06030050 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT aCIUNTRCpR.IIVFORMAeO €T ^
Bu1LDING ADDRESS: FOUR SEASONS GARDENING P"""o-0
0135 NORTHWIND SO
OWNER'S NAME: PERMIT ISSUE DATE
NORTHPOINT H.O.A. 2429 LAST OAK D 03/10/2006
NE: SANITARY NO. CONTROL NO.
(408) 358-8(;03
ARCHITECDENGINEER: BUILDING PERMIT INFO
BLDG el.ecr PLUMB MECH
30a
LICENSED CONTRACTOR'S DECLARATION JbDescriP tion
I hereby of iron that l um
Ann thousand under provisions of Chapter 9(como
encing
with Section 7")of Division 3 of the Business and professions Code,and my Rename is
in full y 72,�� REROOF-REMOVE CALSHAKE-INSTALL 30LB FELT AND
>Bz ucenroc aands n
R4_5GAF GAF GRAND CANYON COMP SHINGLES-CLASS A
s Dab Contractor
oilE ARCHITEClSDECLARATIO
1 undersand my plans shall be used As public mcnrds
g FINALE®
u Licensed Professional
OWNER-BUILDER DECLARATION
r� 1 gusto affirm then 11. exempt from she Contracmfs License Law for the`oo followingmoon. emdun 7(131.3,Businessand Profession Case:Any thy or county
$�i which requires•petrol re ennlmCL albs Mpmw,demolish,ri e a sig ed awment
��n prior units luuemc,a6u requires the applitantforauch permits fileasigmd mabmcm
that he u licensed putsuant b the pnvisiomnf the Conuumr's License Lsw(Chapmr9 Sq.Ft.Floor Are Valuate 15500
(commencing wish Section 7000)of Division 3 arrive Business and Profession Code)or
$ that he is exempt Brmfrem and the basis fm the alleged Assumption.My violation of
Section 7031.5 by am/applicant fm a permit objects the applicant to a civil prulty of APN NuOccupancy T'pe
am th
not roan Bw hundred dolma($500). 316 3 8 0 ..
Q h As owner of the property,or my employ=with wages as tinb role compensation,
will do the wok,and sheatmctmeI. I mended moffesed frank,(Sm.7044,Business Required Inspections
and Professions Code:The Contractor's License Law don not apply b e an ownu of q P
propenywho builcm orimprove Moment.and whodoessuchwork hinoelforthmugh his
owncmploy=.provided datsuch Improvements ere notinended oroRered forsale.if.
a onaver.the building w improvement is sold within one year of compbtion.the owner.
Wilda wild have the Anomm or proving wt be did not build u winnow for purpose of
.I.).
Q 1,As owner of the property am exclusively contracting with licensed emntoctors In
construct the project(Sec.7014,Business and Profn icas Code:)744 ContramoYs Li.
ceme Law d=not apply loan owner of property who builds or Improve thereon,and
who contracts for such projects with a conuacmr(s)0umed pursuing to Ne Conuaa e.
License Law.
Q tun esempt undo See .B&PCfmthtsmaron
Ow= Dan
WORKER'S COMPENSATION DECLARATION
I hemby trirm under penalty of perjury one of to following dmharatans:
41 1 haw end will mdmsin aCenifiosta of Cc nm toself-alum far Worker'.Compery
sedan,An provided for by Sutton 3700 of the Labor Code,for the performance of the
wok for which this permit is issued.
Q 1 have and will maintain Work e;Compensation Insmence,As required by Sutton
3700 of she Iabm Code.far the performance of the work for which this permit is issued.
My Wokds Qatropersadon Insurance cartier and Polley number me
Cartier. M Policy No.: I Z r 2 IF de
CERTIFICATE OF EAEMMON FROM WORKERS'
COMPENSATION INSURANCE
iThH secdoo coed notbecomplead If to permit Is fororo hundreddellus(SI00)
her lea.)
1 certify Met In she perfnrmame of the wok for which this Permit is issued.l eMll no,
employ any person in any wormer an As as become ubjmt to the Wmken'Canpenutan
Laws of Califouia.DM
NOTICE TO APPLICANT`.If.after making this cmdrican or ErompOon,you should
become Subject in the Workefs Compermtlon provision of the Labor Code you muse
w,O forthwith=reply with such provisions m this Permit mod be demand!rewked.
.z„ CONSTRUCTION LENDING AGENCY
[-+ I harebydRrmshet than its construction lending agency for she performuce of
Ci> the work for which this permit ts issued(Sm.309E Civ,C.)
QLender's Nurse ,
z Leader's Add.
U0 I certify that I have mad this application and sub that Ne abew information is
Iy P cones.I nI=b comply with all city and county on inuues and mass laws relating to
O U building construction,and hereby u0bdse repmunmiws of this city to now upon the
W shout-mentioned prepeny for inspemion purposes.
(We)agree to an,indemnify and keep hamlets the City of Cupertino against
W Imbilitiu,judgmcnu.emu and expenses which may In say way seem against mid City
U in consequence of the Smile&of this permit.
APPLICApppggq UNpppERSSS7yy1µJJJJDS AND WILL COMPLY WITH ALJ.NON-POINT Issued by: Date — /(7•— G�-
SOURC➢6BEG�H�ATtEy$� a/o%
` A U —L /�� Re-roofs
Slgnatum ofnppeanuconim m s, Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant more or handle haurdous material
As dented by she Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
Code.Scctiea 1553:(.)7
[:3 Yea No All roofs shall be inspected prior to any roofing material being installed.
Will the applicant of future building occupant me equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
aIt hevssdnns air o naminants u m0ncd by the Bay Am Air Quality Management all new materials for inspection.
oieI?
Q Yes btu
I have mud the hazardous mabrialsrequirmocnts underChaptard95 of thc Califem
nlalkolN&SafmyCodc,Schon 25505,35533 and 25534.1 undersand MAMA building
docs not currently haw a h nm the it u my msponslhility b natty the meupant of she
requirements which mumbe t _,Iauacco(x CatiRcab of Deese Si gnature of Applicant Date
h
04ly v
Owner orauthrated agent I /D�w All roof coverings to be Class"B"or bC[[Ci
CITY OF CUPERTINO
3 of 4 PERMIT RECEIPT OPERATOR: suem
COPY # 3
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 31638012.00
DATE ISSUED. . . . . . . : 03/10/2006
RECEIPT #. . . . . . . . . : 33514
REFERENCE ID # . . . : 06030050
SITE ADDRESS . . . . . : 20135 NORTHWIND SQ
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : NORTHPOINT H.O.A.
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-0551
RECEIVED FROM . . . . : FOUR SEASONS ROOFING
CONTRACTOR . . . . . . . : SCOTT R. JOHNSON LIC # 27258
COMPANY . . . . . . . . . . : FOUR SEASONS GARDENING
ADDRESS . . . . . . . . . . : 2429 LAST OAK DR.
CITY/STATE/ZIP . . . : SAN JOSE, CA 95124
TELEPHONE . . . . . . . . : (408) 358-8003
SE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW HAL
______ _____________ __________ __________ __________ __________ __________
BPERMFEE VALUATION 61000.00 126.36 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
•
Community Development
10300 Torre Avenue
✓' Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPEI�TINO
Building Department
JOB ADDRESS- PERMIT #
h,: , _4 O0oo(lz
OWNER'S NAME: v A PHONE #
GENERAL CONTRACTO , FAX #q,o _o y3-3
I am not using any subcontractors: `PLA , 0
ignature ate
Please check applicable subcontractors an 2�7com 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 .
01 0
Owner/Contractor Signature tate
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
Fax: (408)777-3333
CUPEI�TINO
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: �m�"\`+ 1 c'- f n
Job Site Address: ZU k1,ISwives St
Roofing Company Name: 1 b �G*.i oh' 'Coc) r i rN Q
Applicant's Signature: ��_ Date:S/ I (1 o(D
Greg Casteel
Building Official
Revised 11/2/04
CITY OF CUPERTINO
REROOF
V - a CUPERTINO PERMIT APPLICATION FORM 0�o5AZ
APN #
Da /o
$ O/oAV/Ll$
Building Address:
Qo
Owner's Name: � 1 11 Phone#:
C tractor: Phone#: License#:
vr 2 q 21 S -0330 /0 K
Contact: hone#: Cupertino Business icense #:
.27a -0330
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof O Built-Up roof
❑ Asphalt Shingles * Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
Other(Specify) Ca(8kaK-e— ❑ 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 Comply With Cu ertino's Tear Off Policy:
Job Description: ZLt,.�I— lS I 30 L C ) an
L' Gr"Cd_ Gw ON . ev o5rMc.J 61.,,,n les
Residential I& Commercial ❑
Fire Zone: Yes ❑ No Confirmed with Planning DMt. if
there are anv restrictions:-%:Z'
Cost of Project60 Type�,Gor}struction: Occupancy group:
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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