09120050 (2) CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 18825 PENDERGAST AVE CONTRACTOR:STONERIDGE ROOFING PERMIT NO:09120050
OWNER'S NAME: SHEILA&JIM HEYHURST 2798 GLENFIRTH DR DATE ISSUED: 12/08/2009
ER'S PHONE: 4082577092 SAN JOSE,CA 95133 PHONE NO:(408)729-5101
❑ LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO: BLDG f— ELECT� PLUMB�
License Class `- q Lic.# 2JS"// "
MECH RESIDENTIAL COMMERCIAL
Contractor Date C(. 0O:Q'
I hereby affirm that I am licensed under t e provisions of Chapter 9 INCH, JOB DESCRIPTION: RE-ROOF TEAR OFF TAR&GRAVEL,INSTALL 1 OSQ 1/2
(commencing with Section 7000)of Division 3 of the Business&Professions 0SQ OSB,TWO-PLY 15LBS FELT,30YRS COMP CLASS A
2
Code and that my license is in full force and effect. 0SQ**SEE NOTES**
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:$8000
permit is issued.
APPLICANT CERTIFICATION APN Number:37533022.00 Occupancy Type:
1 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. /
Signature � /�f Date],��G t7��—Ot7 Issued by: Dat9!
Li OWNER-BUILDER DECLARATION
RE-ROOFS:
1 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,1 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: �v !&42rye- Date:D_-=C,p c4'G
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:
I have and will maintain a Certificate of Consent to self-insure for Worker's 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 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: & CZ
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 constriction 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 constriction,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned property for inspection purposes.(We)agree to save
in,' )ify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
c nd expenses which may accrue against said City in consequence of the
granting 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
l/
a7`
CITY OF CUPERTINO
REROOF
CUPEkT1NO PERMIT APPLICATION
APN # Date:
✓ .� "� L .
De o 0
Building Address:
/ cnZe,,rgast Av"
Owner's Name: one #:
HOA: Yes ❑ No �If yes, provide letter from HOA yoG) 25 7 - �o 72
Contractor: Phone o�
D Fax #:
Cupertino Bus ness License #: Contractor License #:
66Vi
Type of hoof Covering:
Existing: Proposed:
Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles &Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other (Specify) ❑ Other (Specify)
Number of existing coverings ❑ Provide I.C.C.E.S. Report#
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description: 2®
o I ten sivicres '/ two.-Ply ) r c0 P
Residential Commercial
Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if
Green Building Checklist & attach it to the application or if there are any restrictions: ❑
applicable, include in plan set & the sheet inclex.
Valuation:
, o
I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
Signa re
Revised 02/05/09
CITY OF C'UPERTINO
:a REROOF
CUPEkTINO FEE SCIJEDULE
Number of Fee ID Fee Descr:.ption Fee Permit Type
Squares Group
1REROOFCOM Re-roof Co;nmercial B 1COMMLROOF
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
1BSEISMICO Seismic Commercial B
1RER00FRES Re-roofRe,,idential B 1SFDWLR00F
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
1BSEISMICRE Seismic Re3idential B
1 REROOFMRES Re-roof ML.lti-Family B 1MFDWLROOF
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commissio a Fee
1BSEISMICRE Seismic Re3idential B
1BUSLIC Business License B
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
Fax: (408)777-3333
Building Department
Subject: Re-roofing policy for the City of Cupertino
1. Prior to permit issuance,you must a€;ree to comply with 2007 IBC Standards
and manufacturers specifications on re-roofing.All roofs are Class "A"per Cupertino
municipal code 16.04.080.
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 performed.
7. NOTE: If you call for a plywood nail inspection 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 cz n be scheduled.
IMPORTANT:
1. Flat roofs must have a minimum of 1/ "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 abo,re stated policy on re-roofing.
Homeowner's Name:
Job Site Address: /'00°o2 S P,,,,
Roofing Company Name: J � 7"' r
.17
Applicant's Signature: &221 Date: �C , 200
Greg Casteel
Building Official
Revi:;ed 07/30/08