12050008 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20303 NORTHCOVE SQ CONTRACTOR:FOUR SEASONS ROOTING PERMITNO: 12050008
OWNER'S NAME: BARBERA-KEEN KATHLEEN TRUSTEE PO BOX 1668 DATE ISSUED:05/012012
OWNER'S PHONE.: 4082578911 SAN JOSE.CA 95109 PHONE NO:(408)278-0330
V— LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
License ChasC—
Sq{S n . Lic.q ,a, 02
MECH r RESIDENTIAL r COMMERCIAL r
Contractor ('8/ !IX• Date
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I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: RE-ROOF TEAR-OFF EXISTING CAL-SI IAKE ROOFINGSYSTEM
(commencing with Section 7000)of Division 3 of the Business&Professions AND INSTALL 308 FELT UNDERLAYMENT AND INSTAL[.GAF
Code and that my license is in full force and effect. GRAND CANYON SHINGLES,COLOR:STONEWOOD CLASS A 15
1 hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a cenificme of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.FI Floor Area: Valuation:$6500
APPLICANTCERTIFICATION
1 cenify that I have read this application and state that the above information is APN Number:31641065.00 Occupancy Type:
correct. I agree to comply with all city and county ordinances and state laws relating
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, PERMIT EXPIRES IF WORK IS NOT STARTED
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply WITHIN I DAYS OF PERMIT ISSUANCE OR
with all non-point source regulations per the Cupertino Municipal Code,Section 180 DAYS M LAST CALLED INSPECTION.
9.18_ 1�y I"�,1�7/Jv,
SignatureDate S'Z' )Z Issue y: °� Date:
❑ OWNE:R .DF.R DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of RF.-ROOFS:
the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
1,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for
will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection.
Business&Professions Code) 2 2
I,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant Dale: S' J
construct the project(Sec.7044.Business&Professions Code).
1 hereby affirm under penally of perjury one of the following three ALL ROOF COVE NGS TO BE:CLASS".\"OR BETTER
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE
Compensation,as provided for by Section 3700 of the Labor Code,for the
1 have reed the hazardous materiels requirements under Chapter 6.95 of the
performance of the work fix which this permit is issued.
I have and will maintain Workers Compensation Insurance,as provided for by California Ilealth&Safely Code.Sections 25505,25533,and 25534. 1 will maintain
Section 3700 al'the Labor Codc,far the performance of the work for which this compliance with the Cupertino Municipal Code.Chapter 9.12 and the Health&
Safety Code,Section 25532(a)should I store or handle hazardous material.
permit is issued. Additionally,should I use equipment or devices which emit hazardous air
I certify that in the performance of die work forwhich this permit is issued,I shall contaminants as derived by the Bay Area Air Quality Management District I will
not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code.Chapter 9.12 and the
Compensation laws of California. If,after making this certificate of exemption,I I leallh&Safely Code,Sections 25505,25533,and 25534.
become subject to the Worker's Compensation provisions of the Labor Code,I must
i
forthwith comply with such provisions or This permit shall be deemed revoked. Ownero1 zed 1: Dale:
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENC\'
I cenify that I have read This application and state that the above information is
correct. I agree to comply with all city and county ordinances and state laws relating I hereby affirm[hal(here is a construction lending agency for the perfommance of work's
to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.)
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the Lender's Address
granting of this permit,Additionally,the applicant understands and will comply
with all non-point source regulaGaa per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION
9.18.
1 understand my plans shall be used as public records.
Signature Dale
Licensed Professional
c � C) '
REROOF'PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE CUPERTINO,CA 95014-3255
1 ,;!I ; i
_
CUPERTINO 1 .
(408)777-3228.-•FAX(408)777 -3333•buildingecuoertino-om
17
PROJECT ADDRESS ,. - AM q I _
OWNER NAMEkwWeea a PHO &MAB.
- �/� 91762 FAX
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STIIEErADDRECM
SS Z 03D3 o B :.may .
CONTACT NAME a PHOtCff� 'O EMAIL
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STRFEf ADDRESS CRY.STATE.ZIP FAX
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❑ OWNER ❑ OWNER-BUILDER ❑ ON'NERAGENT �Ir CoIrrRACTOR ❑COHIRACInR AGENT ❑ ARCHITECT ❑1TIGINEER ❑ DEVELOPER ❑"Il:NA\T
CONTRACTOR NAMELICPNSE NMBER LICENSE TYPE r BUS.LIC.d ^
112 R
COMPANY NAME 1 E-MAIL FAX S
SIREET ADDRESS CrrY,STA ZIP PI TUNE
02 S
ARCIUTECTlENGINEFR NAME 1 LICENSE NUMBER BUS.LIC.M
COMPANY SANTE E-MAIL FAX
STREET ODRFSS cny.s-TATE.ZIP PHONE
USE OF ❑ SFD or Duplex Multi-Family ROOF AREA: VALUATION:
STRU rUPLE: [3Commercial $ S00
LxiyrusG ROOF TYPE. .BUILT-UPROOF ❑ASPHALT SHINGI PI 13J .WOOD SHAKES ❑WOOD SHINGI CR /1OTHB:R(SPECIFY) /EffL STr,A
R IIOVE REPLACE OYES 6NO. � PLYWOOD. 19 H' 13RYWD QOSB PITCH: t E ROOF rT
0 No
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CLASS A
' ICC-ESREPORT1
YROIVSEU RI>OF TYPE: ❑BULLY-UP ROOF AI SPHSHn1(B
ALT PS i❑
. WOODSEWCFS '0 WOOD SIIINCI cc ❑orTo:R
DESCRfP`nON OF WORK:
inSl--,I1 3d rAIi7 IIAA4t A4meA+ J; inSiaII CAF L�'rr�Y d CmA pA
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by my signature below,I certify w each of the following: I Bm the property owner br authorized agent 10 anon the property,owner's behalf. 1 have reed Nis
application and the information I have provided is correct- I have read the Description of Work and verify it is accurate. 1 agree to comply with all applicable local
ordinances and score laws relating to buildingon. riu tauves of Cupertino to enter the above-identified property for inspection purposes.
Signature of ApplicanJAgenC iPr
Date:
SUPPLEMENTAL INFORMATION REQA&D - OFFICEUSEONLY
IfbuildingisatsociatedwithaHome Owner'sAssocietionprovideletter i�,.,PLANCEM9r1YPE%---'' ' - ROUTING SUP
of approval from HOA. ... ,❑�o`v�-t�ootNr[n.�,..,,. ❑ tRm.DINC PLAN tievIKw
Provide Planning approval to verify if there any restrictions. ;❑ �p�gY.' I' 't i ❑ PLANNING Pun aevlEw
m
_Pvidc copy Of Manufacturer's Installation Specifications. ❑ srvaDnRD'" ❑ FIRE DEPT
I
Provide signed copy of Cupertino's Tear-Off Policy. -�'" .'cl, - ❑ OTHER:
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Rer fApp_2011.doc revised 03116111
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CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 20303 Northcove Sq. DATE: 05/01/2012 REVIEWED BY: Sean
APN: BP#: 'VALUATION: $6,500
*PERMITTYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Duplex PENTAMATION 1SFDWLR0OF
USE: P I PERMIT TYPE:
WORK LC
ear-off existingcal-shake roofing system and install 30#felt underla ment and install GAF Grand
SCOPE anyon shingles, color: Stonewood.
FEEID ROOFAREA
s.f.
1REROOFFRES 1,500
1/"ch. Non Cher APhrnrh. Ph",C/rcek Elec. Phm Check
,Llrch. Pwmir Fee: l'Inmh. Pirrnrir Frc•: O<% Pdrnria Fre.
Onc"r,l It,,/I. /'.'p Other Plumb peep. Orher Ocv. beep.
J L:elr. hr..p. /4x:: Plumb. hop. Fc•a; li(cr. heat Fee.
NOTE: This estimate does not include fees due to other Departments(i.e. Planning,Public Works, Fire,Sanitary Sewer District,School
District,etc. . Thesefees are based on the relimina information available and are only an estimate. Contact rite Dept for addn'l info.
FEE ITEMS (Feu Resohaion 11-053 Ef. 7/1/1/) FEE QTY/FEE MISC ITEMS
Plan Check Vee:
.Supp/. PC Fee
l'lunrb.;':1derlr.:li lc•c
Permit Fee: $210.00
Sup/ /. hcep Fee
/'l11121h.O'lec/1./Elec Pel mit Feu:
C'onslrnc•/ian Tine:
Adninlsurnive Fee:
Work Without Permit? O Yes 0 No $0.00
ddraneell Planning, Fees:
Travel Dniamrenlnliun Fees:
Strong Motion Fee: IBSEISMICR $0.65 Select an Administrative Item
131de Sids Commission Fee: IBCBSC $1.00
SUBTOTALS: $211.65 $0.00 TOTAL FEE:' $211.65
Revised: 04/01/2012
f,. ._ .�.. w- �.. ���•�.�,�_�i+�.---.•"�J�—.iV-`.,Jr..:ti:.-rtry'.I.! v - :A:w.. .:.;r,a:..S-:._.` .:r/'.a-.v^'r�_y.... .-—. .•.:,.�—,r.�
REROOF TEAR=OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
CUPERTINO 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228•FAX(408)777-3333•buildinll(D.cuoertino.orD
PROJECT ADDRESSAPN a
�0?03 or-itc
OWNERNAME /1 �G — O PHONE„ 0� E-MAIL
STREET ADDRESS (,1 � CITY,STAT&ZIP FAX
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C e a ' _ -/ 1 t
CONTRACTOR NAME LICENSENUMBER LICENSE TYPE BUS.LIC.a
COMPANYNAMEr EMAIL FAX
'
STREET ADDRESS CITY STATE,BP_ PHONE
Col " - c I :c L<. t -1 Z > � •U` =x�
1 /
I UNDERSTAND AND AGREE TO THE FOLLOWING:
I. The re-roof project shall comply with all applicable provisions of the 2010 California Codes.
2. An inspection request can be scheduled up to the day before the inspection date. Please call (408)777-
3228 from 7:30 - 3:30pm (Mon-Thurs) or 7:30 - 2:30pm (Friday) to schedule the next day inspection.
For Tear-Off and Nailing Inspections, you must also call on the day of the inspection only after that
phase of the work is completed. The building inspector will be available within one hour. Progress
and Final Inspections will be given a two hour window.
3. Tear-Off Inspection is required. Any and all dry-rotted wood shall be replaced prior to this inspection.
Unless new plywood roof sheathing is proposed throughout, all the nails/fasteners shall be either
completely knocked-down or removed prior to this inspection.
4. If plywood is installed, a plywood Nailing Inspection is required.
5. Roofing shall not be applied without first obtaining all prior inspection and written approvals from the
building inspector. Any roofing which is applied without first obtaining an approved inspection will
require the removal of all new material down to the sheathing so a proper inspection can be performed.
6. Progress Inspection is required when approximately 50% of roof covering is installed.
7. A Final Inspection and approval shall be obtained from the building inspector when the re-roofing is
completed. To receive a final sign-off, the following items will be verified:
a. Flat roofs shall have a minimum of V44" per foot of slope and demonstrate there is no ponding.
b. Listings from approved testing agencies for all pre-manufactured products used shall be
available on-site to review at the time of the inspection.
c. Proper spark arrestor installation, vents painted, gutter/downspouts installed, debris removed.
8. NOTE: If you call for a tear-off or plywood nailing inspection and the work is not complete, you will be
charged a re-inspection fee of$126.00. The re-inspection fee shall be paid before another inspection
can be scheduled.
By my signing below, 1 certify each of the following is true: I am the property owner or authorized agent to act on the
property owner's behalf. I understand and agree to comply with the re-roof policy stated above. I also understand that
smoke detectors and carbon monoxide detectors are required to be installed in accordance with Sections 11314 and R315 of
the 2010 California Residential Code.
Signature of Applicant/Agent: - Date:
Reroo.woficr_20/Ldoc reused 02116/II
CITY OF CUPERTINO
3 ITEMS OF 24 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng:- Sub: Blk: Lot:
APN 31641065.00
DATE ISSUED. . . . . . . : 05/01/2012
RECEIPT #... . . . . . . . : BS000016675
REFERENCE ID # . . . : 12050008
SITE ADDRESS , . . . . : 20303 NORTHCOVE SQ
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER BARBERA-KEEN KATHLEEN TRUSTEE
ADDRESS . . . . . . . . . . : 20303 NORTHCOVE SQ
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . r FOUR SEASONS ROOFIN
CONTRACTOR . . . . . . . : DIAZ, ALFRED LIC # 21323
COMPANY . . . . . . . . . . : FOUR SEASONS ROOFING
ADDRESS . . . . . . . . . . : PO BOX 1668
CITY/STATE/ZIP . . . : SAN JOSE, CA 95109
TELEPHONE . . . . . . . . : (408) 278-0330
FEE ID UNIT QUANTITY - AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- --- ------ ---------- ---------- ---------- ----------
1BCBSC VALUATION 6,500.00 1. 00 0.00 1 .00 0. 00
1BSEISMICR VALUATION 6, 500.00 0. 65 0.00 0 .65 0.00
1REROOFRES SQ FEET 15 .00 210 .00 0 .00 210 . 00 0 .00
------- -- ---------- ---------- ----------
TOTAL PERMIT 211.65 0. 00 211 .65 0. 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
309 EXTERIOR LATH 311 SCRATCH COAT
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF