08090146 CITY OF CUPERTINO a * ��� Y 's= •�•�I' "� " '
Bl1ILDINC DIVISION PERMIT CONTfkXdT0RANF4U..RMATIOvNWh'
BUILI G D FSS: PERMIT NO.
T!MD6 STONYDALE DR DIAZ ROOFING 08090146
OWNER'S NAME: I FMWT ISSUE DATE
STOCKLMEIR ALAN L AND BARBARA 4652 SHETLAND WAY 09/22/2008
NE: (925) 565-0960 SANITARY NO. CONTROL NO.
ARCHITECTiENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
Sop LICENSED CONTRACTOR'S DECLARATION Job Description
j d C 1 herem Nm li¢ma W
by affirm I am er provisionls of Chapter 9(commencing P
G ridsSccdon70(nofDivi,ion3ofthefrorcd,andPmlessiovCode.andmyiicemeu RE—RF T/O SHK INSTL 1/20SB GRNND SEQUOIA SHNGL
c, in ten form andeft g
i'q.: Lkemocl , Lie.xCLSA 27SQ
Conime or
nQ W ARCHTIECTS DECLAR ON
W7� 1 uncommon,my plans sbJl he tied as puE Ns
gG Licensed Pmfessiooel
7OWNER-BUILDER DECLARATION
4 i F I hereby afrum Nat 1 em aaempt from Ne Convanoh Leon.Law for Ne
p O following moon.(Section 703 1.5,Business and Prolcssioo Code:Any city or county
$ which requlms a permit to ennmuw6 alcor,improve,demolish.or repair any structure
prior to its issuance.also mquima Ne applicant forcech permit to Bk a signed abutment
—�'< that he is licensed pooment to the provisions of the Connector's LJccoe law chapter Sq. Ft.Floor Area Valuation
y�� (commencing with Section 7f1f10)a Division 3 of the Business and Professions Code)or $14855
,t $ that be u exempt therefrom and Ne bub for the alleged exemption.Any violation of
Section 7031.5 by any applicant fm a permit subjects;the applicant to a civil penalty of
wx tome elm five hundred dellen IS= 32637026 AM Number Occupancy P Y T ype
L of ownerk.the property,m my otimoren with wager ar Ne'v roe.compensNon,
win do Neburet,and the samuctum onaranotmmMed oraffersud wdoforampply 7044.Business
of
and Nrty,whou Calc The Convxms,License Law don rot apply to an ower of Required Inspections
propertywho thermos,improvements
who onesauchwork hiwelfm through his
owncer,me uiprovidedthld such ntitwemenuare not intended
mplcuee(anal,IL
Wilder+,Ne Wilding or Mpeovement la,alt within one meld of completion.purpose,
owrcr-
Wilder w01 have Ne Wrder of proving that he did rot dem a improve for puryote of
sale.).
❑1,u owner of the property am exclusively contracting with Iicerued convectors in
construct the project(Sec.7Wd.Business and professions Cad,)The Conmcmh U. .
cnue law enter not apply m an owner of property who,Wilds or improves demon,and,
who carriers for such projects with a eororaetor(s)Rcensed punwns be do Canuactor's
Lict ue Law.
❑Iamnemptundersec. .B@PCf.miamaon
Owrc —Care-
WORKER'S
ateWORKER'S COMFENSAITON DECLARATION
I hereby affirm under penalty of perjury aro of Ik following declaoliats
40 I ham and will maintain a Certifier,of Cnoem in self-ioum furwarkers Compcn-
ssrted,u provided for by Section 3700 of the labor Coat,for the performance of Ne
work for which Nu permit is issued.
❑1 hove and will munrsln Workefs Compensation I..u requited by Section
37M ofthe labor Cook.for me performance clubs work for which this permit is issued. '
My Workef,�[ntnpnsa{yon Inwn1na nfriar and policy number am:
Carrier. 'i 0.t` V/);7; Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(Thiaaonlon need met be completed Jthe permit is raranchundrd collar(SIM)
or ICA)
I cmnuf-v Not in Ne perfmmanct of the work for which this permit is issued,1 shall not
employ any,mann in any mannerso as m become subject to the Workers'Conformation
Laws of Califomia.Date
Applicant
NOTICE TO APPLICANT.IL after making this CcnlEeate of Exemption,you should
become subject to NC Workar's Compensation provisions of Ne Labor Cade,you rated
.,O forthwith comply with such provision,m Nu permit shall W dmre
ece! mked.
'Z CONSTRUCTION LENDING AGENCY
[r rN. Ihereby afBrm that Ncrt is construction krding agency far the perfornma of
C
the work for which this permit Is issued(See.3097,Civ.C.)
W Q Lender's Name
Z)Z !tinder's Address
U O 1 mtify that I have mil this applicadon and state Nld the above information is
II, cmrst.l agree to comply wits all city and county ordinances and ante laws relating o
0 Wilding consouction,and hereby nutbodm mprerenutives of Nis city te enter upon the —j,]-t-\���(�/��//
+hove-menuoned property for inspection es whichmpurposes. ""tel/tgVk/
(We)agree to save,indemnify and keep harmless the City or Cupenirm against
rn incoitiermence cnrs,coruand expenses of thoc grarting of this which may in any way acmuc againstsaid City
U z APPLO.ANTeUNDERSTANDS AND WIL PLY WITH ALL N N-POI Issued by: Date
SQU GULATION /
Re-roofs
Si reof ApplianvCanuanor Dam `�—
FIAZAHDOUS MATERIALS DISCLOSURE Type of Roof
Will Ne applicant rm(Muni Wilding e.Chaps r 9A msnMk hruNon maurial
C Berea by do Cupertino Municipal Cade.Chapter 9.12,and the HNN and Safety
cmm,senior 25532(a)T Ter 1312N.— All roofs shall be inspected prior to any roofing material being installed.
Will thea applicant or forum Wilding occupant use, If a roof is installed without first obtainingan inspection,I agree to remove
pp g W equipment or devices which P
t hoaardnes air conuminams as defined by the Bay Area Air Quality Management all new materials for inspection.
nminT ^-
❑Yes Mr°'
I have mad the baaNrnu maeriaHrequimmow under Cbapterti.95olthe Cdifm-
nJuanHcalth kSecty Codc.kaom M3.25533M34: dcwd NnifNc Wilding ilding
tcurrendyhavesten Naatumy abilitifyNtmsupanerdo
_
mgti tewnKnmtu tetarmrenr
roaup.mey. Sign tureofApplicant Date
ow r anharisedagent r Dam 1 All roof coverings to be Class')q"or better
CITY OF CUPERTINO
• 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32637026 . 00
DATE ISSUED. . . . . . . : 09/22/2008
RECEIPT #. . . . . . . . . : BS000006154
REFERENCE ID # . . . : 08090146
SITE ADDRESS . . . . . : 10240 STONYDALE DR
SUBDIVISION . . . . . . :
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . :
OWNER . . . . . . . . . . . . : STOCKLMEIR ALAN L AND BARBARA
ADDRESS . . . . . . . . . . : 10240 STONYDALE DR
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1030
RECEIVED FROM . . . . : RODOLFO N DIAZ J GU
CONTRACTOR . . . . . . . : RODOLFO DIAZ LIC # 26457
COMPANY . . . . . . . . . . : DIAZ ROOFING
ADDRESS . . . . . . . . . . : 4652 SHETLAND WAY
CITY/STATE/ZIP . . . : ANTIOCH, CA 94531
TELEPHONE . . . . . . . . : (925) 565-0960
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 14, 855 . 00 1 . 50 0 . 00 1 . 50 0 . 00
1REROOFRES SQ FEET 27 . 00 351 . 00 0 . 00 351 . 00 0 . 00
---------- ---------- ----------
TOTAL PERMIT 352 . 50 0 . 00 352 . 50 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 352 . 50 #5467
---------------
TOTAL RECEIPT 352 . 50
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------= -------- ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 .ROOF IN-PROGRESS 605 FINAL REROOF
CITY OF CUPERTINO
�= REROOF
•CUPERTINO PERMIT APPLICATION
APN # Date: A-,,3 �. ( 37v � (P - ") � a
Building Address:
malos n r
Owner's Name:: Phone #:
141ar✓t •y0?) `739. 317'5_9'
Contractor: Phone #: 179D ej5t1—/45'k'
Fax #: ,P
Cupertino Business License #: Contractor License #:
A'11 a'99-
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ar Asphalt Shingles
w,'Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other (Specify)
Number of existing coverings o Provide I.C.B.O. Report #
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description: Aeall QW 5t1A&f X5 ( y asc �-7 p
)rO474 el'Yand, Sc�uia slttrv;le- Cb-,s5 A-•
Residential LLJ 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 index.
Valuation:
I Have Read, Understand and Will Co h Cupertino's Tear-Off Policy:
•
Si a re
Revised 6/16/08
CITY OF CUPERTINO
Q REROOF
OF
CUPERTINO FEE SCHEDULE
Number of Fee ID <' Fee Description Fee Permit Type
Squares Group
1REROOFCOM Re-roof Commercial B 1COMMLROOF
1BSEISMICO Seismic Commercial B
IREROOFRES Re-roof Residential B 1SFDWLROOF
IBS EISMICRE Seismic Residential B
IREROOFMRES Re-roof Multi-Family B 1MFDWLROOF
1BSEISMICRE Seismic Residential B
1BUSLIC Business License B
Revised 6/16/08
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 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 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: r7 ai'rL!'►/�Q{L 1
Job Site Address: �OB�fD �n y d, le,
Roofing Company Name: Ilitz, (1
Applicant's Signature: L Date:
• Greg Casteel
Building Official
Revised 07/30/08
Community Development
10300 Torre Avenue
t % Cupertino CA 95014
Telephone(408) 777-3228
CITY Of Fax(408) 777-3333
' �UPEI�TINO
Building Department
JOB ADDRESS: PERMIT #
►'• 0&6 -eo of S
OWNER'S NAME: j5 — PHONE # NOFl S
GENERAL CONTRACTOR: - FAX #
I am not using any subcontractors: 2
Signature Date
Please check applicable subcontractors and complete the followinginformation:
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
as
Owner/Contractor Signature Date