06040089 (2) CITY OF CUPERTINO � s>;;, t 7i77 .
T " F,OMO>tisP
BUILDING DIVISION PERMIT
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BUILDING ADDRESS: FOUR SEASONS ROOFING PERMIT NO-06040089
10836 NORTHRIDGE 90
OWNER'S NAME: PERMIT ISSUE DATE
NORTHPOINT H.O.A. 502 HORNING ST 04 /17/2006
ONE: SANITARY NO. CONTROL NO.
(408) 278-0330
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
B O PLO MO
iOp LICENSED CONTRACTOR'S DECLARATION Job Description
I bercby affirm Net 1 am Hamad under Povidone of Chapter 9(commencing p
with Section 7000)of Division 3 of the Business and Profession,Code.and my license is
M.�y k tunforceandeffece _3 Lled 4'11iuP REMOVE CALSHAKE ROOF, INSTALL 30LB FELT, AND GA
d5� o.nteclass Contractor PIL I c• GRAND CANYON COMPOSITION SHINGLES, CLASS A
IR°� ARCHITECTS DECLARATION
< I undeuund my plans ahall be used to public rcrnNs ,
as Licensed Professional
SysOWNER-BUILDER DECLARATION
I I barony affirm
that 1 em exempt from the,Contractors Lieente Law for tits
.O a folloo na Mason.(Section 703 L5.Bualncem and Profession Cade:Any city or County
5 16! which wquirus a Permit m emuwe4 slim,improve.demolW,or repair any,Immo.
iy prior mits iasmna,also requires the aPPlicentforsah permit to Ek asilncd auwmcm
�< that he is licensed pursuant to the provision of assCharacter's Lice=law(chapter 9 Sq.F[. Floor Area Valua[i$�500
8 (commencing with Sudan 7000)of Division 3 of Ne Business and Profession Coe)or
—
that he 4 exempt a,^Tfmm and the basis fm the alleged ewnption.My violation of
Section 7031.5 by any applicant for a permit,ubjecu the applicant to a civil penalty of APN Number Occupancy Type
Out tort.than five hundred dollars(5500). 31636046 . 0 0
❑Lasawneraftiw p°Petry.ermytemploycer with teagnesdte'v,aleeompewdm,
will do Newede.and Nemumme 4 ha ndso e!oroffe.d forsawisce.70s4,11" as Re tore
and Profession CNm The Canncturs license Law does sur ns
apply w an owner of q
propertywhobuit"orimpm.nd�a.andwhodaeaaachwarkhim fmthrough his MAY — C
am employees.provided Nrch tee not aimprovements tenot intended oroRered forsak.It. — 200(vs
however-the building or Improvement it sold within am year of carapkdm,the owner- u
=a. MB love the burden of proving dot k did ant bdW.improve(or Purpose of s7 v,�� ���...>as
coke). U U' �
Q 1.as Owner of dw property,am exclusively contracting with Ilcened cercocters he
conuvct Ne project(Sec.I 1044.weer of pand!roperty
Predicrty whdon Cade:)M Cmtracmrs nd
cease law den not apply m in with
4 of property who sedds rs impmw thereon,and,
who um Lace for such projects with a canlraclor(q Iiammmd pursuant u Ne Conuacmrs
Llc1 arm Law.
❑Lem exempt under See ,BRPCfor this mars
Owner Dow
WORKER'S COMPENSATION DECLARATION
I mmby affirm under pcaalty of perjury,am of Ne following doclamdms:
❑flhave and will maintain a Cardinals ofConsant m self-ictus a fm Worker's Campers
ration,asprovided far by SeNon 3700 of the Labor Code,tar the pedarmence of Ne
work for which this permit is Issued.
7x0
1 ban and will maintain Worker,Compensation Insurance,as m�uimd by Section
of du labor Code,for Ne performance of the wank for which Nis Permit is issued,
My Worker,Compensation human,carrier and Policy number are:
Carrier. b,N .A . Policy Nan l a a1 a'L`1 M Y
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
I
(TIO,section med notbecompkted if the permit 4 forone hund.ddollars($100)
or I..)
1 certify Nat in we perf°manm of the work far which this permit 4 issued.I shall not
employ any pemon In any mmnerm as to become subject m the Workcu'Compensation
Law,of Califomia.Dass
Applicant
NOTICE TO APPLICANT.IL after making N4 Cenincaw of EsemMio°.you should
become subject to the Worker,Compensation providan of the labor Code you most
.J 0 forthwith comply with each provision or this Permit sal be dared reveled.
�y CONSTRUCTION LENDING AGENCY
[—m I hereby dam than Nem isa constructhn loading agenry,for the Performance of
ai > the work for which this permit 4 named(Sm.3097.Civ.C.)
QLenders Name
D.D LAmmesAdd.a,
U Q I certify that I have read this application and sou Na the show information 4
I2.H cnmcL 1 agree to comply with all city and county moinamra am suss laws.ladng m
Qbuilding comuuction,and hereby audience representatives alibis city to enter upon the
U above-momioned property for irpcetion purpmn.
(We)agree to taw,indemnify and keep n makal the City of CuPcnim against
Taj) liabilities judgmems.eon and expenw which may in my my acem°aldol said City
U in consequence of the gmnting of this penia 4-1111>106APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURC EGU NS. -
4_/7-Orn Re-roofs
SigumufforApplitamonCan car Dau
X US MATERIALS DISCLOSURE Type of Roof
Will Ne applima Dore building accupmtaore or handle hanmdous material
m de0md by the Cupenwm Municipal Code.Chapter 9.13,and the Health and Safety
Code.Section 75533(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yna °
Will the applicant at future building Occupant ase equlpmmt m deem whim If a roof is installed without first obtaining an inspection,I agree to remove
omit n®aNnus air canuminanu a defused by the Bay Am.Air Quality Management all new materials for inspection.
DiarictT
r]You we
I have real the hamdou,matedals mquimmena under Chapter 6.95 of doe Califor.
nix Hcalth k SafetyCade,Sadao 25505,25533 and 75534.1 understand Los If Oar Wilding
does ant a tly Mt enam I�t it 4 my.spanscroll,dhility mscroll,Ile Occupant of the
require. rem say orwissumaofaccrdreamofOccupancy. SIgnatur o Applicant Date
Owncronuthovada t I Daw'o6 roof coverings to be Class"Burr Or better
CITY OF CUPERTINO
am 4 of 5 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec: Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 31636046 . 00
DATE ISSUED. . . . . . . : 04/17/2006
RECEIPT # . . . . . . . . . : 34017
REFERENCE ID # . . . : 06040089
SITE ADDRESS . . . . . : 10836 NORTHRIDGE SQ
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : NORTHPOINT H.O.A.
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-0526
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 PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BENERGY PERMIT FEE 126 . 36 60 . 65 0 . 00 60 . 65 0 . 00
BPERMFEE VALUATION 6, 000 . 00 126 . 36 0 . 00 126 . 36 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 187 . 01 0 . 00 187 . 01 0 . 00
Community Development Department
Building Division
t City of Cupertino
Asa *'- 1030D Torre Avenue
•
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
CUPEkTINO
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: /c►1 1 �1 u
Job Site Address: I;(.a 1 0C{ nv)C1S4 4t�1"t no
Roofing Company Name:
Applicant's SignatureDate: CP
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
Community Development
10300 Torre Avenue
d ✓' Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
&UPEI,TINO
Building De artment
JOB ADDRESS: PERMIT#
ID s r.o I
OWNER'S NAME: PHONE #
GENERAL CONTRACTOR--1j:---
. < RFAX #
I am not using any subcontractors:
�e' (7,U4�
SignaW Date
Please check applicable subcontractors and com let the following information
SUBCONTRACTOR BUSINE S 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
Al y-o cQ
Owner/Contractor Signature Date
CITY OF CUPERTINO
REROOF
CUPEiZTiNO PERMIT APPLICATION FORM
APN # Date
IN to o L4 Lk 140(D
Building A ress:
o o C.-A CK I Ll
Owner's Name: �1 II "" Phone #:
c4j
0 - oin E— O, PQ .
C tractor: }� Phone #: License #:
P q Loo Yos Z 2 S -03 30 /O 8'
Contact: /� hone #: Cupertino Business License #:
c Cjo lit Z afz� .2) $ --o 33 o
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles Asphalt Shingles ?
❑ Wood Shakes ❑ Wood'Shakes
❑ Wood ShinglesI ❑ Wood Shingles
;W— Other(Specify) Cg $hcK-C ❑ Other(Specify)
Number of existing coverings / ❑ Provide I.C.B.O. Report#
117 To be Removed O Provide Mfgr. Installation Specs.
• I Have Read, Understand and Will Com ly With Cu ertino's Tear Off Policy:
Job Description: / e S t s{�c.l[ 3 o G C I an
Residential Commercial ❑
Fire Zone: Yes ❑ No Confirmed with Planning De t. if
there are any restrictions:
Cost of Project Type of Construction: Occupancy group:
Qty. if
A licable 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
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