06060163 (2) CITY OF CUPERTINOr-+'+'r'tk?'va'�%kvuL�'x.
BUILDING DIVISION PERMIT CONTRA®TOR IN>{'URMATIQN
�?P' S Sign 5 fTb^ '. r!
Bu1LDINGADDRESS: FOUR SEASONS ROOFING PERMITNO.06060163
20268 NW S
OWNER'S NAME: PERMITLSSUEDATE
NORTHPOINT HOA 502 HORNING 07 06/19/2006
HE
SANITARY NO. CONTROL NO.
(408) 278-0330
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDGO ELECTO MECH
O l�
uoo LICENSED CONTRACTOR'S DECLARATION Job DaSCrI Description
"r1 1 W.by affirm dot 1 Sm licensed der provisions of Chapter 9(cemmeacing P
�x with Section 7")ai'Divlsion 3 of the Business tab Professions Coda.and my licwc is
infullfmcesndeDect. EMOVE CALSHAKE ROOF, INSTALL 30LB FELT, AND GA
^�� LD�e ac 1 rsD ND CANYON �> � CLASS A
Fp J�JGanlrKb
?�I`,i� As shall use DEC cr ON
U I undenunJ my phos shall W used u public records
�C Limemd Professional
OWNER-BUILDER DECLARATION isJ(1(y(s
^ i hereby alarm that I am exempt from db Connectors license Taw for the JUL is,! 2006
2 a o fallowing mason.(Section 7031.5.Business and Professions Code:Any city or county
12 which requires a permit b cco mrucL alter.Wpmve,demolish,Or MPdr any suoctum
-zy prior At its issuance,also requires the applicant for such pcsmit in Ok a signed statement Valuatyy6500
that W is liccmcd pursuant b the provisions of the Contractor's License Law(Chapter 9 3q.Ft.FIo RILP'
$es
(commencing with Section 700M of Division 3 of the Business And Professions Com)or
�..
that W is attempt thmofrom and the bash for Ne alleged eatmption.My violialon of -
section 7031.5 by any applicant(m a permit subjectsthe applicant to A civil Penalty of AypN Number Occupancy Type
.at mare Nan five hundred dollars(5500). 31639044 . 00
1,u awoer of Hct property,a my esepbyen wW m{n u Nev tole mmpewdoa,
will do lac wore,And Ne rwclsrc Is rummurded oraifered foruk(Sm.7044,Business Required Inspections
and Professions Cade The Contractors Lica.Law does not apply b An owms of q P
property who builds m im prawn thmson.and who does each Anal,himul(Or through his
awn employees,provided Nat such Imprmemenu Am set mantled OraRered formic.B.
however,Ne building or impmwment is mid within can car o(coropledon,the Owner.
bell&'will have W burden of pmving Nn Im did not build ar Improve for purpose of
ask.).
❑1,An Owner of the property,am exclusively contracting with licensed cenuactors to
constmm the project(See.7044,Business and Professions Code:)The Contractors Li.
cense law docs sot apply in an Owner of property who Wilds ar Improves Hereon.and,
who contracts fat such projects;with a cenuutor(s)licensed purmant b the Conuanues
License law.
❑I sen exempt under See .B d P C for Lida resson
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby Larm under penalty a(pedury^m of the following declarmans:
I have and will maintain aCeNOcam of Comem to self-lasum far Workers Compen,
utlon,As provided for by Sect an 37M of the Labor Code,for He performance of the
work for which this permit is issued.
❑1 have and will maintain Workers CompemWon laaursom,As required by Section
3700of the labor Cade.for the performance of the wank for which His Permit is IssmQ
My We SCompegFWonias mcarrierod Policynnnn,m'MA::
Cartier. Polky Na.1 -7 14 q�
CERTIFICATE F mEmmobt FROM WORKERS'
COMPENSATION INSURANCE
CThisuction mcd not W completed if the Permit 4Imam hundredd^Oan(1100)
nr less.)
1 celsfy that in the performance or th0 work for which this permit is issued.l shall Out
employ any person in any massacres As in becoma subject to the Workers'Compens n on
laws of Califoma.Date
Applicant
NOTICE TO APPLICANT:IL after making this Certificate of Esempilm.you Abreast
become subject in the Worker.CornNnsadon provisiam of to,Labor Cade.You mon
.J O fOMwide comply with such pmvidons or Nis permit awl he domed rt+vked.
z ti CONSTRUCTION LENDING AGENCY
[-t IWreby.M.land them is•cemmtmma lending agency for Ne performurmof
lx 7 the work for which this permit is iumd(Sec.3097.Civ.C.)
W�0 Lender's Name
,7 z Lenders Add.
U O I mNfy that 1 have read this application sod sum Nn the above information is
IL 6~- correct.I qme to comply with all city and county ordinances and Sam laws misting b
OU building construction,and hereby authorise representatives of Nis city to enter upon lac
W ahove.memiu^ed propeny fm inspection purposes.
I We)gree b save,indemnify and keep harmless lire City of Cupertinoatoms
ti y Ihbilitin.JW{menrs.eau andtapemu which mayldany nYamue agdnstsaid City
UZ incomeqummof Negrantin Sp mi
^' APPLICANT UNDE0.57A Dg A WI COMPLY WITH ALL NON.POINf Issued by: Date
ULAT70N5
Re-roofs Z�
Signals.of Applimu br Dam
HAz DOUS MATERIALS DISCLOSURE Type of Roof
Will the appOcam o forum building occupantame orhendk hazer lour material
As defined by the Cb2CW&Municipal Cade.Chapter 9.11.and Ne Health and Safety
Cade.Encu.25532(x)7 All roofs shall be inspected prior to any roofing material being installed.
Yes o
Will the applicants or future Wilding Occupant use stalemate,of devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit baveism.air aonummams as denned by the Bay Area Air Quality MAA{Cment all new materials for inspection.
District?
❑Yq
I hoc mad the haardnns mamrisls.quimmenu under ChAPmr6.95 of the Cehfor.
nh Health Ir SafctyCode,Sxtions 27505,25533 md25534.I understand thall ik building
does not 1 hoc• t, 1 my mspomihllity b notify He occuPIOL of Ne
A. na muss metpi 'sumeofaCerti�ofOyapan .ol Signature of Applicant Date
owner Or ammirrsd a nt 17 'e'�J Dam. 'll All roof coverings to be Class "B"or better
CITY OF CUPERTINO
�m 3 of 4 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 31639044 . 00
DATE ISSUED. . . . . . . : 06/19/2006
RECEIPT # . . . . . . . . . : 34921
REFERENCE ID # . . . : 06060163
SITE ADDRESS . . . . . : 20268 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
*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
•
ti
Community Development
10300 Torre Avenue
/- Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
GJUPEkTINO
Building De artment
JOB AD 6 O
DR S: PERMIT# / O l ��
OWNER'S NAME. Q . PHONE # ('
GENERAL CONTRACTOR!V-->. 5 , K FAX # // '
I am not using any subcontractors: Carl e C*
ignature Date
Please check applicable subcontractors m fete the followinginformation:
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/Contrac c Signature Date
Id
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.
1,. ._ ._ _ .__ . _ .
Homeowner's Name: !.JDrilrN PD i r,
Job Site Address: D Y)O
Roofing Company Name:
ApplicanPs Signature: Date: ^ b
Greg Casteel
Building Official
Revised 11/2/04
CITY OF CUPERTINO
REROOF
• CUPEkTINO PERMIT APPLICATION FORM
APN # Date-
S1 cnr ro 4&2_0(v
Building Address:
O �
Owner's Name: Phone#:
0 O, IN
C tractor: /�1 Phone#: License#:
vT 2 t �00� qbg 22 S -0330 /0 $'
Contact:�1 ��11 hone#: Cupertino Business License #:
o lA 2 xe— �2) -0 .o O Z
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles '9, Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ^ ❑ Wood Shingles
Other(Specify) l:q 16 kaK2 ❑ 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 Will CoTRly With Cu ertino's Tear Off Policy:
Job Description: ZZ.0,0UL/ Cal S 1 TN s .l 3 0 1 L 1 an
Y Gr"X c1K) O+✓ G0 c9f C>,,
Residential ;-111-1 Commercial ❑
Fire Zone: Yes ❑ No Confirmed with Planning De t. if
there are any restrictions:
Cost of Project Type o onstruction: Occupancygroup:
Ssao
Qty. if
Applicable 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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