06060212 (2)C
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CITY OF CUPERTINO
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-BUILDING DIVISIONPERMIT
NFUItM
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BUILDINGADDRESS:
FOUR SEASONS ROOFING
PERMIT No 06060212
20237 NORTHBROOK SO
ER'S NAME:
PERMIT ISSUE DAM
NORTHBROOK HOA
502 HORNING ST
06/2g/200i;
PHONE:
SANITARY NO. CONTROL NO.
(408)278-0330
ARCHITEC (ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
l� O
LICENSED CONTRACTOR'S DECLARATION
Job Description
lately affirm Nn 1 am licensed under provisions of Chapter 9 (commencing
with Section 70110) ot'DivWon 7 of the Business and Pro(esdon Cade. and my license is
in felt to. and affect. t{ -I ZI��
AEMOVE CAL SHAKE ROOF, I IIGLES
Liceyc Clgqs IJc. M
'I
L}
� n
Do. 0
Dow
I ^C�
S�ID'I
ARCHRECTSDECLARATION
a
I ander owed my plus $hill be used as public records
JUL
Licensed Pmfessioasl
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractors License law for the
following mamn. (Section 703 1.5, Business and Profession Code: Any city m county
which require; a permit to comensm aper, improve. demWla6, a rePoll my maxum
Q
prior w is issuance, alto requires flocipplimnt for such permitto Ble signed moment
Ft. Floor Area
that he is licensed Personal the provision of the Contractor',Lkcnw Law (Chapter 9
Sq.
(aromancing with Section1l").f Division3oftiw Businwand Profession Calc)m
that on is exempt tocmfrom and the Buis for the alleged exemption. Any violation of
Occupancy Type
Seaton 70315 by my applicant far a permit causes the applicant to a civil Penalty of
rat mart than Rvu bumdred dalWa ($500).
D I, nowner artist property. a my employe" with maga as their mlecompensadon,
Required Inspections
e p
will do site work and thostnmum Is not inwndesarolfered farsale(Sec. 7644, Busiasa
owr of
and Prefe tdon Code: The Contractors License Law does mot apply w w e
q
property who builds ter improves thermal. and wha doessuch west himself m through his
owmamployces, provltled that such imProveman0 ace not intended aoRemd forule. IL
however, the building or Improvement is said within one year ofc mplotin,theownwr-
bulldu wtI1 have ahn. burden of proving that he did not build or improve for purpose of
ale.).
D 1. u awns of the property. am "mesivtly... 4 lot with Iioensad mntracwm as
contact the project (Sec. 7044. Business atd Profession Code:) Toc Contractor' Li -
came Law does not apply to ari owner of property who builds or improvrs Reason, and,
who concocts fm such projects with aconuaewu(q Ikeneed pursuant to the Conuacwrs
Licence law.
D lam exempt under See ,B&P C fm this mason
ser Date
WORKER'S COMPENSATION DECLARATION
10
1 busby, affirm under penalty of perjury one of the fallowing decimal onst,
1 have and will mdnWn sCeNOcawa(C...tw self -imam for Warkers Compen-
sation, u provided for by Section 3700 of the Labor Code, for the perforations of the
wort for which thin permit is issued.
D 1 have and will maintain Workers Cmnpeossion Insurance, u taquired by Section
370) of the labs Cade, far time pelfarmance of and weh far which this permit is Issued.
'
My Workers Compensation Insurance carrier and Policy number art:
Casrier.NfNjig at J ^,,LPollsy No.: ,,g gy q
CERTIFl FE)(EMPIIONFROMWORKER
COMPENSATION INSURANCE
(Tabs wain red out N completed If Ute permit Is foram hundred dollars (SIM)
or loss.)
1 cuufy shot in toc performance or the wort fm which this permit is bused, I OWI am
employ any pecan in my mamrcrso as to become abject w the workess'Canpensa0n
Laws of California. Data
Applicant
NOTICE TO APPLICANT. If, after making this Certificate of Exemption. you should
homes subject w the Workers Compensation provision of on Lmm Code you mum
forthwith comply with such Provision or Nu permit shall be dcemas motes.
CONSTRUCTION LENDING AGENCY
1herby affnm that then ha lording agency for the performance of
ad Mac. 30
the wort for which this permit 4 issmwd (Sec. ]097. Civ. C)
'
Lenders Name
Leaders Address
1 I coNfy that I have man this application and saw that the above infonauen is
t torten, l aa= to comply with all city and county onlinances aM mw laws slating M
building construction, and hereby mthmoc mpmsentathes of Nis city to enter upon we
i •hove-mentiuned property for infection purposes
(We) ag.a to save, indemnify and kecp harmless the City of Cupertion gains
j liabili0",judgmenw. coaw aM expenses which may In my way meow against aid City
I. consequence of the Swung of this
2
permit.
' APPLICANT UNPs AND WILL COMPLY WITH ALL NON -POINT
O
Issued by: Date
so LARe-roofsSignuumarA
Of Roof
TypeWill
l"or D's`
DISCLOSURE
OUSMATERIALS
acere building acupantatme"handle haxudoes martial
dcgned by the Cupertino Municipal Code. Chapter 9.13, and ata Health and Safety
Section 25532(a)
All roofs shall be inspected to any roofing material being installed.
Oyu No
prior
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant a future building occupant LLC equipment a devices which
emit hwaNmu air cenuminwts u defined by dw Bay Arts Air Quality Management
all new materials for inspection.
District?
Dyes u
I haus mad use husnkusntawriab mquhemcn s underChoPwr6.95 of saw Califor-
nia Hanish &SafetyCode, Sections 25505.255334 uI25534. 1 undcnwnd dtatifdw Welding
does not currently how • tones. that It u my maponihility to notify the oecupanwf Ne
kha= a Iuuaucc.f.C.Mute.foccupa¢�yy�
Signature of Applicant Date
All roof coverings to be Class "B" or better
owns ar,athariv rot Da"w
FW
It€m 3 of 6
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 31639035.00
DATE ISSUED.......: 06/26/2006
RECEIPT #.........: 35013
REFERENCE ID # ...: 06060212
SITE ADDRESS .....: 20237 NORTHBROOK SQ
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OPERATOR: suem
COPY # : 2
OWNER ............: NORTHBROOK HOA
ADDRESS ..........:
CITY/STATE/ZIP ...: CUPERTINO CA, 95014-0501
N.'
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.:?a.
TELEPHONE .........:.(408)278-0330
FEE
----------
.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
VOICE
ID DESCRIPTION
VOICE
ID DESCRIPTION
305
FRAME
307
INSULATION
601
ROOF TEAR OFF
602
ROOF PLYWOOD NAIL
603
ROOF BATTENS
604
ROOF IN -PROGRESS
N.'
al
�UPEkTINO
•
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Building De artment
ADDRES :O h 1 � PERMTT #
OWNER'S NAME: J� PHONE #
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors: 6a�
Signature Date
Please check applicable subcontractors an complete the following information
tae- (_0
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
tae- (_0
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.
Homeowner's Name: X6\1 1'1
Job Site Address:
Roofing
Applicants Signature:
Greg Casteel
Building Official
Revised 11 /2/ 04
Date: (0 —0(_0
CITY OF CUPERTINO
REROOF
PERMIT APPLICATION FORM
060p;4A
APN #
Bldg Permit Fees
BUILDING
Date
1 3 151 -o
BUILDING
BSEISMICRE
Building Address: 1
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S
Seismic Commercial
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O
Plan Check Fee
BUILDING
ntj
Owner's Name:�`
BUILDING
Phone #:
p(- vi(t k- O, It}.
C tractor:
Phone #:
License #:
Seq door
l V09
Z3 3 30
7.2 /0 8'
Contact:
C
Phone #:
Cupertino Business License #:
AA o Z ares
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Type of Roof Covering:
Existing:
Proposed:
❑ Built -Up Roof
❑ Built -Up roof
❑ Asphalt Shingles
>!�, Asphalt Shingles
Cl Wood Shakes
❑ Wood Shakes
❑ Wood Shingles
jf' Other (Specify) Ca (6 kuKe—
❑ Wood Shingles
❑ Other (Specify)
Number of existing coverings /
❑ Provide I.C.B.O. Report #
p' To be Removed
❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and WillCom
1 With Cu
ertino's Tear Off Polic
Job Description: ,c l S
Tro s{w.l .70 l
9
1= Cir d—
CSN oN
6P v94!c.) 61.1n les --1A NS.
Residential Commercial ❑
Fire Zone: Yes ❑ No
Confirmed with Planning De t. if
there are any restrictions:
Cost of Project Type
of Co tion: Occupancy cup:
Qty, if
Applicable
Fee ID
Fee Descrintion
Fee Gmun
BPER IFEE
Bldg Permit Fees
BUILDING
BENERGY
Ener_gy
BUILDING
BSEISMICRE
Seismic Fee Res
BUILDING
BSEISMICOM
Seismic Commercial
BUILDING
BPLANCHK
Plan Check Fee
BUILDING
BUSLIC
Business License
BUILDING