06070108 CITY OF CUPERTINO >,eF - -
BU:LDING DIYISION PERMIT �CONT"C"T,OR�-NFORMIAT,TOP):
BUILDING ADDRESS: STONERIDGE ROOFING PE"M`r"°'06070108
10780 BROOKWELL DR
OWNER'S NAME PEILWr SUE DATE
ML PALIK KAYO 2440 POP /2006
NE
SANITARY NO. CONTROL NO.
(408) 729-5101
ARCHITECTIENGINEER: BUILDING PERMrr INFO
BLDG F1ELT PLUMB MEC1
loo LICENSED CONTRACTORS DECLARATION
1 hJob DeSCfI UOn
F
erby.IBrm thin 1 w If¢mN tnac povi.aCo.p«9(cone -z P
"" wiN Sedan 70DW of Divluo.la(thc Bvtlrca and Ra(iabm Com.iol my lln+<u
in full fora AMcff t_ TEAR OFF WOOD SHAKE. 1/2" OSB, 30LB FELT, 30 YR
,�? LITm Cud c-%9 Lc.i COMP
Dun ' '/A-nif Camrcmr , CLASS A
ARCNrIECTS AT ON STONERIDGE ROOFING RENEWED BL 7/18/06
i < I,mdcrRand my Prim"I he rued u public reward.
�u
l.iirtcd Prufetiaml
.T3
OWNP=ucmp ER DECLARATION
< 1 ro .Ran mu I a1.eBoo from the Cams. Co :A n c�for ae
.° r bichlorwin;muon.(Sccmn]031.5,Budnauni Pmr oru l Coat:Any city«canary
S$ whor i regi,°.prn L Tom ft Jmr.impow.awah4 m mfaU any Wmura
prior bsl iv,nod ...lto ru me appl;^y+f«icy pMror Lick.n .(ChKill mnenn
• <
thin rlieu,ice�dp«m.Mbthcpen.Imrlof too Coou.cmr'rLlamelAw(CE.pux9 Sq. FL Floor Area Valuation
(eoonmeociMwhit S«ao.]minora.uiort3athe Bto� Ptaeaion,Cmc)« $6900
3 mu Y u.,,maefnm uW We hut+for We Jkted estmpaon Any v '.of
soction70auer•m•ppBaMfor.pomit,m;e° the-W in-ciwp®Byor APN Number Occupancy Type
not more then live b«Ered doper($500).
Q L u owscc of Ne ptq rr.a my wplayrr�viN ward u Nelr.ak c«nprnvniw.
wnmdrw«L name Rmmamtm�ma«okmr«. ls�.roM. Required Inspections
W Pm(aaom Cade:The Caurcml.luny,,uw Iov,.m appy m a owe or q P
pvpny who hull.IXimposa tmem..rW Mtodaoarmh workbwuif«tkmthm
bindeonpbtzb povNeErpro Improtvurnuwoar,n.9OfCaortae for ale B,
Eowewr,mebvlldi, atmpfPn, uh.ald Bi as lar of irn lfor deovmerr
b,u16r
will,hate th Wrdeh of porint that K db lid bJM«impale!«potpo¢of
0
❑1.u ova,M me p c 7 .m eaektlwiy camr.ulnt CoJ,)Theea mvucrars m
c.Li the punct(Sec.to.. of and r,wtaom Code:)The eone.]or.LL
came Vw tlm nt.pp,y m m ownof property who halter IX impvws)mem..nd
rem rnnncu fa.ih pvjeeb won.eonR.m«fU&xnvd p«vuM In me Cm,enaY.
❑Iw uemp urge See .Be PCfor d,u moon
Owxr Due
WORKERS COMPENSATION OFLLARATION
1 hereby.Rioeller praJry a perjury me of me fJmwlntd J.ationc
1 haw W will mnnuio•CeAOwe aC.M on toff-In.me I.Waken Campcm
atim,n povided for by Section 3`700 of ttr Labor Code.(m do Nrfom oc,of do
wart far which Lir petit if lauem
.r 1 hate uW will m o non Workch CoMpmm,an Inwruse.n roonni by Savor .
3]W of ac Libor Code,for Ue prrfamunce of the work for abet thin Nrmh is W l—I
My Worke,C.Pemw lmoiucco atW Policy numm a rt:
Cartfc. 5I[k' /V/t F[ Po,iry Na.: 165V-
CERT �Fl FGTE EXEMPr10N FROM WORKERS
COMPENSATION INSURANCE
(Thh,nim aid rot 4 compldW J We Nrolh u for.hvMM not(5100)
lir Iu.1 -
1 wtifv,yet fn me pafarmua of me Mort(a which W i pxmit h aR.e4 I elnll tmt
vpby
int,Nrnan1n.vya.mermu m became abjott to Ne Warkem'Cwpeesw,av .
Law.of Cnira Due
App,iom
NOTICE TO A)'PLIGNP.B.aror miring mi.Centro°¢of Ercaptim,you mauN
heeeme Whim to t c Wane.Coo,Novtbn pry i a the Liw Code,yat muv
.,O forthwith comply with smh pvv or tis perrciL.h0l be dr«ncd makct
z CONMUCfION LENDING AGENCY
1-+ Ihertby.Rimt nh.r Lae it acmmrunim hiding atony fIX,hr perrormvcc or
h� > the w«kfor which dnap nnnit h ioniod(See 3097.Civ.C)
,
az l<rdcta Addw
U0 I¢Nfy dint 1 hue rW mu gpliaion ab.um mu Ne.how W«mamn u
LL r earth I.tone m comply with nl city end county r.tllt.,,...all 4WL hv.rtlaint m
VbuiWioteonsuucti to,utlkmby.ua,oriimpe.rnoics,tof mutiny Lecnor rtion2 ml
r a .bore-rrcntivaa pmNny f«w'Won purPoc..
(Wfudlna .arc,inti ex oycs kiph my
the City of CuNrwu.d City
F" rAI IUMlitin,}mtmcou,caw. cdc.pnc�.which they In coy wyam«.tautaad City
V?
APPLICANT UNDERSTANDS AND WILL COMPLY WTIH ALL NON-POINr Issued by: Date
SOURCE REGULATIONS. 6L
9718 O Re-roofs
SipuLrt or iuHAZARI)D Due
FIALSRDWSdb,:MATERIALSpDISCLOSURE Type of Roof
Willy thoC mW«fmao Eullmet&.Clow part2.tond or hawdvuo Way
u dolled by Uc GuNnln Monicipl Code.Ch.pmr 9.li end the Hem aW Way
Com.sodic.25532(,) / All roofs shall be inspected prior to any roofing material being installed.
❑Yon Oho
ttipmaa«arw�.which.pplinrn wIf a roof is installed without first obtaining an inspection,I agree to remove
will,xa More boldin{uiapM uec
tonin btt a ar conwnirud.u mnid by me Bay Am Air Qmllty Mao.tcmcnn all new materials for inspection.
Dp a`7
❑Von ET.
I hew mil do h.aNw.omerine rcq troncau under Chper S95diho C.Efor.
mHcilmh Sally Coric,Sav«n 25505.25533 and 21534.1,v,lmu 1th.tif,tr holdbt Se 9/'a 7w�ge'L
dae.na cunentfy he •w roan mu a it my mpormdn
liny L nary do oayvM or me _[ t
mwohcmcnmwhicn mop hr,oetpnormiaa,ri or.cr„irr.teararapr..y. Signature of Applicant Date
��9Q7t2d1 e7 03'f$-06 All roof coverings to be Class 'B"or better
CITY OF CUPERTINO
em 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 36921036 . 00
DATE ISSUED. . . . . . . : 07/18/2006
RECEIPT # . . . . . . . . . : 35292
REFERENCE ID # . . . 06070108
SITE ADDRESS . . . . . : 10780 BROOKWELL DR
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : PALIK KAYO
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
RECEIVED FROM . . . . : SERGIO GONZALEZ
CONTRACTOR . . . . . . . : SERGIO GONZALEZ LIC # 25625
COMPANY . . . . . . . . . . : STONERIDGE ROOFING
ADDRESS . . . . . . . . . . : 2440 POPLAR DR
CITY/STATE/ZIP . . . : SAN JOSE, CA 95122
TELEPHONE . . . . . . . . : (408) 729-5101
�EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- -- - ---------- ---- - ----- - --------- ----- ----- ---------- -- --------
BPERMFEE VALUATION 7 , 000 . 00 137 . 16 0 . 00 137 . 16 0 . 00
BSEISMICRE VALUATION 7 , 000 . 00 0 . 70 0 . 00 0 . 70 0 . 00
BUSLIC FLAT RATE 1 . 00 105 . 00 0 . 00 105 . 00 0 . 00
------ ---- -- - - ------ - --------- - ----- ----
TOTAL PERMIT 242 . 86 0 . 00 242 . 86 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
---------------- - ------------ --- ------- - -------
CHECK 242 . 86 562
TOTAL RECEIPT 242 . 86
•
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
C OF Fax(408)777-3333
40UPEkTINO
Building De artment
JOB ADDRESS: PERMIT #
io 4 06 0 761 alo-
OWNER'S NAME: PHONE #
GENERAL CONTRACTOR / FAX #
I am not using any subcontractors: P163i 74A /e t ��"i 8'0
Signature Date
Please check applicable subcontractors and complete the following information
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
• Linoleum/ Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
• Set')
01
Owner/Contractor Signature Date
' 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 agree to comply with 1997 UBC Standards
and manufacturers specifications on re-roofing.
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 can be 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 the job site at the time on inspection.
I understand and will comply with the above stated policy on re-roofing.
Homeowners Name: P�►i K !u%O
Job Site Address: I D 7e n k loD K L-le�// nY,
Roofing Company Name: ")ion e-Y1
Applicant's Signature: X20// AP2.12 P.1 Date: o Z-) —o
. Greg Ca steel
Building Official
Revised 11/2/04
FI
CITY OF CUPERTINO l)! Me
`sas REROOF
• CUPEkTINO PERMIT APPLICATION FORM
APN#
Building Address:
Owne 's Name: Phone#:
Cl- lol
Contractor: License#:
c 67
Contact: Cupertino Business License #:
Type of Roof 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 ff ❑ Provide I.C.B.O. Report#
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description:
w l'y, lnc� osa au6s fcq ao
Residential Commercial
Fire Zone: Yes No ❑ Confirmed with Planning De t. if
there are any restrictions: LJ
Cost of Project: Type of Construction: Occupancy roup:
12
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
•