12030135 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10280 MIRA VISTA AVE CONTRACTOR:STONERIDGE ROOFING PERMIT NO: 12030135
OWNER'S NAME: SHEN DAVID Y AND JOSEPHINA Y 2798 GLENFIRTII DR DATE ISSUED:03/28/2012
OWNER'S PHONE: 4086904209 SAN JOSE,Cy 95133 PIIONF.NO:(408)779-5101
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
License Class
_39 Lic. ZSISS� r r
H
�7 MECH RESIDENTIAL COMMERCIAL
Contractor ) q e �// 1`//� Date J —,C— )L
1 hereby affirm 91 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION: RI:-ROOF TEAR OFF WOODSHAAE,2 I SQFT&INSTALL 1/2
(commencing with Section 7000)of Division 3 of the Business&Professions INCH OSB RADIANT BARRIER.30LB FELT WITI 140YR
Code and that my license is in full force and effect. :NCH
COMPOSITION CLASS A
I hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area: Valuation:$10500
permit is issued.
APPLICANT CERTIFICATION APN Number:35702025.00 Occupancy Type:
I certify that I have read this application and state that the above information is
correct.I agree to comply with all city and county ordinances and state laws relating
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify
dexpenskeep
swhiche may
accrue
ofCupenino idCityinconst nseques.njudgments, WITHIN Igo DAYS OF PERMIT ISSUANCE OR
costs,and expenses which ma}'accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
Signature �r Ji9'i' Date 3 —��—I1 Issued by: ��N �iliT/ Date:3"��"/�
❑ OWNER-BUILDER DECLARATION
RF:ROOF'S:
hereby affirm that 1 am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is
the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
1,as owner of the property,or my employees with wages as their sole compensation, inspection.
will do the work,and the structure is not intended or offered for sale(Sec7044,
Business&Professions Code) Signature of Applicant: Date:
1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code), ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1 hereby affirm under penalty of perjury one of the following three
declarations:
I have and will maintain a Certificate of Consent to self-insure for Workers HAZARDOUS MATERIALS DISCLOSURE
Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Ilealth&
Section 3700 of the Labor Code,for the performance of the work for which this Safety Cade,Section 25532(1)should I store or handle hazardous material.
Additionally,should I use equipment or devices which emit hazardous air
permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will
1 certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's Health&Safety Code.Sections 25505,25533,and 25534.
Compensation laws of California. If,after making this certificate of exemption,I
become subject to the Worker's Compensation provisions of the Labor Code,1 must Otiner or authorized agent:
forthwith comply with such provisions or this permit shall be deemed revoked. Dale: Z
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENC1"
I certify that 1 have read this application and state that the above information is I hereby affirm that there is a consimcdon lending agency for the performance of work's
correct.I agree to comply with all city and county ordinances and stale laws relating for which this permit is issued(Sec.3097,Civ C)
to building construction,and hereby authorize representatives of city to enter Lender's Name
upon the above mentioned properly for inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
costs,and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply ARCIIITF.f.T'S DECLARATION
all non-point source regulations per the Cupertino Municipal Code,Section
9.18. 1 understand my plans shall be used as public records,
Signature Date Licensed Professional
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35702025.00
DATE ISSUED. . . . . . . : 03/28/2012
RECEIPT #. . . . . . . . . : BS000016379
REFERENCE ID # . . . : 12030135
SITE ADDRESS . . . . . : 10280 MIRA VISTA AVE
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER SHEN DAVID Y AND JOSEPHINA Y
ADDRESS . . . . . . . . . . : P 0 BOX 4046
CITY%STATE/ZIP . . . : MOUNT VISTA, CA 94040
RECEIVED FROM . . . . : STONERIDGE ROOFING
CONTRACTOR . . . . . . . : SERGIO GONZALEZ LIC # 25625
COMPANY . . . . . . . . . . : STONERIDGE ROOFING
ADDRESS . . . . . . . . . . : 2798 GLENFIRTH DR
CITY/STATE/ZIP . . . : SAN JOSE, CA 95133
TELEPHONE . . . . . . . . : (408) 729-5101
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
-- ------------ ---------- ---------- ---------- ---------
1BCBSC VALUATION 10,500.00 1. 00 0. 00 1. 00 0. 00
1BSEISMICR VALUATION 10, 500.00 1. 05 0. 00 1 .05 0.00
1REROOFRES SQ FEET 21.00 294 . 00 0. 00 294 .00 0.00
TOTAL PERMIT 296. 05 0. 00 296 . 05 0.00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 296 . 05 #1276
---------------
TOTAL RECEIPT 296 . 05
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
---------------------------- -------- -------------------
309 EXTERIOR LATH 311 SCRATCH COAT
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
ALBERT SALVADOR, P.E.. C.B.O., BUILDING OFFICIAL
CUPERTINO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228- FAX(408)777-3333-building(cDcuoertino.oro
PROJECT ADDRESS APNA
D D l�.(/ 5 lc-.
OWNER NAMEi PHONE. E-MAIL
STREET ADDRESS CITY, STATE.T.IP FAX
CONTRACTOR NAME. J%e G/ LICENSE NUMBER ^ LICENSE TYPE ��I BUS.LIC.M
COMPANY NAME ! L E-MAIL 421 / FAX
C,(l ooEiklp
STREET ADDRESS CITY,STATE,21P PHONE C, G
336S eltn D� 0 Y '1' , - r� 1Z -slv
I UNDERSTAND AND AGREE TO THE FOLLOWING:
I. The re-roof project shall comply with all applicable provisions of the 2010 California Codes.
2. An inspection request can be scheduled up to the day before the inspection date. Please call (408)777-
3228 from 7:30 - 3:30pm (Mon-Thurs) or 7:30 - 2:30pm (Friday) to schedule the next day inspection.
For Tear-Off and Nailing Inspections, you must also call on the day of the inspection only after that
phase of the work is completed. The building inspector will be available within one hour. Progress
and Final Inspections will be given a two hour window.
3. Tear-Off Inspection is required. Any and all dry-rotted wood shall be replaced prior to this inspection.
Unless new plywood roof sheathing is proposed throughout, all the nails/fasteners shall be either
completely knocked-down or removed prior to this inspection.
4. if plywood is installed, a plywood Nailinp Inspection is required.
5. Roofing shall not be applied without first obtaining all prior inspection and written approvals from the
building inspector. Any roofing which is applied without first obtaining an approved inspection will
require the removal of all new material down to the sheathing so a proper inspection can be performed.
6. Proaress Inspection is required when approximately 50% of roof covering is installed.
7. A Final Inspection and approval shall be obtained from the building inspector when the re-roofing is
completed. To receive a final sign-off, the following items will be verified:
a. Flat roofs shall have a minimum of Y per foot of slope and demonstrate there is no ponding.
b. Listings from approved testing agencies for all pre-manufactured products used shall be
available on-site to review at the time of the inspection.
c. Proper spark arrestor installation, vents painted, gutter/downspouts installed, debris removed.
8. NOTE: If you call for a tear-off or plywood nailing inspection and the work is not complete, you will be
charged a re-inspection fee of$126.00. The re-inspection fee shall be paid before another inspection
can be scheduled.
By my signing below, I certify each of the following is true: I am the property owner or authorized agent to act on the
property owner's behalf. I understand and agree to comply with the re-roof policy stated above. I also understand that
smoke detectors and carbon monoxide detectors are required to be installed in accordance with Sections 8314 and R315 of
the 2010 California Residential Code.
Signature of Applicant/Agent: Date:
RrroolPnlier 2011 h)c revived(12116111
CITY OF CUPERTINO
its. FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 10980 Miravista Road DATE: 03/28/2012 REVIEWED BY: Sean
APN: BP#: 'VALUATION: $10,500
*PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Duplex PENTAMATION 1SFDWLR00F
USE: PERMIT TYPE:
WORK Tear off woodshake 2100 s.f. and install 1/2 inch OSB radiant barrier, 30 Ib felt with 40 yr Landmark
SCOPE composition.
FEEID ROOFAREA
s.f.
1REROOFFRES 2,100
,tfe,:h. Pion C'he k Ylmrd+. Plow Ch'!(Ah7e,:. flit Clmnk
dh•ch. Poona Fec: Phunb, Permit h".e tiler'. l'errnil ltd:
01/1(." '11("/7 lay Odrer Plumb ln.cp. Li 1 Other li/c•r. Imp,
Hccli. ln,p. fie": /'lmnb. hepr. Fee: lila•. lisp. lSrc:
NOTE: This estimate does not include fees due to other Departments(i.e. Planning, Public Works, Fire,Sanirary Sewer District,School
District,etc). Thesefees are based on the prefimina information available and are only an estimate Contact the Dept for addn 7 info.
FEE ITEMS flee Re.solulion /1-053 EfL 7/1//11 FEE QTY/FEE MISC ITEMS
Plan Check Fra:
S'erppl. PC 17c
P(mnh.A1 tech./1,1c•c
Permit Fee: $294.00
Supp1, hicp Fee
F'lmnh.;•Flesh./Elc•c
I'lumh./d•lecll./lilcu fermi/ Fels.
C'ouslriwtipn Tax
Adininisu•ative Pec:
Work Without Permit? 0 Yes (E) No $0.00
Advam ed P/mming leas:
Travel Dncmnenlalion Pees:
Strontt Motion Fee: IBSE1SMICR $1.05 Select an Administrative Item
131da Stds Commission Fee: 1BCBSC $1.00
SUBTOTALS: $296.05 $0.00 TOTAL FEE: $296.05
Revised: 1/19/2012
C 3 0 3
REROOF PERMIT APPLICATION
COMMUNrlY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORREAVENUE•CUPERTINO. CA 95014-3255
CUPERTINO (408)777-3228 •FAX(408)777-3333•buildinD(cDcuoertino.orD
L/
PROJECT ADDRESS APNp�J
OWNER NAME a-y E-MAIL
STREET ADDRESS QTY, STATE,IIP FAX
APPLICANT NAME PHONE 64AAB.
SRtEEr ADDRESS // CITY,STATE,]IP FAX
1311❑OWNER OWNER-aIIRDat OWNE �,
RAGENT CONTRAMR ❑CONTRACTDR AGENT ❑ ARCH ❑ENGINEER ❑ DEVELOPER ❑T ANT
CONTRACTOR NAME J I 0 ` NlUSE NUNMER / , LICEN TYPE L BUS.LIC.9
COMPANYNAIV[E &MAR FAX
"4-orlen-dje goofi
STREET ADDRESS`S�S S
h_ r. CITY.STATE,IIP PHONE
J l� S O gI2 8 -SJO
AKCHITECr/ENGINI}A NAME LICENSE NUMER. Bus.LIC.M
COWANY NAME E-MAIL FAX
STREET ADDRESS CRY,STATE,ZIP PHONE-
USE
HONEUSE OF SFD or Duplex - M--', ^—i:�- ROOF AREA. VALUATION:
STRUCTURE ❑ Commercial S O O
EXI,TrNr ROOF TYPE: ❑BUILT-IIP ROOF ❑ASPHALT SH3NOT-FS wOOD SHAXFS ❑WOOD SHINGLES ❑OTHER(SPECIFY)
REMOVE/REPLACE KES PNO, PLYWOOD K" ❑ _ PLYw'D OSH PIILFE ROOF
❑N a ❑ 5/B" TYPE: ❑ X :12 S A
PROPOSED ROOF TYPE: ❑HURT-UP ROOF IIQA ,,,ALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT a
DFSCRIPTLON OF WORK
i. O
ZlUdi&)74.1✓Y'C% 30coo
By my signature below,I certify to each of the following: Imo the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have provided is com= I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and sate laws relating to building construction. I authorize,representativw of Cupertino tc enter the above-identified property for inspection purposes.
SignatureofApplicant/Agent Date:
SUPPLEMENTAL INFORMATION REQUIRED
_If buildingis associated with a Home Owner's Association, R �_ �
� 4 Provide letter �-��'..`� .oururc�sl�, -i
of approval from HOA via ",.� '-''�;INZNG
� _
Provide Planning approval to verify if there my restrictions.
Provide copy of Manufacttner's Installation Specifications. ,U�'�
r-
Provide signed copy of Cupertino's Tear-Off Policy.
ReroofApp_2011.doe revised 03/02111