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CITY OF CUPERTINO
INF�ORMr�T,I�A'N
BUICDING DIVISION PERMIT
�C,ON=TRACTOR ,
BUILDING ADDRESS:
FOUR SEASONS ROOFING
PERMITNO.06060164
20258 NW S
OWNER'S NAME:
PEPMIT ISSUE DATE
NORTHPOINT HOA
502 HORNING ST
06/19/2006
NE:
SANITARY NO. CONTROL NO.
(408)278-0330
ARCHITEC IENGiNEER:
BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
O O l�
LICENSED CONTRACTOR'S DECLARATION
- Job Description
memtng
thereby atirm Nn 1 are 14xtaxd under provisional of Chapter 9 (rom
with Session 7001)) ofDivImm 3 afthe Business and Proreuddum Code. aM my Ikxne is,
iv 1.11 fora and efree. •Zlpy
REMOVE C HAKE ROOF, INSTALL 30LB FELT, AND GA
�ir1 ar,
oma a cone
�G12AND CA1ji3LES, CLASS A
SS
ri
ARCHITECTS DECLARATION
' I understand my plans andl W used u public records
BNaap�
JUL vJ �jrypyra
Licensed Prof a.ional
OWNER -BUILDER DECLARATION
CormaON
I hereby (Erre n 1 am exempt from the Csntrmmh License Law for the
S�
following mama. (Section 703 L5, Business and Probmiom Cade: My city ar caumy
. o
which requite permit m •(ser, Improve. demul W, m repair any structure
y„
udeeapionso for such file awcmw
n place the
Wuanewshe
-500
r re Valuati$fi
Contractor's Law
medto a! oft Conwcmr'a Manx law (Chapter 9
BameJ pursuant to use
thatkiu
dear W
of Division of the Business and Cade)of
e with Seethe 7000) of
as, MY11rofessions
Nertrmm and the buts ma alleged esempmon Any violation of
Old is basis for
that io ts
7Av,7t1Ij1
Tye
Occupancy •7 Pe
fur. permit mbjecu the applkant m a civil penalty Of
Section1031.5Ban by say it
31.5 b
red dolla
not more than five hundred dollars ($SW).
{�s;pyy�1
31 O.J 7 U 4 � .' 0 0
O I, u owner of me property, m my employm wW wages a thshmte compcmdm.
ns
Required Inspections
9 P
winds Newark,mdthes tumlamtinxndedorartemd mraae ls«. TBa+.Busineu
rot apply owner or
ts Code: The Clucme, Lt.. Law dm N an
and Profudmm
property who builds m improves mterean, end who does a ueh work himself o through his
own employees, provided Out such improwmsnu rte net intended ora8'ered forade. If.
hswaver, the building or improvement Is mid within and year of complader, the awner-
bullder will have the burden of proving mut he did not build Or improve for putpom of
sets.).
O 1, u ownm of the property am exlusively contracting wide Bcmued wase m
roruumn the project (Sec. 7044. Business and Profession Cads:) The Cssuisc tes Li -
consist law dm no, apply an an owrer of property he Wilds Oc improves desmon. and.
who contracts for such pmjeas with a conuxmtp) Boosted purmant m the Comrmmr'a
I ... Law.
❑ Iammumple,ca Sea ,B&PCfarllvstuson
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following dalwisu:
1 ham and will maintain a CeNOrom of Consent to self -lava for Worime,Campen-
udon, u provided rte by Section 3700 of the labor Cade, far the perfannimen of Ne
work for which this pmmit is isaad.
O 1 have and will maintain Worker's Compensation insurance, u requited by Section
3700 of the Labor Cade. for six performances oftW wart bar which this permit is latned.
'
My Worker's Compeaution Instromes, carrier and Policy bar ate:
Carder. r•s Policy Zit! Z 4 tri tvl
CERTIFICAT OFIX ;PION FROM WORKERS'
COMPENSATION INSURANCE
(ThtsseNm need Out W completed If the permit is foam mu keddollsn ($100)
or teas)
1 certify out in the perfarmanee of the work for which this Permit is Issued. I shall not
employ any person in any mannerm IS m became subject m lW WorkeWCompensation
Laws of Califamia. Data
rot
NOT) IL,Mrmaking N6 G9dfieam
NOTICETO APPLICANT'.
Labor cn,youshould
of tie lobo Code, you muse
become the Waher'a compensation the
the Work
arovidom
' foMwiN comply with men provisimu or Nb permit,hdl W maned rewkeQ
, comp y
1 CONSTRUCTION LENDING AGENCY
lending agency for tie Performance of
1Wrehy•Buntthat mit
issued (Sec. 3n
' docLe work for which this pcmtil u issued (Sro. 3097, CH. C.)
lander', Name
lander'a Add.
j 1 ceNfy that 1 have read this application arm nue that me above intonation. is
' correct. I agree to comply with all city and county aMunm and state laws relating In
building construction. and hemby autWrim representatives of Nis city to enter upon the
( .hove -mentioned Property for inspection purimses.
(We) agree to sew, indemnify and keep harmless tW City of Cupenim against
i Ilabilitles, judi murs. casts and sapeuea which may in my way same agaiutssid City
in comequena of ms Swung of this permit.
' APPLICANT UNDER ND WILL COMPLY WITH ALL NON -POINT
Issued by: Date i(
5 R[:GULATI S. �� I�'O
Re -roofs
Type of Roof
Signalmoof ppli VCs Date
DISCLOSURE
A]ARDOUS MATERIALS
Will t m hatme building oaupantsmre or handle huasdous material
u defined by me Cupertino Municipal Cade. Chapter 9.11. and me Health and Safety
Code, Seeuon2553d(a3g
All roofs shall be inspected prior to any roofing material being installed.
OYcs �6f No
If a roof is installed without first obtaining an inspection, I agree to remove
Will W applicant at future building Occupant use equipment or dcvim which
emlt hammnus aIt csnuminerm u defined by me Bay Am, Air Quality Managemam
all new materials for inspection.
DuuictT
OYaa
I have mad the hvardou mamrWs requhcneis undcrChaper G95 of the Caiiter•
nix Health B Saletyeade. Setibia 25305. W33 aM 15534.1 understood man if the building
dm not currently have a aawn Nat it b my responsibility In notify de occupant of the
n ianmuwW t m ancmdI of�ctmwy.-_
Date
SignatureofApplicant
'7D,m
All roof coverings to be Class "B" or better
owner ar atrmadr=d agent
I CITY OF CUPERTINO
16m 4 of 4 PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 31639045.00
DATE ISSUED.......: 06/19/2006
RECEIPT #.........: 34921
REFERENCE ID # ...: 06060164
SITE ADDRESS .....: 20258 NW SQ
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA
OWNER ............: NORTHPOINT HOA
ADDRESS ..........:
CITY/STATE/ZIP ...: ,
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
�EE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL
-------------------------------------------------------------------------
BPERMFEE VALUATION 6,000.00 126.36 0.00 126.36 0.00
BSEISMICRE VALUATION 6,000.00 0.60 0.00 0.60 0.00
TOTAL PERMIT : 126.96 0.00 126.96 0.00
METHOD OF PAYMENT
-----------------
CHECK
TOTAL RECEIPT :
0
AMOUNT
------------
507.84
507.84
NUMBER
------------------
005606
JOB ADDRESS:
OWNER'S NAME:
I am not using any
Buil
Please check applicable subcontractors
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Department
PERMIT #
0
PHONE#
FAX #
Signature Date
mplete the following information:
C
e /Contractor Signature
IZL�L1��
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
C
e /Contractor Signature
IZL�L1��
Date
Cl
•
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 $176.18. The re -inspection fee must
be paid before another inspection can be scheduled.
IMPORTANT:
1. Flat roofs must have a minimum of 1/4 " per foot slope and demonstrate
that there is no ponding.
2. An I.C:B.O. report is required to be on the job site at the time on inspection.
I understand and will comply with the above stated policy on re -roofing.
II
Homeowner's Name: . O r" r k RI0 � 1 O
Job Site Address:
Roofing Company Name:
Applicant's Signature:
Greg Casteel
Building Official
Revised 11/2/04
Date:6 I lC� 0 YJ
6
•
CA
CITY OF CUPERTINO
REROOF
CUPEkTINO PERMIT APPLICATION FORM
APN #
lr1Permit Fees
1'GG VIuu
BUILDING
Building Address:
2
S
BUILDING
e
Owner's Nam1
e:
BUILDING
Phone #:
0r,tL oil t—
O, 1T.
BPLANCHKlan
C tractor:
12000
Phone #:
License #:
_St'LSg.%S
yos Z I S -0 3 30
/0 ("
Contact:
hone #:
Cupertino Business License #:
Ci o l�2ar2$
.27$-0330
Z
Type of Roof Covering:
Existing:
Proposed:
❑ Built -Up Roof
❑ Built -Up roof
❑ Asphalt Shingles
,2Asphalt Shingles
❑ Wood Shakes
❑ Wood Shakes
❑ Wood Shingles^ I 13 Wood Shingles
Other (Specify) (2q! kcKe—❑ Other (Specify)
Number of existing coverings /
❑ Provide I.C.B.O. Report #
,y To be Removed
❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Com 1 With Cu ertino's Tear Off Policy:
Job Description: ,jt
S , aneA- s -o 3o L C 1 an
G7 j (Sr"OL
CAvv oN CV o9Mc j �1.vn Ie.s r
Residential Commercial ❑
Fire Zone: Yes ❑ No
Confirmed with Planning De t. if
there are an restrictions:
Cost of Project
Type of Construction: Occupancy group:
Qty. if
Applicable
Fee M
Foo Tlo «ti,.
BPERMFEE=Business
lr1Permit Fees
1'GG VIuu
BUILDING
BENERGYner
BUILDING
BSEISMICREeismic
Fee Res
BUILDING
BSEISMICOMeismic
Commercial
BUILDING
BPLANCHKlan
Check Fee
BUILDING
BUSLIC
License
BUILDING