04060038 (2) CITY OF CUPERTINO 4^,' Via, ' n ]r e'g'g }/"��ar
IT
DIVISION P>✓ 'MIT. Z4CONT 1. A`l O'.14� ". AVl\a-;'
BUILDING ADDRESS: STONERIDGE ROOFING 1ERMITNO04060038
11264 REDONDO CT
OWNER'S NAME: PERMIT ISSUE DATE
PATRIC LEON 1643 SHORTRID
SANITARY NO. CONTROL NO.
(408) 729-5101
ARCHITECr/ENGINEER: BUILDING PERMITINFO
BLDO ELECT PLUMB MECH
3086 LICENSED CONTRACTOR'S DECLARATION
I by effirtn that 1 em licensed undevuians of CM1apuer 9(commencing Job Description ��
withSoct )of Diviaion3ofthc Budnms P.C..imu Co ,..dmyliccnwis
eon, ser up ad erce,t REMOVE SHAKE INSTALL 1/2 ALE®
j n Z Licen ass Llc.# J r /
�r,—c Dam conue,tor INCH OSB, 50-YEAR PRESIDENTIAL;
A CNITELTS DECL D JUN 21 200¢
1 understood my plans shall&used u public records
k6
}u. Liccnud Pndcssinnal ppp���see
D S
OWN ER-BUILDER DECLARATION BUILDING
1 hereby.('firm that 11. exempt from the fesnuacmrs License Law for the
pO which following turner.Permit
7031.5,Business and ve,derml Code:Any oily or county
5-.0
$ which requires a permit re uiros dm,almn improv,demellit t fie pair any tuement
yZT Priorto incensed pursarcquime thovisiosofcant thrsuch e Contractors
iecrom Law
slauemcm
FF mm a
that be is licensed pursuant to the provisions of the Commcmri nd Peon aw(ChePtcr 9 - Sq.Ft.Floor Area Valuat�§1g12 0 0
y F m that he I,exempt Section 7M)t f Division r or al Buseged em and pr,fmainns Cndc)tar
y�$
that he u exempt dmre(rom and dm bssu f.the alleged..option.Any=of
Section]031.5 by any applicant for a in mall subjects the applicant to a civil penalty of APN Number Occupancy e
m.more Nan five hundred dollars($500). P Y 'J P
❑1,u owner ofthe property,or my employees with wages u their solccompensadon, 35621012 . 00
will do the work and the structure iarotim anded oroRered forsam(Sec.9044,Business
and Proposed..Cade:The Contractor's License Law dos oat apply to an owner of Required Inspections
property who builds ori emotes thereon,and who doessuch work himselfor through his
own employees,provided thatsuch improvements are not intended or offered for rale.IL
however,me building or improvement is sold within one year of completion,the owneo-
builder will have me burden of proving met 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 Comactora Li _
me law does not apply to an owner o(propeny who builds or improves thereon,and
who contracts for such pmjecm with a contramons)licensed pursuant to the Convector's
License law.
❑I am exempt under Seo. .B&P C for this rcawn
Owner Dam
13CMIWORKERS COMPENSATION DECLARATION
I hereby amrm under per.lty of perjury one of the following declarations:
ave and will maintain a Certificate ofConsant to self-insure for Workers Compen.
-I!,
,an provided for by Section 3700 of the labor Code.(m the performance of the
or which this permit is issued.
ave and will maintain Worker's Compensation Insurance,as required by Section
tpe labor Code.for meperformance of me work for which mis permit is issued.
EfkerssCompensation humna e.nuierend PokrffAFt&r am:r,_�I Ce fiiiN� Po11ry No.: 1/AGR1
C—ETF'ICAA F�P170N FROM RKERS' -
COMPENSATION INSURANCE
(Thu section need not he completed Run,permit lsfnrone hundred dollars($10r)
or less.)
1 certify that in the performance of the work for which this Permit is issued.I shall not
employ any person in any manners,ss to become subject to the W,rkeri Compemadon
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:IL truer making this Certificate of Exemption,you should
become subject to me Worker's Compensation provisions of the labor Code,you must
0 forthwith comply with such previsions or this Permit shall be deemed hawked.
z CONSTRUCTION LENDING AGENCY
[r,fir I herchyaffom that mem is a construction lending egmtcy for performance or
y' > the work for which this permit is issued(Sec.3097,Civ.C.)
QLender's Name
Q z Lender's Address
V Q I ttnify that 1 have mad this application and sum mat the above information is
IL, F correct.I agree to comply with all city and county ordinances and state laws mixing to
0rJ building construction.and hembytenhorim representatives of this city to enter upon me
W about-mentioned property for inspection purposes.
0. (Wc)agree to save,indemnify and keep harmless the City of Cupertino against
tit H liabilitim,judgramms,costs and expenses which may in any way accrue against said City
t)Z in consequence of to granting of this permit. \\
r..m APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL-brAV icr Issued by: Date
SOUYAtt REGULATIONS.
� �o f 2 de L 0(1-00-or{ Re-roofs
S' m.m of Applicam/CommEtor Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle hazardous material
C"
defined by the Cupertino Municipal Code,Chapter 9.12,end the Health and Safety
Ind,semen 2ss3z(.n � All roofs shall be inspected prior to an roofing material beim
❑res []Na P P Y g being installed.
Will the applicant or future building occupant use equipments devices which If a roof is installed without first obtaining an inspection,I agree to remove
t hazardous air contaminants as defined by me Bay Area Air Quality Management all new materials for inspection.
❑Yes �u
1 have mad the hmmdnmmatedals requirements underchapter6.95 orlhe Caliror.
nu Health&SafctyCode,Sections 25915,25533 and 25534.1 understood thatifine building
docs not currently how a mount.that h is my responsibility to nod('y she occupant or me
requirement%which must he met poor to issuance or a Certificate of Occupancy. Signature of Applicant Date
rZfala o L Q6' -
ceroraathonzedagent ore All roof coverings to be Class"B"or better
CITY OF CUPERTINO
1 of 1 PERMIT RECEIPT OPERATOR: nancyC
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35621012.00
DATE ISSUED. . . . . . . : 06/03/2004
RECEIPT #. . . . . . . . . : 25746
REFERENCE ID # . . . : 04060038
SITE ADDRESS . . . . . : 11264 REDONDO CT
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . o PATRIC LEON
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4740
RECEIVED FROM . . . . : STONERIDGE ROOFING
CONTRACTOR . . . . . . . : SERGIO GONZALEZ LIC # 22435
COMPANY . . . . . . . . . . : STONERIDGE ROOFING
ADDRESS . . . . . . . . . . : 1643 SHORTRIDGE AV
CITY/STATE/ZIP . . . : SAN JOSE, CA 95116
TELEPHONE . . . . . . . . : (408) 729-5101 '
ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
_____ _____________ __________ __________ __________ __________ __________
BPERMFEE VALUATION 8, 000.00 137.00 0.00 137.00 0.00
BSEISMICRE VALUATION 8,000.00 0.80 0.00 0.80 0.00
BUSLIC FLAT RATE 1.00 100.00 0.00 100.00 0.00
__________ __________ __________ ----------
TOTAL PERMIT 237.80 0.00 237.80 0.00
METHOD OF PAYMENT AMOUNT NUMBER
_________________ ------------ ________-_________
CHECK 237.80 431
TOTAL RECEIPT 237.80
CITY OF CUPERTINO
ao REROOF D0006CUPEkTINO PERMIT APPLICATION FORM
APN# / o2/ D/ Date:
L(� O •-4I-O
Building Address:
126y o o CT.
Owner's Name: Phone#:
e,108) 83 6 - 0eig
Contractor: Phone#: License#:
Contact: VPhone#: Cupertino Business License#:
icy No 0) 321- )0
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles Ue-Asphalt Shingles
R 'Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ 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: 2-
Job Description:
V ✓ / 1/ S ) -
Residential [ Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: IJ
Cost of Project: Type of Cons ct n: Occupancy group:
Qtyi
A li ab Ie Fee ID Fee Description Fee Group
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
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
kCITY OF Telephone: (408)777-3228
PEkTINO Fax: (408)777-3333 s
I
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. j
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.
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: P�. yi C� A
Job Site Address: 112y fiC fP/1,1(5 G T
Roofing Company Name: �fC)ne// �fG 0011-zn c. h
A plicanYsSignature: 9/Q 6742L'16F Date: a/-0l-0V
Greg eel I
Building Official i
Revised 1/30/03
Printed on Recycled Paper