06040132CITYOFCUPERTINO
OR.�INFAItMATIUN'gk
BUILDING DIVISION PERMIT
CO TRAC'
Su1LDl"cADDRFss:
FOUR SEASONS ROOFING
PE1MITNO'0604O132
10843 NORTHOAK S
OWNER'S NAME:
PERM171SUEDATS
NORTHPOINT HOA
502 HORNING ST
04/21/2006
ONE:
SANITARY NO. CONTROL NO.
(408)278-0330
ARCHITELT/ENGINEER: -
,
BUILDING PERMITBLDG ELECT PLUMB MECH
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LICENSED CONTRACTOR'S DECLARATION
J Description
P
1 herby af0m that 1 we 10.evn under Provisions of Clupur 9 kaon—JUS
Ara
with Section 70111) of Division 3 of the Business M1 Profcscnon Coda arta my lamas u
in fall forte amdruct. Z
REMOVE CALSHAKE ROO FELT AND GAF
Licealu Clgs Lk. a
Dula Lam- a i con r
atop CANYON COMPO CLASS A
At, we;
ARCHITECT$ DECLARATION
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I underwnd my plans ill be uud as public records
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M
_ _ 7006
Licensed Pmfcssional
OWNER -BUILDER DECLARATION
1 hereby that 11. exempt font the Canmanara Law for
Any
. (Sect
:
county allowing reason.
7031.5,Bualtar. and esu Code: Any c or roture
mity
U h,
which requires a permit o ennwm, alar. Improve, demolish, at repair any neuemm
permit vee. de
prior m its Issuance. also requires Ile applicant rat such permit to Rk a signal statement
Sq. Ft. Floor Area Valua[ ID 5 0
that he is licensed pursuant m the provisions of the Connector's License Law (chapter 9
(commencing with Section 7000) of Division 3 orM a Business and Profession, Code) or
that he is exempt tharal m and the basis for the alleged exemption. My violation of
pa.N m er Occupancy Type
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Sudan 7031.3 by any applicant for a permit objects the applicant to a civil penalty ofp,5
am mom than five bunred dollars ($300),
0 O V 4 O 0
❑ L u owneruf the popery, army employeeswith wages u thebmle compewtinn.
will out the work.an the overture Is not Mtendcamartertd mrnle,(Sec. 7O". Bummaa
Required Inspections
and Pmfcdon Code: The Conlsacmrs ucnes se Law donot apply In an owner of
9 P
Property who bas lids or int proves The men, and who does such wmk Nmulf ar through his
own employers, provided Ih timed, Improvement am not intended monered for safe. If.
however. the building or Improvement Is old within am year of camplcdan. The ownv-
builde will have the leadan of proving that he dna not ddld or improve for purpose of
ask.).
1, as owncr Of the property am exclusively conlMing with licensed onuawrs to
Wnchael the pojem (Sec. 7044. Business and Pmfesdon Code:) The Cwuaeors Li-
cuou Law dors rot apply m an oamer m popery wbo Wilda or impmvn da�, and .
who can== forslah prelates with a conmcthr(s) licensed purmant In the Gnuanors
Licenm Law.
❑ Iuneaemptundrs Sed ,BSPCfmthianuon
Ow v D+u
WORKER'S COMPENSATION DECLARATION
I hereby atom under penalty of perjury ane of the following delaeuom
❑ Ihave and will meinuinaCeeti0esu afGasemoulf-Irsurt fm workersCmnpem
ation, u provided fm by Section 3700 of the Labour Code, for Iles perromanm of the
work for which this pewit is issued.
❑ 1 haw and will maintain Workers CampeasaMon humanness, as required by Section
3700 of the Labor Cade, fm the performance orthe aura fm which this permit is bawd.
My Workers Compensation Insummixt a.ones and Polity number art:
Grtler.Dlir,% Policy No.: MNZLLA4
+
ERTIFIG7E o•.ffi oN FROM WORKERS'
COMPENSATION INSURANCE
v
(7htsoction need notbecompimad Bthe permit Is ferone hundred dollars (SIM)
or leu)
I certify that In the performance of The work for which this permit is Wood, I shall ant
,
employ any person in any manoran as o became subject to the Warteri Compendon
Law& of California. Data
Applicant
NOTICE TO APPUCANI`. IL after making this CeNOrsu of Exemption, you shouhl
haeme subject o the Worser's Compensation provisiam of the Labor Code you Most
forthwith comply with such provisions or this permit shall he deem^ waked.
ON LENDING AOENCY
CONSTRUCTION
1 Mrw alum Nat Nem 4•d(Sex.307.Cing agency for du perfomanem
Is a construction
' Ma wart for which Nu pewit Is issued (Sec. 3(197. Civ. C)
Loners Namc
lsnders Mdreas
1 curly, that 1 haw read this application and mm that the show iclamaMm k
' correm I agme in comply with all city and county ordinances and sou laws relating o
a
Wilding convection, and hereby anthems representatives of this city In enter upon the
shove-menuuned PmpenY for impecdon pant .
.
(We) agree o saw, indemnify and keep hamlets Be City of Cupertino apimt
liabilities, jngencnts,com and expenses which may in anyway smut agarol mid city
in mnaequerae of the trandng of this pemR
' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
tun -0
LI
Re -roofs
Type of Roof
Si um of anuecor Dam
HAZARDOUS MATERIALS DISCLOSURE
applicant or future building acupant start or hank bauedon malarial
as defined by the Cupenian Municipal Cade, Chapter 9.12, an the Health and Safety
Code. see ^^ 25532(')T -,.
All roofs shall be inspected prior to any roofing material being installed.
(:]Y.Bja
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future Wilding Occupant use equipment or devices which
emit haardoua air contaminants u defined by the Bay Area Air Quality Management
all new materials for inspection.
Disuicla
�Nu
❑Yrs
I haw mad the haardous materials requirements under Chapter 6.95 order Glifar.
Me Health& SAfetyCode, Secdmu 25505,25533 an 2553/.1 undernan Ida ifthe building
does not cumndy how a unam, that it is my mpoasihllity m nodry the acupanl of the
kh must be rm ^nae ar a Carafe m of ccpanry.
Signature of Applicant Date
All roof coverings to be Class "B" or better
Owneraraathod nae m D�
f Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Cl OF Fax (408) 777-3333
WUPEkTINO
Building Department
C�
I am not using any subcontractors: //c---� 1T L>✓'V u- Z ( 10 (O
gnature Date
Please check applicable subcontractors and complete the following information:
JOB ADD ESS:
PERMIT #
BUSINESS LICENSE #
to CaweAh6 q5o/qo
Yo
OWNER'S NAME: a k }-
PHONE #
Cement Finishing
GENERAL CONTRACTOR: —
FAX #
C�
I am not using any subcontractors: //c---� 1T L>✓'V u- Z ( 10 (O
gnature Date
Please check applicable subcontractors and complete the following information:
/Contractor Signature
Date
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
/Contractor Signature
Date
.Y�
• CITY OF
CUPERTINO
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 co rply with the above stated policy on re -roofing.
Homeowner's Name: D *h J�7✓ 4
Job Site Address:
Roofing Company
Applicant's Sign
• Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
Date ll�C� (o
�y
am 2 of 6
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 06040131.00
DATE ISSUED.......: 04/21/2006
RECEIPT #.........: 34091
REFERENCE ID # ...: 06040132
SITE ADDRESS .....: 10843 NORTHOAK SQ
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OWNER ............: NORTHPOINT HOA
ADDRESS ..........:
CITY/STATE/ZIP ...: CUPERTINO, CA 95014
OPERATOR: amyw
COPY # : 2
RECEIVED FROM ....: FOUR SEASONS ROOFING
CONTRACTOR .......: DIAZ, ALFRED LIC # 21323
COMPANY ..........: FOUR SEASONS ROOFING
ADDRESS ..........: 502 HORNING ST
CITY/STATE/ZIP ...: SAN JOSE, CA 95112
TELEPHONE ........: (408)278-0330
•FEE ID UNIT QUANTITY AMOUNT
---------- ---------------------------------
BPERMFEE VALUATION 6,000.00 126.36
BSEISMICRE VALUATION 6,000.00 0.60
TOTAL PERMIT : 126.96
•
PD -TO -DT THIS REC NEW BAL
------------------------------
0.00 126.36 0.00
0.00 0.60 0.00
---------- ---------- ----------
0.00 126.96 0.00