05110082CITY OF CUPERTINO�{`
BUILDING DIVISION PERMIT
sCONIBQCTOR,INFORMATI
BUILDING ADDRESS:
EASTMAN CONTRACTING, INC
'--"'05110082
11021 BUBB RD
OWNER'S NAME:
PERMIT Ire DATE
SIVAKUMAR ANNANALAI
1418 DOUGLAa 21
11/16/2005
NE
SANITARY NO. CONTROL NO.
(408)971-9000
ARCHITECT/PNGINEER:
PERMIT [NPO
ELECT PLUMB
BLDG CT MECH
UCFNSED CONTRACTORS DECLARATION
Job Description
I bemby .1Grm thu 1 w li¢✓>sd Talo' povbiaa a O-Pmr 9 (romm '1
rith S.omt 7OW) aDMA.a 3 of de Budna..nd Pmfc,dwa Cade. W my Ecus u.
ml rwlraauw
REROOF-T/O LAYER W/SHINGLE-INSTALL OSB
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50 YR COMP
ARCHITECTS DECLARATION
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OWNER -BUILDER DECLARATION
I Wmby ,farm that I m avatyt form tha Cort a Ws U LYw for We
fallvwini mava (S=fim X51.5. Bndeev ud Pra(eadam Cada: My city a roomy
.
which r iztoi I pmnit to camnt0. MW.. Ynpwc, dranal(a, a arm my vnswe
pd.0 , Iawrea..Im rmluima tha.pPlv.. fa vch pcnail m Rb.aiencd.trvnrnt
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Sq• Ft. Floor Area
Valu;$14644
thu be 1, Iitta,tcd'u of to We panaiau of too Cmmacta', (CIbPm9
(mo .&Mth Salim 7000)40ivinoa 3a( thc Budin, and Pmfadmt Codc)a
ibu be b e,esp thoefrm and de bub fa, 0e &Una uemp0m MY rlolaliw of
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Occupancy Type
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CSATION DECLARATION
WORKERSOMPEN
1 bembya mdcr Pendry a pmjmY ala: a the(ol iry
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wvk fa rhim 0i, pewit u inoed.
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ari de pafarmancc om,i wart fna wb Loath pumu ulnad
My Worbc/a Camp•"^.m himrm¢arrim and policy nembu uc^
my scmofa oa
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CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION BRSURANCE
(T1da acylm nad wlbe rompI d u We pumd a rmmr huehN daum($TODD
a leas)
I m (h ft, In the Pmfomams of We wort fa whim dtu P 11 b Imuea, I ah.R int
cmptay my potato to my m.nrmrao u b bcrnme abjal to Ne WmtaY Cmnp-*u
(arra of O Ifiorob. OW
NOTICE NT: If. rtaa m.bint W, Cadrvam th E, lou aboral
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baaoe t at
o..
faWwiN romplY with mcb poridoma0da perroa.bdlWdmvcd mwYM.
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n CONSTRUCTION TENDING AGENCY
4.I3ON
Iheraby df thu dert u,camne.Nn b
a.) fa the rcrfarmeta of
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Lkes I. h NY pumil Y lined (Sat. W. Civ. C.1
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I anify tNt I l vat mad thi..W"tim .rd rule that ft mow iorot a I,
^ cola¢L r ays to eaapty with W city "minty aMnmaea Ind rate IM mudn{ W
y m on,
j buiwiag catuna7ian. mo ma,by.th mm.-^•^ .r tbb mone,aeon to
Ihoe-m Pmrcny fat po. Purpss
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dSatmad
nlubilitba,}udlmea,.cmu and upema vhkhway in my wy cva.{dmta.id City
J
A Perm(.
Z io%���^afae UNDERSTANDS
^ APPI�CANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -MINT
Issued by: Date
'
SOURCE REGlJUT10NS.
✓�--/ �/
Re -roofs
Type of Roof
Slymae of Appllan SUS MATERIALS DISCLOSURE
Win be apPa. a I. boadio, omopmt nae a handle haaaNaY as m
u dented by the Cupentaa Mmdap.l Coda. mlper 9.11.rd Ne H th d LfrtY
oda. Semim25532a)7
All roofs shall be inspected prior to any roofing material being installed.
❑Ya
If a roof is installed without first obtaining an inspection, I agree to remove
WBI de.pPtiam m rauve Wilding acvgm a>c eadpmm a Ileriaa .bah
mit hvarama waaomimm u da&ml by ha B., Arta ARI OtWuy M Ipa ea
all new materials for inspection.
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p Ya
10wnm
�mn, Chapet Q95 of the Uira-
4ma materLl.m Wmundo
1 haw read & hvA
aF th h Safoy Cada.$ oaa 25505.25533 and 255th. l mdamaod tbafde ddlhz
ma cuawfy b.w. coral thu it b my TopWity m nWry de acupnt a the.MmmanWnNpwmI
�ad.c=rramafoa°ymcr.
VZ11
Signature of Applicant Date
I �
All roof coverings to be Class "B" or better
IX uuborired Iynt O.m
•
9
IN
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Building Department
JOB ADDRESS:/
PERMIT #
OWNER'S NAME:
PHONE # Yog. k3%, 335-7
GENERAL CONTRACTOR.
IFAX#
I am not using any subcontractors: a ctv w C, — - / � a o
Signature Date
Please check applicable subcontractors and complete the following information
Owner/ Contractor Signature
Date
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
Owner/ Contractor Signature
Date
Community Development Department
Building Division
' City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408) 777-3228
C U P S IST I N O 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 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 $176.18. The re -inspection fee must
be paid before another inspection can be scheduled
IMPORTANT:
1. Flat roofs must have a minimum of 1/4 " per foot slope and demonstrate
that there is no ponding.
2. An LC.B.O. report is required to be on the job site at the time on inspection.
I understand and will comply with the above stated policy on re -roofing.
r -
Homeowner's Name: �� V��� QnrtaMa(ai
Job Site Address:
Roofing Company Name: 62-yyw,-, f'- L✓/rTEe PBct�G�l
Applicant's Signature: l�i /, Cr/' �� Date: 4a—
Greg
e —
Greg Casteel
Building Official
Revised 11/2/04
Punted on Recyded Pepe,
allITylor
CUPEI�TINO
CITY OF CUPERTINO
REROOF
PERMIT APPLICATION FORM
APN #,�5 S/ / G ��
�J(0
Bldg Permit Fees
Date:
BENERGY
Energy
ii /SoS
Building Address:
Seismic Fee Res
Owner's Name:
BSEISMICOM
Phone #:
-5 umc,--
BPLANCHK
qo$ fS39. z S�
Contractor:
Phone #:
License #:
S71 -074A/
Z/O`6
Contact:
Phone #:
Cupertino Business License #:
�Et7D,c7� ca 8tau
1,
Type of Roof Covering:
Existing:
Proposed:
❑ Built -Up Roof
❑ Built -Up roof
❑ Asphalt Shingles
❑ Asphalt Shingles
❑ Wood Shakes
❑ Wood Shakes
7 Wood Shingles
❑ Wood Shingles
❑ Other (Specify)
[a Other (Specify) DkixP
Number of existing coverings
❑ Provide I.C.B.O. Re ort #
❑ To be Removed
❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: To.(1) (A!YA 4:SA.:51fl
insir.0 056 & 5-b 660-0- nec4 cn�
U
Residential [�' Commercial ❑
Fire Zone: Yes ❑ No Z.
Confirmed with Planning De t. if
there are any restrictions: LJ
Cost of Project: Type of Construction: Occupancy group:
!}/
-e
Qty. if
AMMlicable
Fee ID
Fee Descrintion
Fee Groun
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
L