06060161 (2) CITY OF CUPERTINO
`BUILDING DIVISION PERNIIT ONTRAf3T®R IN)F'URMA. I ?,N :
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BUILDING ADDRESS: FOUR SEASONS ROOFING PFsm"'N0'06060161
20276 NW S
OWNER'S NAME: PERMIT ISSUE DATE
NORTHPOINT HOA 502 HORNING 91 06/19/2006
NE: SANITARY NO. CONTROL N0.
(408) 278-0330
ARCNITECr ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0
�0, LICENSED CONTRACTORS DECLARATION MNm
70th Description
Mu� I horeby affirm 1 am licensed under previsions of CMpmr 9(commencing
with Section 705111)ofDivbion 3 afthe Business and Profession,Code,and my license Is
n in fall U7�( C7 a REMOVE CALSHAKE ROOF, INSTALL 30LB FELT, AND GA
jNZ LlceCl a Lu.g d CANYON COMP SHINGLES
'::Eii4 a.-C,'y�- :ic. A%.-•r +r.,.s. , CLASS A
ARCHITECT'S DECLKRATION
1 me cetand my plana shall he used As public awards
Dle
s0 LmcmtJ Prvfcssianel �I+ V
p
OWNER-BUILDER DECLARATION
S�� I hereby alum that cumpt et I am exempt from Ne Conuarvea License Law for the
i M o following reason.(Section 7031.3,Busioan sed Profassinu Codc:Any city or county
$� which requires a Permit to corsuma alter.narrow.demolish.or repair any ameture
_iy priorm is Issuance.elan requires Me applicant for such permit to file aagml sta¢ment
< that he is licensedpumummtoNeprevislomofMeCanuelar'sLicesso Law(Chapter 9 Sq.Ft. Floor Area JUL Valuat 6500
s� (comm¢Ing with section 7000)of Division 3 of Me Suaneuond Pmfeniou Code)ser Z! 28gfi
f R g-. Nat he is exempt rh rafrom and the but,for the alleged exemption.My violation of
Section 7071.3 by my applicant far,Permit subjects the applicant M a civil pemlty,of ppN N mise Occupancy 1Ype
cwt ream than ftw hundred dollar(5300} 316 3 90 3
❑ w
will do the work,and the tuumure Is not Intended oroneted ferule(see.7014,Bum"•'•
and Premi
feomme Code:The Committees License Law dues ret apply ta an owmr a RegU C
property who builds m i m prewa thcoutm end who does such work himself m threugh his
own employees,provided that such Improvements sate not Intended oroRered farsaie.It.
howawr.the building or Impmvemem I. to within am Ra oftnmplddm,the awner-
builder will have the burden of proHng Na W did rot build ser improw for purpox of
ale.).
I.as Owner of tW property am escluavely canmacting with licensed cemmsewa b
construe the pmjm(Sec.7044.Business axed Prohsaom Coda:)The Conmanoea LF
come law docs not apply to As owner of property who Wilds or impress the en,and.
who conmeu for such projects with a conmaemr(s)peened paramount m the Contasetorsu
License Law.
❑lamexemptunderSm ,BdPCforthi,mman
Owner Data
WORKER'S COMPENSATION DECLARATION
I Mmby of im ander penalty.1 perjury arc of the fallowing declarations
V
haw and will maintain aCenlOamofConsent At If-ileum faW~-CmgAm-
sWon,as pmvided As by Section 3700 of Me Labor Code,for W pedonmenco of the
work for which this permit is Wood.
❑1 have and will maintain Worker's Compensation Insurance,As,required by Section
3700 of the Labor Code,for Ne performance of Ne work for which this pwrmdtts issued.My '
Carder._ aComPF nlnsum tee aIiCyi1 umber
GRler. _IL_YOE all Na
ATE U2* Q4
0 (• f ON FROM WORKER
COMPENSATION INSURANCE
flbtsmmdm aced ret W cmnplemddthe paced,is faaa handled do me(SIM)
ar usual
I certify Nat in the penfomame of the work far which Nis permit u issued.)"1 ret
employ any pemon in my mannerse an In became subject to Ne Waakni CompnuWon
Laws of Caift mia.Data
Applicant
NOTICE TO APPLICANT:If,afar making that Cenificam of Exemption,you should
become subject m the Workers Compenetion pmvWons of Ne Lahr Code,you mum
.,O forthwithna N
with comply with such provisios u pemit shall W daW ro
moked.
zCONSTRUCTION LENDING AGENCY
(-� I thereby alfvm that dem 4 a consumerism lending agency fm site perfamenee of
C> Me"M far which MA permb ts(ts u,(Sac 3097,CN,C.)
94 QLendeh Name
0.z Lenders MJreas
C)Q I coldly that 1 have mad this application and sou Na the show information is
{T.F coact.I agree to comply with all city and county ordinances and side laws relining N
0 Wilding construction,and hereby sutharien repreunmdve of this City to enter upon the
Uj shout-memitmCd Property for impaction purposes.
(We)agree to saw.Indemnify sed keep Minim the City of Cupertino against
T0.jl liabilities judgments,emu me eapensea which may in ay way aceree against said City
fJZ in consequence of Ne Sooting of this permit. y
�-" APPLICANT UNDER WILL COMPLY WITH ALL NON-POINT Issued by: Date �/ G, ab
Guano s. -
10 Y Re-roofs
Slgnaurc of li AADOUS MATERIALS DISCLOSURE Data Type of Roof
Will torroom building acupataom or handle haurdom materia
u&I1nN by the Calendar,Municipal Cade.Chapter 9.13,and de HcaIN and safety
Cale.Satiate 75532(.19- All roofs shall be inspected prior to any roofing material being installed.
❑Ye
Will thw applicant at future Wilding Occupant me equipment a devices which If a roof is installed without first obtaining an inspection,I agree to remove
.it Immolate air cnntamdmmu as detiad by Me Bay Amo Air Quality Management all new materials for inspection.
tsuicR i—
❑Ye �flU
1 haw mad the hamrknemannials mquircmens under lesp06.95orionCelifor-
nuHeal"Saimycode.Semlas73 I7 anJ73534.1 understand Madfthe Wilding
Jaen not currently haw a mnanL t It7su my nsihilitY b name Ne aeupyant of Ne
le seat W met to Wtr Certificate '1 Signature of Applicant Date
Owner m a Nr,riama,genM Data All roof coverings to be Class"B"or better
CITY OF CUPERTINO
�m 1 of 4 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec: Twp: .Rng: Sub: Blk: Lot :
APN . . . . . . . . : 31639043 . 00
DATE ISSUED. . . . . . . : 06/19/2006
RECEIPT # . . . . . . . . . : 34921
REFERENCE ID # . . . : 06060161
SITE ADDRESS . . . . . : 20278 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
Community Development
it,
J orre Avenue
COpOeruno CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
OCUPERTINO
Building Department
JOB ADDRESS, PERMIT #
a f�Ga cS6l
OWNER'S NAME: Mor-,Lko' PHONE #
GENERAL CONTRACTOR: FAX # r
I am not using any subcontractors: o
Signature Date
Please check applicable subcontractors an om lete the----wffig 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
E
et Rock
er/Contractor Signature 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$176.18. The re-inspection fee must
be paid before another inspection can be scheduled.
` s
IMPORTANT:
1. Flat roofs must have a minimum of 1/i"per foot slope and demonstrate
that there is no ponding.
2. An I:C.B.O.report is required to be on the job site at the time on inspection.
I understand and will comply.with the above stated policy on re-roofing.
Homeowner's Name: ••�11111�
Job Site Address:�D�� IJnr- Y ,s,s+ 0--Ux r/�i y
Roofing Company Name
ApphcanYs Signature: Date:i U (p
Greg Casteel
Building Official
Revised 11/2/04
OBD
CITY OF CUPERTINO :=
REROOF
1
{f
f ,m Ylq �� •f 3 S
CUPEkT1NO PERMIT APPLICATION FORM
Datf-
•�yYy7���7 7' _.� ;
Building Ad ress:
2-D <A 0
Owner's Name: Phone#:
Ctractor: Phone#: License#:
4% VOF 2Z 5 -0330 �o.$
Contact:��11 /� Phone#: Cupertino Business License#:
AA CrJc �Zar�s a,7 $ -0330
Type of Roof Covering: `4'
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑. Asphalt Shingles . Asphalt Shingles
13 Wood Shakes ❑ Wood Shakes
❑ Wood ShinglesI C3Wood Shingles
;if-- Other(Specify) (2^q(S kaKe_ ❑ 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 Comply With Cu ertino's Teaz Off Polic
• Job Description: �� S =�si�.1� 3e l C 1
Residential Commercial ❑
Fire Zone: Yes ❑ No Confirmed with Planning D9pt. if
there aie an' restrictions:
Cost ofProject�, Type of Construction: Occupancy group:
Qty. if
A licable Fee ID Fee Description Fee Group
BPERMFEEBldg Permit Fees BUILDING
BENERGY Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
t .�i .