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09070214 CITY OF CUPERTIN,D BUILDING PERMIT BUILDING ADDRESS: 7545 FALLENLEAF LN CONTRACTOR:PH CONSTRUCTION PERMIT NO:09070214 OWNER'S NAME: NAZEEM NOORDEEN :,78 SUNPARK PL DATE ISSUED:07/31/2009 ?R'S PHONE: 4083660486 SAN JOSE,CA 95136 PHONE NO:(408)569-3753 ❑ LICENSED CONTRACTOR'S DECLARATION 13UILDING PERMIT INFO: BLDG F ELECT r PLUMB F License Class Lic.# MECH r RESIDENTIAL r COMMERCIAL Contractor Date 1 hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION:RE-ROOF 33SQ CLASS A KEEP EXISTING (commencing with Section 7000)of Division 3 of the Business&Professions PLYWOOD 1/2" Code and that my license is in full force and effect. PAPER#30 ROOF CHANGED OVER SOME PART OF HOUSE NOT ALREADY COVERED UNDER OTHER CHANGES TO ROOF WITH 1 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 ;;q,Ft Floor Area: Valuation:$7000 permit is issued. APPLICANT CERTIFICATION APN Number:35928038.00 Occupancy Type: I certify that 1 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. Signature Date ssued by.. Date: 46. OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that 1 am exempt from the Contractor's License Law for one of 111 roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: nstalled without first obtaining an inspection,I agree to remove all new materials for 1,as owner of the property,or my employees with wages as their sole compensation, nspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, �� Business&Professions Code) ,iignat re of Applicant:�/— ate: 1,as owner of the property,am exclusively contracting with licensed contractors to 3/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 have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. --alifornia Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain I have and will maintain Worker's Compensation Insurance,as provided for by •ompliance 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 1 use equipment or devices which emit hazardous air 'ontaminants as defined by the Bay Area Air Quality Management District 1 will I certify that in the performance of the work for which this permit is issued,[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 lealth&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,1 must )wne r an ho ' d agent: forthwith comply with such provisions or this permit shall be deemed revoked. Date:'�� APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is 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 'or 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 it lily and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address c uid expenses which may accrue against said City in consequence of the graming of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION 9.18• understand my plans shall be used as public records. SignatureAA4 DateJ3l D Licensed Professional CITY OF CUPERTINO REROOF OF CUPEkTINO PERMIT APPLICATION APN #�� Date: .....�� 3 ,D 10q Building Address: ���� � � � 5 D�� -l' S 661em le2fOwner's Name: Pau,(a /Mw ems,,, f V60 r d e ew, Phone#: HOA: Yes ❑ No Kq--If yes, provide letter from HOA 6(1e(o Contractor: Phone#: `, 5 9 s;'U G-16Nr1 Fax #: Cupertino Business License #: Contractor License #: Type of Roof Covering: fillM ng: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles ❑ Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes �PreSlden`hV ) ❑ Wood Shingles ❑ Wood Shingles Other (Specify) Sla4e, m t4e, o--Other (Specify) ��►�+��� � Ski� �S Number of existing coverings ❑ Provide I.C.C.E.S. Report# ❑ To be Removed ❑ Provide Mfgr. Installation Specs. Job Description: 3 300 5 'C4 P)y wo d Izt 1 -- P #30 46t p Vyen/ S6yr.2, Prxr�S 6� koLtse_ Yl0+" C� r rr w Ir.�� o�r Cees --kb �+ 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 ind-.x. Valuation: 0 -7) 000 c— - I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy: Signature C p �1 ct Revised 02/05/09 CITY OF C'UPERTINO it REROOF CITY OF CUPEkTINO FEE SCHEDULE Number of Fee ID Fee Description Fee Permit Type Squares Group 1REROOFCOM Re-roof Ccmmercial B 1COMMLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICO Seismic Commercial B 1 REROOFRES Re-roof Residential B 1SFDWLR00F 1 BCBSC Cal Bldg S:andards B ALL PERMIT TYPES Commissicn Fee / 1 BSEISMICRE Seismic Residential B 1 REROOFMRE'S Re-roof Multi-Family B 1MFDWLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commissio n Fee 1 BSEISMICRE Seismic Re;,,idential B 1BUSLIC Business License B 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 agi ee to comply with 2007 IBC Standards and manufacturers specifications on re-roofing.All roofs are Class "A"per Cupertino municipal code 16.04.080. 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 Cite,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 nai,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 per:*ormed. 7. NOTE: If you call for a plywood nail nspection 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 abov z stated policy on re-roofing. Homeowner's Name: paL. t / ljaZl' o e t'/V-', job Site Address: -25 5 f S f�A I I ej Roofing Company Name: Applicant's Signature: ��� /=% ?- � Date: Greg Casteel Building Official Revised 07/30/08 1 1 1 0 sad=--d sId dE Jau3 E sep!S glnoS pua IseM eq;uo saaJl snonp!oe4 Iuald•E 0 say(=�t s;d�f Jau3 E sMopuiPA Oulu glnoS jeAo s5uium f 10 S6U-EgJaAQ IIa;SU!'Z 0 sad=d s;d dE Jau3 9 6ullaaH JaloS aA!SSed aleJodmoul'L 6ug000 pue 6upeeH IeJnIuN•-I 1 1 1 0 sad=,t sId d6J 3u3 6 JauJaB;ualpea Ilalsul'L 0 sad=d Id eoJn Dsaa L sle!Jelew 6ugoau e1ge flo PUB afes toeles'9 0 s;d Mau]9 L o;dr 1 (s;u!od 9 L=nvi 9•E'spod Z L=ml tq'spod 9=m,I Z'L) we;SAS(ltd)olallonaloyd IIE;SUI'b 0 sad=d s;d d6J 3u3 i uo!;al!a;SUI(Ad)o!a;Ionoloyd ejn;nH Jol aJyV\-aJd'E 0 sad=d sId d6J 3u3 0 L wa;sdS 6u!;aaH JeIeM MIoS IIa;SUI'Z 0 sad=d sId AL 3u3 b 6ul;eaH JaIeM MOS Jol gwnld-e1d'L 6ui1008 pue A51eU3 algeMeueH•)I 1 1 1 Elm 0 sad=d sId q;IaaH/:)dl S uad;snegx3 eftmE)gejudeS IIa;sul'L l 0 sad=d s;d yllaaH/:)VI g (AUH);Iun uo!;ei!;lJeA kenooaE!IaaH IleMsul-9L 0 sad=d s;d gBeH/3dl b Jell!3 doua101113 q6iH FIR 0 sad=d sId d6J;3u3 S 6wlaaH;uelpea oluoJpdH'peuoZ Ilelsul'bL 0 sad=d ;d d6J 3u3 L sJooc lgoi:P!v IIB;Sul'o 0 sad=d Id d61 3u3 L sJadwaQ eoaldeH/pelsul •q 0 sad=d Id yllaaH/:)dl L SlJasu!ISano;S pooM pag!Ilaa yd3 IPISUI'a seoeldejU 6u!uJne pooM Ill-SL 0 sad=d s;d d6J.3u3 Z eoewnd(3ndy)doua!o43 uo!Iez!!IIn len3!anuuy%06!le;sul'Z L 0 sad=d s;d eoJncsed Z s;uaJe6uIeH odoH-uoN Wm od Ilelsul'L L 0 sad=d s;d d6Jc 3u3 E AXI e q;!M od Jay6!y Jo Fl33 l Vd33S CL Ilelsul'OL 0 sad=d sId A&W3 6 sdwnd IaaH IIEM-sqI-g6ncjgj Qm sJalaaH se0 pua ou;oa13 pelunon-I!aM eoeldaa'6 0 sad=,( sId gl!eeH/Odl E sJaleaH jepM•q 0 sad=d sId gllaaHIDVI E seoewnd•a s;lug uo!Isngwo0 peiEeS Ile;sul'9 0 sad=h s;d 3(BJ,)u3 t ua3 asnoH eIcgM IIa;sul'L 0 sad=d ;d dn"Jou3 L swelsdS ucq'eI!IueA o!IIy Ilelsul'9 0 sad=d s;d d6Juu3 Z ua3 0144 J2IoS IIa;SUI'9 0 sad=d sld 4IIEeH[,Dbl Z douadnoo0 eJoleg slona IIa uaa10•t 0 sad=d Id q;laeH/DVI L ep!s;n0 eq;of pooH 86uaa lueA'E 0 sad=d s;d d6J�u3 6 eoedS peuoi 1puo0 ulipm 3{JoM;ona Ila;sul'Z 0 SGA--d sId d6J�u3 Z spuro f pne w ua 3q%n Pie am'L 6uluol;!puOO ply pue uol;ell;uQA 6u!;eeH•p 1 1 1 0 sad=d Id d6JW3 L 6wze10 uo(sslwsuaJ-LIaaH Mol Ile;sul•Z 0 sad=d sId ffi u3 Z SGUItq l pcMC)•MOJ•s 0 sad=d s;d.d6J€u3 Z (341"4vss*ie-Mal'q 0 sad=d Id d6J.'u3 L petrel©Q E sMpu!M we!043-KIM3 Mur L SMO UI ' CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec : Twp: Rng: Sub: Blk.: Lot : APN . . . . . . . . : 35S28038 . 00 DATE ISSUED. . . . . . . : 07/31/2009 RECEIPT # . . . . . . . . . BSC00008328 REFERENCE ID # . . . : 09C70214 SITE ADDRESS . . . . . : 7545 FALLENLEAF LN SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : NA2EEM NOORDEEN ADDRESS 7545 FALLENLEAF LN CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : NA2EEM NOORDEEN CONTRACTOR . . . . . . . : PHLrOC PHAM LIC # 28683 COMPANY . . . . . . . . . . : PH CONSTRUCTION ADDRESS . . . . . . . . . . : 37E SUNPARK PL CITY/STATE/ZIP . . . : SAPf JOSE, CA 95136 TELEPHONE (4C8) 569-3753 FEE ID UNIT QUANTITY 1,MOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- -- -------- ---------- ---------- ---------- 1BCBSC VALUATION 7, 000 . 00 1 . 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 7, 000 .00 0 . 70 0 . 00 0 . 70 0 . 00 1REROOFRES SQ FEET 33 . 00 429 . 00 0 . 00 429 . 00 0 . 00 -- -------- ---------- ---------- ---------- TOTAL PERMIT 430 . 70 0 . 00 430 . 70 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 430 . 70 #5653 --------------- TOTAL RECEIPT 430 . 70 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF Community Development M1 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 .,UPEkTINO Building Department JOB ADDRESS: PERMIT # -75 H S l le oke u, �� no .Ch 3" -OW& OWNER'S NAME: aulo IU(1,'L cox oo r et/"► PHONE # Lfob - GENERAL CONTRACTOR: PH FAX# I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSIrfESS 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 Y-3 lcq Owner/Contractor Signature Date