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05080009 CITY OF CUPERTINO BUILDING DIVISION PERMIT CONTRACTORINFORMA',F�'ION BUILDING ADDRESS: STONERIDGE ROOFING PERMIT NO-05080009 ' 19021 MEIGGS LN OWNER'S VAME: PERMIT ISSUE DATE SOGHRA MOGHADDAM 2440 POPLAR DR 08/02/2005 )NE: SANITARY NO. CONTROL NO. (408) 729-5101 ARCHITECT/ENGINEER: BUILDING PERMIT INFO' BLDG ELECT PLUMB MECH 0 1-1 0 foo LICENSED CONTRACTOR'S DECLARATION f'� Cy F I hereby affirm That I am boasted under provisions of Chapter 9(commencing Job Description°;. Uil, 4 `+ with Section 70M1)of Division 3 or dor Business,and Professions Cog.and my license is V {r'� )hpj; d mranfn¢eand.1711 - Lica C REROOF W/COMP. Dam nH-!e7- pARCB CI-SIDE'mOCt TION af Peg < I understand my plans shall he used ss public rcsorg t" Licensed Pmfessinnal 03 OWNER-BUILDER DECLARATION �t / <2 1 hereby affirm that 1 am exempt from the Communes License Law for the 00 following mason.(Section 7031.5.Business and Professions Cog:Any city or county 5 5$ which requires a Peemit to construct.alter,improve,demolish,or mimic y sbm 10(]YetgL/7 Z prior to its issue=.alas inquires the applicant far such permit in file a signed statement S s< that he u licensed pungent in the provisions of the Commnur's License Law(Chapter 9 Sq. Ft. Floor Area vase tl�'1 yF$ (commencing with section]000)of Division 3 of the Business and Professions Code)ser r3.. that he is evempt therefrom and the basis far the alleged exemprim.Any violation of Section 7031.5 by any applicant for a permit subjects Ne applicant w a civil Penalty of 3 AR not mom Nan five hundred dollars(1500). r Occupancy Type ❑1,ss owner or dm ProOenY•a my employee with wages m 0xir sole compensation, will dafewark ands: he Con Isoats ndederawredfmuk(Sec.]044, wner of and property who ns code:The ve thereon. and who law aces tort apply lf an owner of Required Inspections .achy who r,provided improver therm r and who dassuch work himself ad for sa h his own ever,On Wilding Nat such improvements are ne year o cc m leered the want.. . however,Ne building or improvement u sold within one)ear of mprove f r the oreof builder will low the W Nen Of proving Nu he did not Wild Or improve for purpose of axle.). O 1,as owner of the property.am exclusively ccrum ing with licensed mmnmma to construct Ne project(Sec.70a4,Business and Professions Code:)The Contractors Li- ccnm Law docs not apply in an Owner of property who Wilds or improves thereon,and who contracts for inch projects with a eomrsewKs)licensed pursuant in the Convector's License Law. ❑I am exempt under sm. ,B&P C for this moon 13110 ner Oma WORKERS COMPENSATION DECLARATION ' 1 hereby affirm under Penally of perjury one of the following declarations: 1 have and will maintain a Cendfieaw of Consent w YR-Insure for Wafkef sCOmpen- on,u provided for by Section 3700 of the Lakr Code,fa the po fotmanec of the rk for which this)emit is issued. 1 have and will maintain Worker's Compensation Insunna,u required by Section of the Labor Code,for the Performance of the work for which this permt is issued. Worker's Compensation lnunnm Cartier and Paliry nu hertier: SF/'�,� ✓».� Polity No.: G j C PI ATE 0�PTION FROM WORKERS' COMPENSATION INSURANCE (TMs senic n rad amheeomplamd lithe permit is fm one hundred oullars(SIM) or ksa) I anify that in the Performance of the work for which this permit is issued.l shall nut employ any person in any man 'me so as w heceme subject to the Workers'Compensation Laws of Califamiti'm �H-'-s9-OG Applicant_�P a sn9i.f C NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the WOfkcr 3 Comawtion provision of the labs Cog.you mug .JO forthwith comply with such Provisions aphis Permit shall he decmad invoked. z 51 CONSTRUCTION LENDING AGENCY I hereby affirm Nat Nem is a commxdom lending agency for NC Performance of C' dor work for which this pesmit a issued(Sac.309],Civ,C.) 111 Q Undoes Name z tenders Addreas o U O 1 cenethat 1 have rod Out application and auto Ng the gave information u s (� F build1 agree in comply with all city and county Ordinances and sum bora on{w w O C.7 building construction.and hereby aumorim mptecnutiws Oof this city m entercr upon tic W above-mentionedpropene for mc coakith impeni n a keepe (We)egto re,indemnify and harmless the City o(Cupenst t nd City Z in Consequence ents.of mtsand axpamarrit. may in any way accrue against gid City U,'Z APPLI AN'r of UNDERSTANDS S A Permit ^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. �+Qo 9 amo A-02 -015 Re-roofs rA.4 &gnaw of AppicanvComwcmr Dau HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant Per future Wilding Occupant store or AarWk hmardous material as defined by thc Cupertino Municipal Code.Chapter 9.12,and the Health and Safmy ,ilftode.Section 2553247 ❑Yea ON. All roofs shall be inspected prior to any roofing material being installed. Will mea applicant or future building=open(use If a roof is installed without first obtaining an inspection,I agree to remove rap e v .Air a of devices whim g P i.1 haramnus air canuminants ss defied by the Bey Arta Air Quality Managcmcnt all new materials for inspection. nlel] ❑Yes ❑No 1 have mad the hmasdousmawrials requirements under Chapm6.95 of the Califor. LOmw th&SafctyCoda Secoom 25505,25533 and 25534.1 understand!Neuf the Wilding t currently hoc a lmant,that it la my mspomibility w notify the occupant of me ments which must W met prior issuance of a CcNOcew of Occupancy. Signature Of Applicant Da1e nt2 e-7 C),2.0 -ck 5ed agent Da¢ All roof coverings to be Class "B"or better Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 � CITY OF Fax(408)777-3333 UPEkTINO Building De artment JOB ADDRESS: PERMIT# /902YS tSbPaoo T' OWNER'S N oA 3Ale-L PHONE # GENERAL CONTRACTOR: FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: 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 1� Roofing 4nc i R i Septic Tank Sheet Metal Sheet Rock Tile �/ q C P/A7n Q!P F Q b - QC_ - b 0TOwner/Contractor Signature Date �> Community Development Department Building Division ]� City of Cupertino 10300 Torre Avenue CITY OF Telephone: (408)777-3228 Fax: (408)777-3333 C 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: 5 . /70G��� ✓C�u A . Job Site Address: S A7 Roofing Company Name: ��S_�y,YW'1�C_2ho6J 6 f `, Applicant's Signature: C-,-09 0) &."'j hems_ Date:j2L-Q2-O 5- Greg Casteel Building Official Revised 11/2/04 CITY OF CUPERTINO REROOF � 6a CUPERTINO PERMIT APPLICATION FORM APN# 295 (,{ �� Date: " - Building Address: 190 2 ) 14lk C u Pc�g' ) Owner's Name: Phone#: Contractor: Phone#: 0 o9 7 Z%- Sion License #: 76011 Contact: c Phone#: (y 0 8) 7 Z 9-S i o/ Cupertino Business License M i Type of Roof Covering: Existing: Proposed: Mr'�Built-Up Roof ❑ Built-Up roof M/ Asphalt Shingles =—Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ll ❑ Other(Specify) 3,�Other(Specify) '�a✓C h 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 Commercial ❑ Fire Zone: Yes ❑ No ❑ Confirmed with Planning De t. if there are any restrictions: LJ Cost of Project: Type of Construction: Occupancy group: Qty. if Applicable Fee ID Fee Description Fee Group BPERMFEE Bld Permit Fees BUILDING BENERGY Energy BUILDING BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING c '(rurrir/yr, ( c, ©52j LETTER OF RESPONSABILITY This is a letter of resposability for the property at 19021 Meiggs Ln. in Cupertino, California, whertwe, STONERIDGE ROOFING install two layer of 15 lbs felt and 40 year composition shingle. in reg4s to the electrical wire, owner agrees to get it fix by him or a profooional. CONTRACTOR OWNER DATE UD /N,SPE-C770,-JS I/A/77L � I DLD CH's /3vr/Nc,�p I � �v �►� �-� jnn9.r1 Cov��-e-r v� . 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