06060162 (2) CITY OF CUPERTINO
BUILDING Df-VISION PERMIT pN l!Uq ORjNFORMATION"
BUILDING ADDRESS: FO R SEASONS ROOFING PERMIT NO.06060162
20228 NW S
OWNER'S NAME: PERMIT ISSUE DATE
NORTHPOINT HOA 502 HORNING ST 06/19/2006
ONE: SANITARY NO. CONTROL NO.
(408) 278-0330
ARCHQEC MNGINEER: BUILDING PERMIT INFO
BLDG D ELECT D PLUMB MECH
D D
�ONG LICENSED CONTRACTOR'S DECLARATION Job Description
Id F I hereby affirm Nal I am Iianscd under innovations of Chapeau 9(rommeming
Zj with Seeman 701)11)of Division 3 of the Bunines and Prameiucs Code.and my licenxu
in fall fora and eff.L REMOVE CALSHAKE ROOF, INSTALL 30LB FELT, AND GA
�qz 0` 1�'i-e?rf codmCwr 1 D CANYON COMP SHINGLES, CLASS A
yyy--- AIR HriELTS DECLARATION
I unMrwnJ my plata slWl he)lad as public records
k Licensed Professional
OWNER-BUILDER.DECLARATION �� [•ai II I�
E 09 I hcrehy affirm that 11. eumpt from the Canuanafs License Lw for da 4/(^j`�fA\I\R II{BA{m lltt7fr^A,
O o which
reran.(Section 703 1.3,Business and ve,dmoli Calc:Any city or rouury
$f<i which In issa a permit re Cores Bn,s@r,improve,demolish,sere pair ed structure
-zi pdormlu ieuadpurcumq the Banapplicantfar schpermitmftm aaiga+dauamem
pp < (that he comms ccewithSuction7 0)ofDiviomofthe ConwcmlanueoeLaw niansoptm9 Sq.Ft. Floor Area VaIUBC X500
loth that he Is rte pt Suction basis n3o(titeegdneaandProfessionsCode)ser 20H
3 Natio r 31-5 b therefrom and the aper for the alleged exemption.In Any violation of pNN b e1
Sudan 7031-5 five
any trepidant Ire a permit abjms the appikal m a Civil penalty of 31A63 9(� 8e Occupancy Type
not mom than five hundad dWlan($500). 16 9 +3
❑Lae;owner of W property,or my employees with wages u their rote compenedon,
will do the work,and lhetuunaa 4 not mmndedm offered forsa c(Sec.]044.Busi oss
and Profenal Cad.The Conucmfs License Law dare,oat apply an an owner of
propenywhobuild¢aImprovesN .andwhodoestechmo himseforduoughbis
ownemplayces,provided that such improvement pee act Immprof .Band(mala IL
however,da b ilding or impmvemunt is sold wWin ane yea of romple0on.the mmr-
bullder will haw use burden of provine WI he did not bald or improve far purpose of
ate.).
❑1,u an=of Ila Property am exclusively rontraning with licensed Contractors to
Construct Ila project(Sec.7044,Bwiaea and Pnofcsmem Code:)The:Cuntrc7oe's Li.
acwe Lw dors vol apply m an owner of property who builds or impnoves thereon,and,
who cantrseta far suchpajemwithaeonvcmrp)Ikenxdi m mmtheomocmfa
License Law.
❑I am esempt under See .B k P C for ddr mum
Owner Dam
WORKER'S COMPENSATION DECLARATION
I herby affirm under Penalty of perjury can of the following declaruimc
1 have and will maintain a CedOcea ofCamentm self-Insure for Worker'sCompen-
ar on.as provided for by Seetion 3700 0(do Labor Cada for the perfonnm of da
work for which this permit is based.
0 1 have and will malmom Wmkefs Compensation Inarance,u required by Section
3700 of the,Labor Cade,fa the performance ofdm work for which dols permit b issued '
My Workees Compensation Imo ce arsies and Pull"number carrier. Policy No �_
CERTIFICATE F (Fid ON FROM WORKERS'
COMPENSATION INSURANCE
(fhissenion reed nothecomplemd lithe aunll is forane hundred centers(SIM)
ser less)
I mnify that in the performance of the woh for which this permit is band I"I off
employ my Peron in any Corner an e an bcromo mbkct an the Wuric re Compenedon
Laws of Ca[vomr.Dam
Applicant
NOTICE TO APPLICANT:If,afar making this CeniBoa of Ea repdon,you Should
become sub]m in On Workefs Compensation provisions of the labor Cade,you most
.J O forthwids Comply with such Provisions m permit pnit shall W domm
ed ated.
.Zi y CONSMUCTION LENDING AGENCY
[+ Iheaby affirm that there at a convection lending agency(or the performance of
ai
But work fm which this permit it;issued(Sec.309].Cih,C.)
WCL,A I noce,Name
Lender's Addmss
U Q I aertlfy that I have real Ws application and sum Wt the¢bow information is
U.(~ COneeL l agree to Comply with all city and county oNinsues and sum laws relating m
0 building convection,and hereby aahmice repmanulives of this city to cater upon the
W .hove-menmuned property far inspection prcous.
91. (Wee)agree to pew,indemnify and kap harmles 0a City of Cupertino against
�..�
CA I(ahlliBcs.Jingmenta.core ual expenses which may in any way amus against aid Lily
U Z in consurn nce of the gmadn5 of thb plump.
APPLICANT UNDER DS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date , ,/.-G'G
SOU C GULAn S, A-1aan0
l l W Re-roofs
siennumor Avyll C means Dam
A2:ARDOUSMATERIALSDISCLOSURE Type of Roof
Will
deer est mfutmc Wilding uccupatstoamhandle hmardow material
as&food by the Cu no and!da l Cade.Chapter 9.1;aHealth had Safety
Code,Section 25532All roofs shall be inspected prior to any roofing material being installed.
❑Yes No
Will dm applicant or forum building occupant use equipment m devices which If a roof is installed without first obtaining an inspection,I agree to remove
Colt haardom air contaminata an dented by the Bay Area Air Quality Management all new materials for inspection.
Duan'e'?
QYesa
I Mw mut the huallous materials requirtmenta under Chapter 6.95 of the Califor-
nia Hond
alifor-
niaHend a&SaklyCadc,Sections 25505,25533 and 25534.1 andcmmmd dust lane Wilding
one Mt c nIIY haw t il'o my respomlbility m notify da acupant of da
mm inwhichto be So assurance Ccttil�a a(occ Signature of Applicant Date
1`ikP
Owner a,aatho < am Data All roof coverings to be Class"B"or better
CITY OF CUPERTINO
M 2 of 4 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 31639048 . 00
DATE ISSUED. . . . . . . : 06/19/2006
RECEIPT # . . . . . . . . . : 34921
REFERENCE ID # . . . : 06060162
SITE ADDRESS . . . . . : 20228 NW SQ
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : NORTHPOINT HOA
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
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
WE 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
•
Community Development
10300 Torre Avenue
aC1010
Cupertino CA 95014
Telephone(408) 777-3228
Fax(408)777-3333
IOUPERTINO
Building De artment
LOB ADDRESS: 6 c PERM� 6 O 6
OWNER'S NAME: J Q. PHONE #
GENERAL CONTRACTOR-" FAX #
I am not using any subcontractors:
ignature Date
Please check applicable subcontractors Tete the following information:
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
er/Contractor Signature Daae
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,"'
nspection, . a
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 complywith the above stated policy on re-roofing.
Homeowner's Name: -L -(
Job Site Address
Roofing Company Name:
Applicants Signature: Date: ^ b
• Greg Casteel
Building Official
Revised 11/2/04
CITY OF CUPERTINO �� 2
REROOF
. CUPERTINO PERMIT APPLICATION FORM
# Date
Building Address: 1
Owner's Name: Phone#:
0CA-L• ok,n-4- . O, Ac.
C tractor: Phone#: License#:
ur' e a vooc- � Yog 2.Z S -03 30 7,2/00-
Contact: //1� hone#: Cupertino Business License#:
AA FCJo laZ 0.f•-e,i �2) g -o ,33 o Z
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof Cl Built-Up roof
❑ Asphalt Shingles >�, Asphalt Shingles
❑ Wood Shakes O Wood Shakes
❑ Wood ShinglesI ❑ Wood Shingles
Other(Specify) Ca(iS y�n� ❑ Other(Specify)
Number of existing coverings / ❑ Provide I.C.B.O.Report#
To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read, Understand and Will Com 1 With Cu ertino's Tear Off Policy:
• Job Description: "'Ll S ��s Fit 30 1 C 1 cin
C Cir o-+ C'o osr`klo� SI.'n les r fol
Residential Commercial ❑
Fire Zone: Yes ❑ No Confirmed with Planning D t. if
there are anrestrictions:1W
Cost of Project Type of Construction: ancy group:
Ssao 1.1 -
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