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12040116 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21861 GRANADA AVE CONTRACTOR:STONERIDGE ROOFING PERMIT NO: 12040116 OAVNER'S NAME: CMU All-IN 2798 GLF-NFIRTII DR DATE ISSUED:04202012 OWNER'S PHONE: SAN JOSE,CA 95133 PHONE NO:(408)729-5101 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r License Class C " > '1 Lic.q FS) K3 a C (f MECH r RESIDENTIAL r COMMERCIAL r Contractor d f(Z� Pl C Dale 7 `7 0 '12 1 hereby affirm that I am licensed under the provisions of Chepler9 JOB DESCRIPTION:RE-ROOF REMOVE AND REPLACE COMPOSITION (commencing with Section 7000)of Division 3 of the Business&Professions ROOFING WITH LANDMARK TL CLASS A 24SQ Code and that my license Is In full force and effect. 1 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(he work for which this permit is issued. Sq.FI Floor Area: Valuation:$10500 APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is APN Number:35716132.00 Occupancy Type: cored.1 agree to comply with all city and county ordinances and slate 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, PERMIT EXPIRES IF WORK IS NOT STARTED costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply. WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non-point source regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION. 9.18. C' A y,, O J Signature \�—li/i• Al,I '1'1 Date 10-I L Issued by: �E�/✓ f7f>�TGf7 Date: ❑ OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of RE:-ROOFS: the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is 1,as owner of the property,or my employees with wages as their sole compensation- installed without first obtaining an inspection,I agree to remove all new materials for will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant Date: construct the project(Scc.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS".A"OR BETTER 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 performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain Worker's Compensation Insurance,as provided for by California Ilealth&Safety Code,Sections 25505,25533,and 25534. 1 will maintain Section 3700 of the Labor Code,for the performance of the work for which this compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Safety Code,Section 25532(a)should I store or handle hazardous material. permit is issued. Additionally,should 1 use equipment or devices which emit hazardous air I certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District 1 will not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Compensation laws ol'California. If,after making this certificate of exemption,I Health&Safety Code,Sections 25505,2.5.533,and 25534. become subject to the Worker's Compensation provisions of the Labor Code,I must O�ner or�authorized e e 1: forthwith comply with such provisions or this permit shall be deemed revoked. Date: Y—&— 2 APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that 1 have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and stale laws relating I hereby affirm that there is a construction lending agency for the performance of work's to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097-Civ C.) upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the Lender's Address granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION 9.18. 1 understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 21861 Granada Ave DATE: 04/20/2012 REVIEWED BY: Sean APN: BP#: -VALUATION: $10,500 *PERMIT TYPE: Minor Building Per PLAN CHECK TYPE: Re-roof PRIMARY SFD or Duplex PENTAMATION USE: P PERMITTYPE: 1SFDWLR00F WORK Remove and replace composition roofing with Landmark TL 2400 sq ft). SCOPE FEEID ROOFAREA s.f. 1REROOFFRES 2,400 .11".J" I lore r_'h,:ek Phunb. Plnu C'An(k 1. Plmr Clr,rk d lydr, !'.•:w it 42•.x' !'lamb. 1'e,inir Fri: lilac. P,:r'mir/4a•: Crlrr, dlarh. lnsp Odrer Plus,lnv, 011w) lilc•r. leap. ;lle<h, hrep. Fac: Numb, h"p. Fre: 1.7c'. lnsp. Fre: NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works, Fire,Sanitary Sewer District,School District,etc). These fees are based ort the relimina information available and are only an estimate Contact the Dept for addn'I info. FEE ITEMS (Fee Re.solulion 11-053 Efl: 7/1/1 U FEE QTY/FEE MISC ITEMS flan Clu:Ch Fee. Suppl. PC Fcc Perm it Fee: $336.00 ,Co/ipl. hrspl�'u l'l��h./A'lech./L•lcc Phunh.!:IderG.;Zilec l'crnril Fee: C onso Indian Tax. iI dmini.elruli i•,t Fcc_ Work Without Permit? O Yes (j) No $0.00 .9c/rmuxsl/'humin,,; FCL--.' Tartu/Docnuranlalion Fees: i Stronn Motion Fee: IBSEISMICR $1.05 Select an Administrative Item 131de Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $338.05 $0.00 TOTAL FEE: $338.05 Revised: 04/01/2012 I REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO. CA 95014-3255 GUPERTINO (408)777-3228• FAX(408)777-3333•building0cuperfino.orG PRO=ADDRP55 APN a OWNER NAME Pi VNG 1- PF30 1OO '_ /9c- EMALL STREET ADDRESS / CTTY,STATE,' FAX V APPLICANT NAME 1. ^ PHONE _ JUJ -MAIL STREET ADDRESS I CRY,STATE,ffi FAX 11A P , ❑OWNER ❑ OWNER-BUHI)ER ❑ OWNERAGFNT @ CDNPRACMR ❑CONTRAMR AGENT ❑ ARaBtER ❑F caNzsst ❑ OEVPIOPM ❑TFNANr CONTRACTORNAME LICENSE NUMBER LICENSE TYPE y BUS.LIC.a fj V / COWANY NAMEE-MJUL FAX S o er% STREET ADDRESS CrrY,STATE,ZIP PHONE 5 ,703C CA 7-�gx ARCHITECT/FNGINUM NAME LICENSE NUM ER. BUS.LICM COMPANY NAME E-MALL FAX STRFsT ADDRESS CRT,STATE,ZIP PHONE USE OF L?'SFD or Duplex .p Multi-Family ROOF AREA. VALUATION: STRUCTURE ❑ Commercial EXISTING ROOF TYPE: ❑BUILT-UP ROOF ASPHALT SHBIGI.ES ❑WOOD SHAKES ❑WOOD SHTNGTFS ❑OTHER.(SPECM REMOVE/RFPIACE YES IF NO. PLYWOOD ❑ K" ❑ _ PLYWD ❑ O58 PRCH .12 ROOF ❑ N a ❑ sm. TYPE: ❑ 0.655 PROPOSED ROOF TYPE: ❑BUILT-UP ROOFT SHINGLES ❑WOOD SHAM ❑WOOD SHINOIFS ❑OTHER ICC-ES REPORT a DESCRIPTION OF WORK- By ORKBy my signawre below,I certify to each of the following:, I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided Is correct' I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction. 1 authorize representatives of Cupertino to enter the above-identified propert; for inspection purposes. SignatmeofApplicant/Agent Date: V-Zo , 12 SUPPLEMENTAL INFORMATION REQLUFD r�r^rx.-` oerrTy% _If building is associated with a Home Owners AssociatloD,provide letter -�"��+�IX.�pE��a"�s�2��• --"�?AounND sR�� of approval from HOA. �-OVER-'TIDrCDAM1 �` �kBTID3mtiG'PLAN'REV _Provide Planning approval to verify if there a>iy,restrictions. Provide copy of Manufact uer's Installation Specifications. �-r N,;. „ -Y` " �t«f"- ls Provide signed copy of Cupertino's Tear-Off Policy. ReroofApp_2011.doc revised 03/02.111