10050018CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 918 ROSE BLOSSOM DR CONTRACTOR: STONERIDGE ROOFING PERMIT NO: 10050018
OWNER'S NAME: APTES AVILASH & MADHAVI 2798 GLENFIRTH DR DATE ISSUED: 05/03/2010
JER'S PHONE: 4082554732
SAN JOSE, CA 95133 PHONE NO: (408)729-5101
LICENSED CONTRACTOR'S DECLARATION BUILi)ING PERMIT INFO: BLDG f— ELECT i PLUMB
License Class -6 p Li,. #,7 6-6/ ll
Contractor�} QhO�r/� Date �,- 3
I hereby affirm that I am Licensed under the provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business & Professions
Code and that my license is in full force and effect.
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
permit is issued.
APPLICANT CERTIFICATION
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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Signature�� l ed2 6/tom Date 51-3-16
11
LJ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
I, as owner of the property, or my employees with wages as their sole compensation,
will do the work, and the structure is not intended or offered for sale (Sec.7044,
Business & Professions Code)
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
I 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 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
permit is issued.
I certify that in the performance of the work for which this permit is issued, I shall
not employ any person in any manner so as to become subject to the Worker's
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
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
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
unify and keep harmless the City of Cupertino against liabilities, judgments,
, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
SignatureSGf?;n1Gl�� Date
MECH F RESIDENTIAL F COMMERCIAL r—
JOB DESCRIPTION: RE -ROOF TEAR OFF WOODSHAKE, INSTALL 1/2 INCH
OSB,
15LBS FELT, 30 YEARS COMP CLASS A 27SQ
Sq. Ft Floor Area:
APN Dumber: 35906030.00
Valuation: $9000
Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
`VITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Dat
at��
Issued by
r
RE -ROOFS:
All rcofs shall be inspected prior to any roofing material being installed. If a roof is
instal ed without first obtaining an inspection, I agree to remove all new materials for
inspe :tion.
Signzture of Applicant:
Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I hai a read the hazardous materials requirements under Chapter 6.95 of the
Calilornia Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safely Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
cont iminants as defined by the Bay Area Air Quality Management District I will
mair tain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
Owr er or authorized agent:
Date: S'� �i Q
CONSTRUCTION LENDING AGENCY
I her -by affirm that there is a construction lending agency for the performance of work's
for N/hich this permit is issued (Sec. 3097, Civ C.)
Len ler's Name
Len Ier's
ARCHITECT'S DECLARATION
I un ierstand my plans shall be used as public records.
Lia used Professional
CUPERTINO
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
(408) 777-3228 • FAX (408) 777-3333 • buildirg(aD-cupertino.orq
PROTECT ADDRESS
APN #
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OWNERNAME
PH
E-MAIL
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STREET ADDRESS
CITY, STATE, ZIF
FAX
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CONTRACTOR NAME
LICENSE NUMBER
LICENSE TYPE
BUS. LIC. #
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COMPANY NAME
E-MAIL
FAX
STREET ADDRESS/�
CITY, STATE, ZIP
PHONE2228
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I UNDERSTAND AND AGREE TO THE FOLLOWING:
The re -roof project shall comply with all applicable provisions of the 2007 California Building Code.
2. An inspection request shall be scheduled the day before the inspection date. Please call (408)777-
3228 between 7:30 - 3:30pm (Mon -Fri) to schedule the next day inspection.
3. After the roof is tom off and the nails/fasteners have been removed and all the dry -rotted wood has
been replaced, you must call for a roof inspection. A building inspector will be available with one hour.
There are special hours for the service: 7:30 — 10:30wn and 1:00 — 3:30pm (Mon — Thurs);
7:30 — 10:30;un and 1:00 — 2:30pm (Friday).
4. If plywood is installed, a plywood nailing inspection is required.
5. New roof coverings shall not be applied without first obtaining all 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 sl eathing so a proper inspection can be performed.
6. 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: tem will be verified:
a. Flat roofs shall have a minimum of/" per foot of slope and demonstrate there is no ponding.
b. A listing from an approved testing agency shall be awLilable on-site to review at the time of the
inspection.
c. Proper spark arrestor installation.
7. NOTE: If you call for a plywood nailing inspection aid the job is not ready, you will be charged to a re-
inspection fee of $126.00. The re -inspection fee shall be paid before another inspection can be
scheduled. -
'1y my signature below, I certify to each of the following: I am the property owner or authorized agent to act on
..ie property owner's behalf. I understand and agree to comply with the re -roof policy stated above.
Signature of Applicant/Agent: Date:
ReroojPolicy_20/0.doc revised 04114//0
1. Use Low/No-VOC Paint
1 IAC/Health pts
y=yes
2. Use Low VOC, Water -Based Wood Finishes
2 IACIHealth pts
y=yes
3. Use Low/No VOC Adhesives
3 IACIHealth pts
y=yes
4. Use Salvaged Materials for Interior Finishes
3 Ra;Dume pts
y=yes
5. Use Engineered Sheet Goods with no added Urea
Formaldehyde
61ACJHealth pts
y --yes
6. Use Exterior Grade Plpkood for Interior Uses
1 IACVHealth pts
y=yes
7. Seal aM Wised t Wtioldb d or MDF
4 IAC JHealth. pis
y=yes
B. Use FSC Certified Materials for Interior Finish
4 Re3ourCe pts
y=yes
9. Use Finger -Jointed or Recycled -Content Trim
1 Resource pts
y=yes
10. Install lI hole House Vacuum System
3 IA )Maalth pts
y=yes
N. Flooring
1. Select FSC Certified Wood Flooring
B Resource pts
y=yes
2. Use Bapidly DenewaWe Flooring Materials
4 Reszource pts
y=yes
3. Use Recycled Content Ceramic Tiles
4 Resource pts
y=yes
4. Install Natural Linoleum in Place of Vinyl
5 IACJHsalth pts
y=yes
5. Use Exposed Concrete as Finished Floor
4 Re=.ource pts
y=yes
6. Install Recycled Content Carpet with Low VOCs
4 Re: ource pts
y=yes
Total Points Available:
Total Points Pro'ect Received:
1401 130 57
01 01=
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CUPERTINO
nn,.Trru A r-rrnu cI TRIPONTRACTOR LIST
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
ti V1\liv ivy-- - -
SU SUBCONTRACTOR
JOB ADDRESS: SSD
PERMIT
OWNER'S NAME: AVi//,Z�
PHONE #
GENERAL CONTRACTOR: G , `
BUSINESS LICENSE #
CITY/ZIPCODE: 5�,-, e -
ADDRESS 23 98 �`?!e� `;i�► DI
_ t--- - r:4., -f t"vinortinn hnsiness license.
*Our municipal code requires all Dusmesses wurning .is • .7 •� •--- • � - _ _
NO BUILDING FINAL OR FINAL OCCUPANCY HAVE OBTAINED AHCITY OF CUPERTINO
UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS
BUSINESS LICENSE. /Q
3
I am not using any subcontractors: Signature Date
._ I h. rstrartnrc anti emmnlete the following information:
1�5�d _ 5--3 -/0
Owner / Contractor Signature Date
SU SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring / Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping EET
Lathing
Masonry
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
1�5�d _ 5--3 -/0
Owner / Contractor Signature Date