03040019 (2) CITY OF CUPERT[NO ' ^°^x' _ ���. , ^"+ '"� �'W"'O ."
BUILDING DIVISION PERMITtC® RAC`TbRIN 'ORMATION..<.
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BUILDING ADDRESS: PERMIT NO.
10310 STONYDALE DR RESPONSIBLE ROOFING INC 03040019
OWNBRB NAME: PERMIT ISSUE DATE
HENDRICKSON MARY E TRUSTEE 2882 SPRING ST 04/03/2003
NE: SANITARY NO. CONTROL NO.
(650) 969-6151
ARCHITECT'/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
OZ LICENSED CONTRACTOR'S DECLARATION O O O O
I hwtb REIM Nell am li[cnw under Provision Of Chapter 9(commomm"g Job Description
zz with Stetion7 ) f Dlvision3oflhe Buss Pfofeuion Ca&..a myliccrmb
e< in full fan an 6 Zfr O
Into, Clus LW.. REROOF .
ARCHITECTSF r RATIO / 1/0 & DISPOSE OF EXISTING ROOF, APPLY NEW
Its mond my pito shall Wused upuhllc records 50 YR. COMP. ������®
>G3 Licensed professional
OWNER-BUILDER DECLARATION
EI I hereby aElrm Net I am exempt from dm ConlnctoYt License Law for 1W APR 1 7 2003
En O O following recon.(Saban 1(D I.S,Buslmu and Pmfess)on Code:Any city or county
$ which require a Permit W castanet.eller.impow,demolish,m repair any structure
prior it)its luuana,also require the applicant for such permit to file a signed statement
h
< that he Is licensed pursuant othe provisions ofMeComnwi,License Law(ChaPler9Sq.Ft,Floor Area V cation
IN (commencing with Section 1000)of Division 3ofthe Business and ProfesdeuCOde)ar BUILD
Nat he Is exempt therefrom and me bub fro the alleged exemption.Any violation of
Seeders 7031.3 by any applicant fora Permit subjects Ne appficant W a civil penalty of APN NumberI y Type
not msec than Ew hundred dollars(SM
❑ t o e wink ori th.mm.or my employees rola seg Ims.1,(Sm.eompenaation,
will dothework,sed Neancture treat intended LAWdofmub(Sec.to an Business
pro ertywhPicificushourbar Code:lore ws themor.License Law rims not apply to an owner of 3 2 6 3 7 0 3 0 . 0 0 Required Inspections
progenywhobutIdaorImprove Ih Improvements
mpr ared who dinttmhwork hlmselfedIboogh M1b
however,Me
uipovior lthattuckimpro old
whine not year
ordmoRtred fro-lar.
b ,Ne building or lmpo roving
that within omyear of InFro ,far Ne owner- 305 — FRAME`
safe.budder w10 haw tk human of proving that W did not build w improv lw purpose of 307 - INSULATION
❑I.as owner of the propeny,am uclwiwly contracting with licensed contractors to 601 - ROOF TEAR OFF
construct the pmjal(Sec.loa,Buaineu and Pwfuemn Code:)The ConrwWrs U. 602 — ROOF PLYWOOD NAIL
mrm
Iso does not apply to an answer of properly who Wilds or improves thereon,and
who conmcu for such projects with a comncmr(s)Iicented potential to the Concraaor's 603 - ROOF BATTENS
License U-
❑IamesemplunderSea ,BAtPCfor this recon 604 - ROOF IN-PROGRESS
Owner Date
WORKERS COMPENSATION DECLARATION
I hereby affirm under penally of perjury am of the following declarations:
1 how and will maintain a Certificate ofConaem W self-Inure for Warker's Comport.
-don,u provided fm by Section 3700 of the Labor Code.for me performance of the
wort for which this permit Is i-u W.
❑I haw said will maintain Warnes Compenudon Insurance.as required by Section
3100 of Ne Labor Cade,for due performance of the wort fwwhich this permit Is Issued.
My\Wor�keYQa C1ompeuallon inwran¢unier antl Poliry numbenrt: p�k�
Certs V7QafP�y a1� Poliry No.. �a+i
1/s CERTIFICATEOF E%EMPnON 0 ORKERS'
COMPENSATION INS CE
(This secdm need not W completed If the remit s faone hundred dollars($100)
yr lc-.)
I unify that In live performance of the work for which this permit b issued,l ahali not
employ any person in any manner an as W Wcome objmt to the Workers'Compewdon
Laws of California Data
Applicant
NOTICE TO APPLICANT:IL aper making this Certificate of Exemption,you should
became object W the Worker's Compensation provisions of the Labor Cade,you must
., ZO forthwith comply with such Provision or this Permit shall W dimmed invoked.
z ti CONSTRUCTION LENDING AGENCY
[.r IWreby.M.that thcrt It a connreNnn Imiingagcny in,Wt performance of
Ni> tied work for which this permit is issued(Sm,309'1,Civ.C.)
4 Q Undoes Name
]z Lender's Address
f,0 I unify that 1 haw mad this application and ame WI Ne show Information Is -
pgr correct.1 agree to comply with all city and county ordinances and sum law relating W
O(, building construction,and hereby someone rePrttematiwaaf this city m tour upon tae
IT7 abormmen0oned property fro inspection purposes.
syr (We)agn to taw,indemnify and kmp harmless me City of Cupertino against
..t rn Iubilidm,judgments,cone and expenses which may In soy way acwuc against old City
V..^^7.. In cvnsegmnce of thegranting of This ptrmlt.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:9 Date
SOURCE REGyLATION
4/'3'!�3 Re-roofs
SI on ofApplicmXonu-tor
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will me applicant or future building occupant nom or handle havAmow material
as tleffne0 by the Cup In.Municipal Cade,Chapter 9.17,no the Health and Safety
Code, Dyes 25537(x)1 Elio. All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or forum building occupant uW equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
It havmdnus sir contsmitunts as defmed by net Bay Am Air Quality Management all new materials for inspection.
❑Yu tarso A/ C��
Ihaw mad mchuamtio 25505.a5533amc5334.1rClnPur Ovalfhe Gelding //�--
di es nith&Safelyhaw a imdnns et It 12%33 and ZS5M.l an modify t thnEtht building —
dma not ermemly haw t tenant mal h tI my mapenalClhy ic tory Icc many. m me J
requlrcmcnt which molWmm pnormiuuanm ofY Certificate of Occupancy.
Of Applicant ate
ovwratWnxed.pool D,W All roof coverings to be Class"B"or better
Building Division
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
Cl 0 Pax: (408)777-3333
CUPEkTINO
Building Department
Subject: Reroofing policy for the City of Cupertino.
1. Prior to permit issuance,you must agree to comply with 1997 UBC Standards
and manufactures specifications on reroofing.
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 reroofing 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) Preinspection and/or tear off approval.
2) In progress inspection approval.
3) Final inspection approval.
a) Spark arrester installation.
S. 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 that the
proper City inspection can be performed.
IMPORTANT:
1. Flat roofs must have a minimum of V"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 of inspection.
We understand the above policy on reroofing and will comply with this policy.
Homeowners Name: Nl r `Pr1(�r i k Sn VI
Address: 1OL- <) hi *l•P DY-1 unyv-bw
Reroofing Company Name: �?� n�i hlP Rin nn =YtC.
Applicants Signature: C Date: 411 /03
eJoe Antonucci
(Chief Building Official)
6125/01
f
G D CITY OF CUPERTINO o 3 0 a a
REROOF
IT
CUPEkTINO ., PERMIT APPLICATION FORM
APN# Date:
A Y I I Cu3
Building Address:
10 O S
Owner's Name: Phone#:
Nor. _OffibZO�-CnOU
Contractor: Phone#: License#:
Re ( -sG�O 3
Contact: Phone#: Cupertino Business License#:
E ? — CA ((os%) IIOS
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up RoofBuilt-Up roof
LI ❑Asphalt Shingles Asphalt Shingles
Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings�_ ❑ 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:`ieat' d -AC1i,5Fo,5e o exls nc` r0C : App IL4 r�.Ct,U SOIjt-.
CO I�-10�1 ►�
Residential Commercial ❑
Fire Zone-.—Yes- No ❑ Confirmed with anning De,Pt.
there are any strictions:
Cost of Project: Type of Construe ton: Occupancyroup:
F.
Qty. if
Appliq bl 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
,I