07090027 7777..
CITY OF CUPERTINO PERMIT J
BUILDING DIVISION PERMIT �� � �� �
BUILDING �tDRESS: PERMIT NO.
103.15 STONYDALE DR WOODS ROOFING 07090027
OWNER'S NAME: PERMIT ISSUE DATE
HOSE RICHARD K TR AND JANET K 1020 HICKORY CT 09/07/2007
NE: SANITARY NO. CONTROL NO.
(831) 637-5576
ARCHTTECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
00 LICENSED CONTRACTOR'S DECLARATION .lob Description
vs I hereby affirm that I am licensed under provisions of Chapter 9(commencing
z with Section 70()0)of Division 3 of the Business and Professions Cade.and my license is TEAR OFF EXISTING SHAKE RO F F RE-SHEET OSB, 3 0 LB
! y in full force and ecu.G,,�3 t Ltc# ?-e /'�l
�? License Class J FELT, 50 YR COMP, CLASS A, 42 1/2 SQ.
-t,,,a Date -I -G 7 Contractor
ARCHITECTS DECLARATIO
i a< I understand my plans shall be used as public records
)yU
'
U.y Licensed Professional
OWNER-BUILDER DECLARATION
> I hereby affirm that I am exempt from the Contractors License Law for the
c Op� following reason.(Section 7031.5,Business and Professions Code:Any city or County
Ii which requires a permit to construct,alter,improve,demolish.or repair any structure
zy prior to its issuance,also requires the applicant for such permit to rile a signed statement
=o that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft. Floor Area Valuation
t~$ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $22000
that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty ofNumber Occupancy Type
not more than five hundred dollars(5500). 3263701
1U
❑I,as owner of the property,or my employees with wages as their soic compensation,
will do the work,and the structure is not intended or offered for We(Sec.7044,Business ns Required Inspections
and Professions Code:The Contractor's License Law dors not apply to an owner of q P
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for sate.If,
however,the building or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑I,as owner of the property,am exclusively contracting with licensed contractors to
contact the project(Sec.7044,Business and Professions Code:)The Contractor's Li-
cense Law does not apply to an owner of property who builds or improves thereon.and.
who contracts for such projects with a conu=tor(s)licensed pursuant to the Contractor's
License Law.
❑1 am exempt under Sec. B&P C for this reason
OwnerDate
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a Certificate of Consent to self-insure for WOrkces Compen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
have and will maintain Worker's Compensation Insurance,as required by Section
700 of the Labor Code,for the performance of the work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number are:
Cartier.-"!io/ J Policy No711_�
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars($100)
or less.)
I certify that in the performance of the work for which this permit is issued,1 shall not
employ any person in any manner so as to become subject to the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
,J 0 forthwith comply with such provisions or this permit shall be deemed revoked.
Z " CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
(1: the work for which this permit is issued(See.3097,Civ.C.)
QLender's Name
Lender's Address
Uz
IJ C) 1 certify that I have read this application and state that the about information is
IL ' correct.I agree to comply with all city and county ordinances and state laws relating to
Ubuilding construction.and hereby authorize representatives of this city to enter upon the
U above-mentioned property for inspection purposes.
a (We)agree to save,indemnify and keep harmless the City of Cupertino against
r�r liabilities,judgments,costs and expenses which may in any way accrue against said City
V Z in consequence of the granting of this permit. Date
APPLI NT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
SOU C EGULA NS.
i- 7-v " Re-roofs
Signature of ppl) Contractor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Code,Section 25532(a)? p All roofs shall be inspected prior to any roofing material being installed.
❑Yes C o
If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
Q Yes rusmaterials
l have read the hazardc requiremens under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 25505.25533 and 25534.I understand that if the building
does not curte ve a tenant-that it is my responsibility to notify the occupant of the
requirements is ust be met p' r to i cc of a Ccrtificate of Occupancy. Signature of Applicant Date
f `� All Too coverings to be Class "B"or better
Owner or authorize age Dare
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIP RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . . 32537011. 00
DATE ISSUED. . . . . . . : 09/07/2007
RECEIPT #. . . . . . . . . . BSS00002578
REFERENCE ID # . . . : 07D90027
SITE ADDRESS . . . . . : 10335 STONYDALE DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : HOSE RICHARD K TR AND JANET K
ADDRESS . . . . . . . . . . : 10335 STONYDALE DR
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1029
RECEIVED FROM . . . . : EDNARD A GREGORY
CONTRACTOR . . . . . . . : WOOD, LAWRENCE E LIC # 20810
COMPANY . . . . . . . . . . : WOODS ROOFING
ADDRESS . . . . . . . . . . : 1020 HICKORY CT
CITY/STATE/ZIP . . . : HOLLISTER, CA 95023
TELEPHONE . . . . . . . . : (831) 637-5576
FEE ID UNIT QUANTITY MOUNT PD-TO-DT THIS REC NEW BAL
----------- ------------- ---------- ---------- ---------- ---------- ----------
13PERMFEE VALUATION 22, 000. 00 299 .16 0. 00 299 .16 0. 00
13SEISMICRE VALUATION 22, 000. 00 2 .20 0. 00 2 .20 0. 00
BUSLIC FLAT RATE 1. 00 107 .00 0. 00 107 .00 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 408 .36 0. 00 408.36 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
------------------ --------------- --------------------
CREDIT CARD 408.36 MC
---------------
TOTAL RECEIPT 408.36
D709ooz77
CITY OF CUPERTINO
RE-ROOF
CUPER`TINO PERMIT APPLICATION FORM
APN# ��z b 3 20 // • ( U Date: — C�
Building Address:e3 ���0 le—
Owner's
� pr
6
Owner's Name: - Phone#:
I clGt d S� Yo ?- 73 6- 4'2 v 3
Contractor: License#: 3
WOODS DS �uu` 0,, __ c_ 3 7—
Contact:
Contact: Cupertino Business License #:
C7 f c�
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles X Asphalt Shingles S—O y r
Jj Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
NAnber of existing coverings ElProvide I.C.B.O.Report#
To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read,Understand and Will Comply With Cuuertino's Tear Off Policy:- ` ` ' ❑
Job Description: Ssr
✓v x, f ti S t /-6L. ,raw 0,5 Q .So
Residential Commercial ❑ S S
Fire Zone: Yes ❑ No P-'- Confirmed with Planning Dept. if
there are any restrictions: U
Cost of Project: 000Type of Construction: Occupancy group:
IF
Qty. if
Applicabip 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
Telephone: (408)777-3228
YJ� 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 perf��rmed.
7. NOTE: If you call for a plywood nail ilspection 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 a/bovc stated policy on re-roofing.
Homeowner's Name: / j 1-G G✓-C� `/ ) S-�
Job Site Address: C9 3 `1q (e- 12t
Roofing Company Name: W c�l� cl S J c7 rJ" �► L
Applicant's Signature: Date: 5;0- 7---)
U 0
Greg Casteel
Building Official
Revised 11/2/04
Community Development
�+ J orte Avenue
C1 p Orono CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
CUPEkTINO
Building Department
JOB ADDRESS: PERMIT#
�-rV
OWNER'S NAME: PHONE # -112 U 3
x GENERAL CONTRACTOR: FAX #
/I I am not using any subcontractors: 7 7
Signature Date
Please check applicable subcontractors and co m )lete the following information:
SUBCONTRACTOR BUSII*,fESS 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 (i(JD j-S s�c t,
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contract Signa Date