho o8. 1 Contractor: hone#: License#: Contact: Phone#: Cupertino Business License#: Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof zr Built-Up roof ❑ Asphalt Shingles ► Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles je Other(Specify)SIC* Toch ❑ 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:. ', �u���o ek R0* Residential Commercial ❑ Fire Zone: Yes ❑ NoConfirmed with Planning Q t. if there are any restrictions: lJ Cost of Project: © 0'4 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 BUILD BPLANCHK Plan Check Fee BUILDIN BUSLIC Business License BUILDING �vrrex�tt� W&-yK*i 040A buy ca"tir-k is .Aaav�v\�3 v h�.r '►� Ya�►r�s, S►r�c�ly, lour VwV3 o, Moos oJpov� e ash oma..