07100191 CITY OF CUPERTINO ` (`� ' n '
BUILDING DIVISION PERMIT ���� �`"��� ����������
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BUILDI RES : PERMITNO.
�1 � STELLING RD STONERIDGE ROOFING 07100191 .
ER'S NAME: PERMIT �SUE �ATE
SIMONDS BERKELEY B AND 2798 GLENFIRTH DR 10/29 2007
PHON��T D T(1D T SANITARY NO. CONTROL NO.
(408)729-5101
ARCHITECT/ENGINEER: ' BUILDING PERMIT INFO
HLDG ELECT PLUMB MECH
c� o 0 0
i p Q LICENSED CONTRACTOR'S DECLARATION JOb DeSCilpt1011
� v F:. I hcreby affirm �hat I am licenscd undcr provisions o( Chaptcr 9(commcacia;
;Z � withScction7000)afDivision3ofihcBusincssandProfcssionsCode TEAR OFF EXISTING WOOD SHINGLES �1ND REPLACE WITH
�= y in full foree and clfecL
��z LicenscClazs _5��3� c ��� �„� ASPHALT SHINGLES
: �, � Da�c _..I.�4-�I - o
ARCHTfECI'S DECLA ATION
i a 4 1 undcrstand my plans shall bc uscd as pubiic reconls
�yU
' 4. y Liccnsed Pru(cscional
� y � OWNER-BUILDER DECI.ARATION
� I hcrcby atTirm thnt 1 am excmpt Crom thc Con�ractor's Liccnsc Law far the
j o O Collowing reuon. (Sccuon 7031.5, Busincss and Profcssions Codc: Any city or couaty
�,°, � which requires a pertnit to conswc4 e��r, improvc, dcmolLsh, or rep�ir any sauctuie
� z y �', priar ui i�s issuancc, alsu rcquires thc applicant Cor such permit to filc a signcd sulemeot �� Ft. Floor Area Valuation
�_ � ihat hc is liccnscd pursuant to thc provisions af thc Cantractor's Liccnsc taw ((7up�cr9 .
u F- �(commencing with Scction 7000) of Division 3 of thc Busincss and Profcssiant Codc) or $16 6 0 0
,, �_. ihat he is exempt thcrc[rom and the basis (or the altegcd ezempdon. My violuim ot
Section 7031.5 by a�ry applicant Cw a permit subjects �he applicant to a civil p�xutqr of ��y Number Occupancy Type
noc more �han 6vc hundred dollars (5500). 3 6 2 2 3 014 • v v
❑ I, u owner o[ ttie property, w my employces with wages at their sole compmsuioa,
wiil Qo the wock. snd �he suur.ure is not intendcd or affered far salc (Sec.7044,Basness Re uired Ins ECUOt1S
and Professions Code: The Conuactor's License Law dacs wt apply m an awoa d q P
property who builds or improves thercon, and who does such work himself or tbmas6 6is
own employccs, provided that such improvements are not iniended ar o[tered forsale. I[
however, the buildiag or improvement is sold within one year of compktion, �he arov
builder will have the burden o[ proving that he did not huild or improvc [or pu�poae �
sakJ.
❑ I, as owner o[ U�e property, am eacclusivdy conhacting wilh licensed cm�traetars m
conswct �he project (Sec. 7044. Business and Pro[essions Code:) The Conuauals ["r
ccnse Iaw docs aot apply io an ownu of propeny who builds or impmves �he¢ao. ffi_
who wmrac�s for such projects with a con�rxtor(s) Ii«nsed pursuant to the Cmtranars
License Law.
� am ezempt under See. . B& P C fa this Rssm
eu Date _. .
WORKER'S COMPENSATTON DECLARATION
I hercby afCicm under penalty o[ pe�jury one a( the lolbwing declantioos
❑ I hsre and will mainuin a Certi(cate of Conscnt to self-insure for Workc�s Campm-
sation, az provided far by Secdon 3700 of Ux Labor Code, far �he performarce d the
work for which Uiis pertnit is issued.
❑ I havc and will maintain Workefs Compensation Insunnce, u rcquired by Scctim .
3700 ot ihc Labor Codc, for thc perfortnancc of the arort for which this permit is iaued
My Workels Compensation Insurance carricr and Policy nu�ue� ���
Cartier. 3_ �� �✓J� .� - Polity No.: �
� CERTIF[CATE OF EXEMPfION FROM WORKERS'
COMPENSA'C10N INSURANCE
(This scctian necd not bc completed if tde pertnit is for onc hundred dn0us (SIO�
or Icss.) �
I cenify that in thc performancc o( ihc work for which this permit is issucd. I shaD oa
employ any person in any manner w as W become wbject w �he Workers' Compeo�tian
Laws of Califomia Datc
Applicant
N07'ICE TO APPLICAM: lf, aftcr making �his CcrtiGca�c of Exemption, you should
become subject to the Worter's Compensation provisions of the La6or Cade, yoo muu
� O for�hwi�h comply wi�h such provisions w this pecmit shall be decmed ecvakcd.
� ""' CONSfRUCI'ION LENDING AGENCY
( r�-�. 1 herehy a(Lrm Uut there is a consuucuon knding agcncy for tAc perCarmanoe of .
p�., � thc wark fnr which this pertnit is iuued (Scc. 3097, Civ. CJ
k7 Q L.endcr's Namc '
j � L.ender's Addrcss
U � I certifY Uiat I have read this applieation and statc ihat thc abovc iafama�un is
� '-" cortcct. 1 agrce to comply wiih all ci�y and county onfinances and sta�e laws relatinE in
� U building conswction, and hereby authori�e represenutives of �his city to enter uptm the
� a aAovc-mrntioned property forinspccuon purposes.
(Wc) agrce �o save, indcm�iFy and kecp harmlcss thc City of Cupenino abaiost
�� liabilitiu, judgmcnts, costs and ezpcnscs which may in any way accruc agaiost said Gtr
U z in consequence oC the granting of �his pertnit. Date �
►�-� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-PQQ�f[' Issued by: � ��� (^ 7
SOURCE REGULATIONS.
��-��i��c�/� /c���� Re-roofs
S�gnuurc ApplicanUConuactor �'.
HAZARDOUS MATERIALS DISCLOSURE Type of R� �of
Will thc applicant or futurc building occupant swre or handlc ha•rarda�s maoerial
:ftncd by Uu Cupertino Municipal Codc. Chaptcr 9.12, and �hc Hcatth md SaCar
�c, Scction 25532(a)? �, All roofs : hall be inspected prior to any roofing material being installed.
❑ Ycs
Will the applicant or futurc building occupant usc cquipmenl a devi¢s w�hicb If a roof i: installed without first obtaining an inspection, I agree to remove -
cmit harardaus air comaminants az Jcfincd by thc Bay Area Air Qualiry MaoaSa� all nev�+ m�terials for inspecrion.
District?
aY� e�
1 havc rcaJ the ha�ardcws matcrials rcquircmen�s undcr Chap�cr 6.95 of t6e Calitar- g
nia Hcalih & Safcty Codc, Scctions 25505.25533 and 25534.1 undcrst�nd thatiCthe Iwl�a6 -�;� �Y� �G� M�L / �' 2 � 4 �
docs not curtenily havc a �cnan4 �at it is my responsiAility w noafy thc omipmt of rte r
rcquiccmcn� which musi bc met prior w issuancc oC a Ccnificatc of Occupac� Signatu e �f Appl icant Date
���1%�� � j°�� All roof coverings to be Class "B" or better
Owncr or uthori�cd agent Datc
CITY OF I�UPERTINO
: �� RE�2Q(3F
CUP�R;Tt�v� PERMIT APPI,ICATION FORM
�`j10�1`il
APN # Date:
���?� �::� � -C�' �� - Q �,
Building Address:
Owner's Name: Phone #:
�., C y��) 32 �J sJ� 1
Contractor: License #:
�
� �
Contact: � Cupertino Business License #:
' 0 I e .5�,.�? �.
Type of Roof Covering:
Eatisting: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles �Asphalt Shingles
l� Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other (Specify) ❑ Other (Specify)
Nuinber of existing coverings ❑ Provide I.C.B.O. Report #
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Com ly With Cu��ertino's Tear Off Policy: ❑
Job Description:
�"� o ' ,Q ` ,. ,� � 1. �� 4 ,� b� e re ��en���.�
Residential [�— Commercial ❑
Fire Zone: Yes ❑ No e� Confirmed with Planning D�t. if
there are any restrictions: LJ
Cost of Project: Type of Construc tion: Occupancy roup:
a -� �- -�
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE F31dg Permit Fees BIJILDING
BENERGY Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BLJILDING
BUSLIC Business License BUILDING
CITY OF CUPERTINO
2 ITEMS OF 2 PERMI7' RECEIPT OPERATOR: bethe
COPY # : 1
Sec : Twp : Rng : Sub : B11�_ : Lot :
APN ........: 36�23014.00
DATE ISSUED.......: 10�29/2007
RECEIPT #....•••••: BSC�00003097
REFERENCE ID # ...: 077.00191
SITE ADDRESS .....: 11"1 S STELLING RD
SUBDIVISION .......
CITY .............. CUF'ERTINO
IMPACT AREA .......
OWNER ............: SID[ONDS BERKELEY B AND MARJORI
ADDRESS ...........
CITY/STATE/ZIP ...: CUF'ERTINO CA, 95014-5025
RECEIVED FROM ....: SEF'.GIO GONZALEZ
CONTRACTOR .......: SEF'.GIO GONZALEZ LIC # 25625
COMPANY ..........: STC�NERIDGE ROOFING
ADDRESS ..........: 27�8 GLENFIRTH DR
CITY/STATE/ZIP ...: SAl`f JOSE, CA 95133
TELEPHONE ........: (4C8)729-5101
FEE ID UNIT QUANTITY F,MOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 16,600.00 245.16 0.00 245.16 0.00
BSEISMICRE VALUATION 16,600.00 1.70 0.00 1.70 0.00
---------- ---------- ---------- ----------
TOTAL PERMIT : 246.86 0.00 246.86 0.00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 246.86 445
---------------
TOTAL RECEIPT : 246.86
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408) 777-3228
Fax: (408) 777-3333
Building I)epartment
Subject: Re-roofing policy for the C'ity of Cupertino
1. Prior to permit issuance, you must agre � to comply with 1997 UBC Standards
and manufacturers specifications on re- roofing.
2. New roof coverings shall not be appliec 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.
I 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 matE�rial 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 c�f $176.18. The re-inspection fee must
be paid before another inspection can �e scheduled.
IMPORTANT
1. Flat roofs must have a minimum of 1 /4 " per foot slope and demonstrate
that there is no ponding.
2. An I.C.B.O. report is required to be on t1e job site at the time on inspection.
I understand and will comply with the above stated policy on re-roofing.
Homeowner's Name: ���'� � io�g��
Job Site Address: f/,� ��"�, ll i�I� ��
Roofing Company Name: � 0 � � b01"J �l �s`
Applicant's Signature: S�/�fl,� �G� Z�l �' Date: a-^ °� �
Greg Casteel
Building Official
Revisec l 11 / 2/ 04