12080099 CITY OF CUPERTINO BUILDING PERMIT
RUILDINGADDRSS: 6416 MYRTLEWOOD DR CONTRACTOR:STONERIDGE ROOFING PERMITNO: 12080099
OWNEIR'S NAME: PERNG DAVID Y AND JENNY H 2798 GLENFIRTU DR DA'Z'E ISSUED:08l09P012
OWNER'S PHONE: 4089963896 SAN.IOSE.C\ 95133 PHONE NO:(408)729-5101
❑ LICENSED CONI'RACfOCR-'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
License-Class_C3 9 Lic.N � l,S 1
0 NIECIi r RESIDENTIAL r COi\111\IERCIAL r�
contractor_, iane d—ci— - /n5(l�Date
I hereby:(firm that l ant litt•.nseJ raider the prot'i.+ions of Chapter`) JOB DESCRIPTION: REMOVE EXISTING COMPOSITION ROOFING AND
(corn mencing with Section 7000)of Di,W...i 3 of the Ilusinexs&Professions INSTALL
Cade and that my license is in full force and effect. ROOFNEW ISLB FELL'AND NEW 40YR COMPOSITION
- ROOFING
1 hereby affirm under penally of perjury ane of the follotcing nen declarations:
I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided lox 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
permit is issued Sq.F1 Floor Area: Valuation:$2400
.U'I'LICAN"I'CIil2'I'I PI C\"PION
I certify that I have read this application and stale that the above information is MIN Number:36920025.00 Occupancy Type:
correct.1 agree to comply with all city and county ordinances mid state laws relating
to building construction,and hereby authorize representatives of this city In enter
upon the-above mentioned properly for inspection purposes. (We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, PERMIT EXPIRES IF WORK IS NOT STARTED
costs,anti expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source regulaticros per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION.
9.18.
Signaturec�G 1 Date a�/'� I� Issued by: Date:
❑ O\VNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractors License Law for one of RE-ROOFS:
the fullnwing mo reasons: All roofs shall be inspected prior to my roofing material being installed.Ifo roof is
1,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an.inspection.I agree to remove all nesv materials for
will do the work mid the stmemre isnot intended or oftcred for sale(Sec.7044, inspection.
Business&Professions Code)
I,as owner of the properly,an exclusively contracting with licensed contractors to Signature of Applicant: Date:
constant the project(Sec.7044,13usiimess&Professions Code).
I hereby affirm under penalty of perjury one of the fulluwing three ALI,ROOF COVERINGS TO BE CLASS"A"OR 131 1-I'ER
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's IIA'/.ARDOUS MATFRIAI S DISCLOSURE,
Compensation,as provided for by Section 3700 of the Labor Code,for the
perfomance of the work for which this permit is issued. I hate real the hazardous materials requirements under Chapter 695 of the
I have and Will maintain Worker's Compensation Insurance,as provided for by California llcalth&Safety Code,Sections 25505,25533.and'5534. I will maintain
Section 3700 of the Labor Code,for the erl'onnance of the work for which This compliance with the Cupertino Municipal Code,Chapter 9.1_and the Health&
p Safety Code,Section 25532(a)should I store or handle hazardous material.
permit is issued Additionally,should 1 use equipment or devices which emir hazardous air
I cerffy that in the performance of We work forwhich this permit is issued,I shall contaminants its defined by the Bay Area Air Quality Management District I will
not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code.Chapter 9.12 and the
Compensation Imus of Cali lomia. If,after making this certificate of exemption,I Health&Safety Coda Sections 25505,25533,and 25534.
become subject to the Worker's Compensation provisions of the Labor Code.I must Owner or authorized agent:
forthwith comply with such provisions or this permit shall be deemed revoked Sc `gG �•�TI/�G Dntr� I�
APPLICAN'I'CI'RTI FICA'1ION '] CONSTRUCTION LENDING AGIS\Cl'
I certify that I have read this application mid state that the above information is
correct.I agree to comply with all city and county ordinances mid state Imus relating I hereby affirm that there is a construction lending agency for the performance of work's
to building construction,mid hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Cir C.)
upon die above mentioned property for inspection purposes.(We)agree to save Lender's Name
indemnify and keep hamiless the City of Cupertino against liabilities.judgments,
costs,and expenses which may accrue a^_ainsl said City in consequence of die Lender's Address
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code.Section ARCII ITFCT'S DECLARATION
9.18.
I understand my plan shall be usedis public records.
Signature Dale '
Licensed 1'ndcssianal
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
CUPERTINO
(408)777-3228• FAX(408)777-3333• building(g)cuoertino.org
PROJECT ADDRESS y16APN a
Y�l
OWNER NAME / PHONE E-MAIL
� n
STREET ADDRESS CITY,STATE,ZIP FAX
c ��oo D� G� fin C .
CONTRACTORNAME3 `1
LICENSE NUMBER LICENSE TYPE BUS.LIC.0
l�rr
COMPANY NAME E-MAIL FAX
STREET ADDRESS ' / C• CIT'.STATE,ZIP M\ �0 SIJ PHONE '510
I UNDERSTAND AND AGREE TO THE FOLLOWING:
1. 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 Nailing 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. Progress 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$126.00. The re-inspection fee shall be paid before another inspection
can be scheduled.
By my signing below, 1 certify each of the following is true: I am the property owner or authorized agent to act on the
property owner's behalf. 1 understand and agree to comply with the re-roof policy stated above. I also understand that
smoke detectors and carbon monoxide detectors are required to be installed in accordance with Sections R314 and R315 of
the 2010 California Residential Code. c
Signature of Applicant/Agent: L / Date:_$— ! I�
RerooJPolicv_201 Ldoe reviser/02116/1l
12-tz-:� R Uv� 1
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO,CA 95014-3255
(408)777-3228• FAX(408)777-3333 -buildinG(dcuperlino.orp
CUPERTINO
MYrile-L-62(id-
PROJECT ADDRESS / ✓- APN4 ��-- b 25
OWNER NAME PHONE _ 896 E-MAIL
♦ 7
STREET ADDRESS 6V16CITY,1 G 0 STATE,ZIP O FAX
CONTACT NAME PHONE E-NlA1L
STREET ADDRESS CITY.STATE,ZIP FAX
❑ OWNER ❑ OwNER-BUILDER ❑ OWNERAGENT CONTRACTOR ❑CONIRACrORAGENT ❑ ARCHITECr ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME LICENSE NUA83ER IU 0 LICENSE TIDE BUS.LIC.k
r J
CONTANY NAME V(� E-AL1IL FAX
STREETADDRESS I reg ✓ CITY.STATE.ZIP 0 p I193t
PHONEkg -510
ARCHITEC(ENGINEER NAME LICENSE KMIDER ` BUS,LIC.M
COMPANY NAME E-MAIL FAX
STREET ADDRFSS CITY,STATE,ZIP PHONE
USE of SFD or Duplex ❑ Multi-Family. Rwr AREA: VALUATION: Q
STRUCTURE: ❑ Commercial (L /Q 0
EXISTING ROOF TYPE: 11 BUILT-UP ROOF ASPHALTSHINGLES ❑WOODSHAI:FS ❑WOODSHINGLES ❑OMER(SPECIFY)
REMOVE REPLACE YES IF NO. PLYWOOD ❑ :5' ❑ PLYwD ❑ OSBROOF
PITCH:
❑ O u AYERS S. ❑ SFE" PE' ❑ j'12 CLASS A
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑wOOD SHINGLES ❑OTHER ICC-Es REPORT M
DESCRIPTION OF WORK:
O`- P
0Uh I IS O n
By my signature Wow.I certify to each of the following: I am the propem'owner or authorized agent to act on the property o♦♦ner's behalf. I have read this
application and die information I have provided is correct. I have read the Description of\fork,and verify it is accurate. 1 agree in comply with all applicable local
ordinances and state laws relating in building construction. I uudiorize repr s nmtives of Cupertino m enter the above-identified property for inspection purposes.
Signature ofApplicanUAgenC 5Date:
SUPPLEMENTAL INFORMATION REQUIRED OFPICE USE ONLY
_If building is associated with a Home Owners Association,provide letter PLAN CHECK TYPE-. :ROUTING SLIP
ofapproval from HOA. 19 OVER-THE-COf1N R BUILDINCPLAN REVIEW
_Provide Planning approval to verify if there any restrictions. 9`LXeRris PLANNINGs'cAN pEiTew
_Provide copy of Manufacturer's Installation Specifications. ❑ STANDARD D FIRE DEPT.
_Provide signed copy of Cupertino's Tear-Off Policy. El OMER; -
Xeroojdpp_2011.doc revised 03116/11