11070015 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7549 BARNHART PL CONTRACTOR:STONERIDGE ROOFING PERMIT NO: 11070015
OWNER'S NAME: YU EUGENE L AND ELAINE S 2798 GLENFIRTH DR DATE ISSUED:07/01/2011
-NER'S PHONE: 4089103852 SAN JOSE,CA 95133 PHONE NO:(408)729-5101
CJ LICENSED CONTRACTOR'S DECLARATION
1 BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class C i f Lic. `Po
MECH RESIDENTIAL COMMERCIAL
Contractor 5�G n (lU3'1»SDate
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:RE-ROOF TEAR OFF WOODSHAKE,INSTALL 1/21NCH
(commencing with Section 7000)of Division 3 of the Business&Professions COMPORADIANSITION
LASS A FELT,PRESIDENTIAL
Code and that my license is in full force and effect. COMPOSITION CLASS A 33SQ
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:$16000
permit is issued.
APPLICANT CERTIFICATION APN Number:36616075.00 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 and keep harmless the City of Cupertino against liabilities,judgments,
costs,and 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 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. r-�
Issued by: _ ' ! Date: /-
Signaturet�-rte/D� �GnZG�'� Date
OWNER-BUILDER DECLARATION
RE-ROOFS:
I hereby affirm that I 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(Sec.7044,
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
I hereby affirm under penalty of perjury one of the following three
declarations: HAZARDOUS MATERIALS DISCLOSURE
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 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 Health&
Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)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
I 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,I must Owner or authorized agent:
forthwith comply with such provisions or this permit shall be deemed revoked. Date: I r
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's
correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.)
to building construction,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
s,and expenses which may accrue against said City in consequence of the
.ting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. I understand my plans shall be used as public records.
Signature Date Licensed Professional
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 7549 barnhart DATE: 07/01/2011 REVIEWED BY: bobs.
APN: BP#: 'VALUATION: 1$16,000
PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY SFD or Duplex PENTAMATION 1 SFDWLROOF
USE: PERMIT TYPE:
WORK tear off wood shake re lace with comp shingles.
SCOPE
NOTE: Theseees are based on the preliminary information available and are only an estimate. Contact the De t or addh 7 info,
FEE ITEMS (1,ee Resolution 09-051 1: f. '1.-'I OZ FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 3,300 s.f. Re-roof
Suppl. PC Fee: G Reg. 0 OT 0-q hrs $0.00 $462.00 IREROOFRES
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl.Insp.Fee<D Reg. 0 OT 0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Acoustical Fee: Q Yes (D No $0.00 0
Work Without Permit? Q Yes E) No $0.00 E)
Planning Fee: $0.00 Select a Non-Residential E)
Building or Structure Q
Strong Motion Fee: 1BSEISMICR $1.60 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $2.60 $462.00 TOTAL FEE: $464.60
Revised: 07/01/2011
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
CU PERTI NO Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: 1�,f PERMIT# '� ;
OWNER'S NAME: , ` PHONE#
GENERAL CONTRACTOR: n BUSINESS LICENSE#
ADDRESS: - CITY/ZIPCODE: v )`
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors: elll
Signature Date
Please check applicable subcontractors and complete the following information:
V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring/Carpeting
Linoleum /Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting /Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
r REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
C U P E RT I N a (408)777-3228• FAX(408)777-3333 • building cupertino.org
PROTECT ADDRESS Cl
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OWNER NAME PHONE (, E-MAIL
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STREET ADDRESS CITY, STATE,ZIP GU FAX
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APPLICANT NAME PHONE a O jj j E-MAIL
STREET ADDRESSel CITY,STATE,ZIP
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❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT LJ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME _ LICENSE NUMBER O LICENSE TYPE BUS.LIC.#
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COMPANY NAME EMAIL FAX
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STREET ADDRESSCITY,STATE,ZIP _y PHONE
ARCHITECT/ENGINEERNAME LICENSE NUMBER BUS.LIC.#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE ZIP PHONE
USE of SFD or Duplex ❑ Multi-Family ROOF AREA: S 3 VALUATION:
STRUCTURE: El CommercialQIZ
EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY)
REMOVE/REPLACE YES IF NO, PLYWOOD %" ❑ PLYWD OSB PITCH`
ITCH ROOF
❑N #LAYERS: THICKNESS: ❑ 5/8" TYPE: ❑ CDX :12 CLASS: A
,�� ICC-ES REPORT#
U A
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF SPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER
DESCRIPTION OF WORK
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By my signature below,I certify to each of the following: I am 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 correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building construction. I authorize representatives of Cupertino tc enter the above-identified propervy for inspection purposes.
Signature of Applicant/Agent ELLr-* Date:
_.-
SUPPLEMENTAL INFORMATION REQUIRED 3
_If building is associated with a Home Owner's Association,provide letter -
.�_aof approval from HOA. : , ° W__%,
jM4
Provide Planning approval to verify if there any restrictions. s Y - PLIvi
- _
Provide copy of Manufacturer's Installation Specifications. �L7-sa'AND�:eD � -�.�
Provide signed copy of Cupertino's Tear Off Policy.
ReroofApp_2011.doc revised 03/02/11