12050108CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20225 NORTIiGLEN SQ
CONTRACTOR: FOUR SEASONS
PERMIT NO: 12050108
ROOFING
OWNER'S NAME: HOLSINGER ROY W
PO BOX 1668
DATE ISSUED: 05/11/2012
OWNER'S PHONE: 4089963734
SAN JOSE, CA 95109
PHONE NO: (408)278-0330
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL
License Class G"361 I.ic. poZ OO
RE-ROOF 13 SQ- TEAR OFF EXISTING, CAL SHAKE
C, II
ROOFING SYSTEM, INSTALL 30# FELT UNDERLAYMENT
Contractor I Dale
&
1 hereby affirm that 1 am licensed under the provisions of Chapter 9
INSTALL GAF GRAND CANYON CLASS A
(commencing with Section 7000) of Division 3 of the Business & Professions
Code and that my license is in full farce and effect.
1 hereby affirm under penally of perjury one of the following two declarations:
I have and will maintain a certificate of consenito self-insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
Sq. Ft Floor Area:
Valuation: $6500
performance of the work for whichthis permit is issued.
1 have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of (he Labor Code, for the performance of the work for which this
.\PN Number: 31639006.00
Occupancy Type:
pemtit is issued,
APPLICANT CERTIFICATION
I certify that I have read this application and stale that the above information is
PERMIT EXPIRES IF WORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to budding construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
180 DAYS FROM LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
(]
costs, and expenses whidh may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
(. J1
Issued by: Dale:
with all non-point source regulations per the Cupertino Municipal Code, Section
9.18.
S
RE-ROOFS:
Signature Date
All rIDCc shall be inspected prior to any roofing material hong installed Its roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
❑ O\' ' sR-BtALDER DECLARATION
"
I
Signature of Applicant: Date-S
I hereby affirm 1 at 1 am exempt from the Contractor's License Law for one of
the fallowing two reasons:
ALI, ROOF COVE 'GS TO BE CLASS "A" OR BETTER
I, as owner of the property, or my employees with wages as their sole compensation,
will do (he work, and the structure is not intended or offered for sale (Sec 7044,
Business & Professions Cade)
1, as Owner Mime property, am exclusively contracting with licensed contractors to
HAZARDOUS MATERIALS DISCLOSURE
construct the project (Sec.7044, Business & Professions Code).
1 have read the hazardous materials requirements under Chapter 6.95 of the
California Ileallh & Safety Code, Sections 25505, 25533, and 25534. [will
I hereby alarm under penalty of perjury one of the following three
maintain compliance with the Cupertino \lunicipal Code, Chapter 9.12 and the
declarations:
Ilealth & Safety Code, Section 25532(a) should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's
material. Additionally, should I use equipment or devices which emit hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the
air contaminants as defined by the Bay Area Air Quality Management District 1
performance of the work for which this permit is issued.
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
I hace and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safely Code, Secfilms, 25531 and 25534.
Section 3700 of the Labor Code, for the performance of the work forwhich this
Owner or authorized agent: Date.
permit is issued -
I certify thal in the perfornimcc of the work for which this permit is issued, I shall
�IONLENDING
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of Cal ifomia. If, after making this certificate of exemption, I
CONST ,\f.4:Nfl'
become subject to die Worker's Compensation provisions of the Labor Code, I must
I hereby affirm (hat (here is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked.
work's for which this permit is issued (Sec. 3097. Civ C.)
Lender's Name
APPLICANT CERTIFICATION
Lender's Address
I certif)' 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
to building construction, and hereby authorize representatives of this city to enter
upon the above nientiamed property for inspection purposes. (We) agree to save
and keep harmless the City of Cupertino against liabilities, judgments.
,\RCIII'fF.C.'I"S DECLARATION
costs, and oxpenses which may accrue against said City in consequence of the
I understand niy plans shall be used as public records,
granting of this permit. Additionally, the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code, Section
Licensed Professional
9.18.
Signature Dale
CITY OF CUPERTINO
3 ITEMS OF 9 PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 31639006.00
DATE ISSUED.......: 05/11/2012
RECEIPT #.........: BS000016789
REFERENCE ID # ...: 12050108
SITE ADDRESS .....: 20225 NORTHGLEN SQ
SUBDIVISION ......:
CITY .............: CUPERTINO
IMPACT AREA ......:
OPERATOR: SylviaM
COPY # : 1
METHOD OF PAYMENT
-----------------
CREDIT CARD
TOTAL RECEIPT :
AMOUNT
---------------
550.95
---------------
550.95
VOICE ID DESCRIPTION
-------- ----------------------------
309 EXTERIOR LATH
601 ROOF TEAR OFF
REFERENCE NUMBER
--------------------
ax
VOICE ID DESCRIPTION
-------- ----------------------------
311 SCRATCH COAT
602 ROOF PLYWOOD NAIL
604- ROOF IN -PROGRESS 605 FINAL REROOF
OWNER ............:
HOLSINGER ROY W
ADDRESS ..........:
20225 NORTHGLEN SQ
CITY/STATE/ZIP ...:
CUPERTINO, CA 95014-0517
RECEIVED FROM ....:
FOUR SEASONS
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 SAL
----------
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 13.00
182.00 0.00
182.00
0.00
TOTAL PERMIT
183.65 0.00
183.65
0.00
METHOD OF PAYMENT
-----------------
CREDIT CARD
TOTAL RECEIPT :
AMOUNT
---------------
550.95
---------------
550.95
VOICE ID DESCRIPTION
-------- ----------------------------
309 EXTERIOR LATH
601 ROOF TEAR OFF
REFERENCE NUMBER
--------------------
ax
VOICE ID DESCRIPTION
-------- ----------------------------
311 SCRATCH COAT
602 ROOF PLYWOOD NAIL
604- ROOF IN -PROGRESS 605 FINAL REROOF
REROOF TEAR -OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
CUPERTINO _ -
(408) 777-3228 •FAX (408) 777-3333 • buildinaCaDcuoertino.org
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I UNDERSTAND AND AGREE TO THE FOLLOWING:
1. 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 tlly-rotted wood shall be replaceld 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 -rooting is
completed. To receive a final sign -off, the following items will be verified:
a. Flat roofs shall have a minimum of'" 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. 1 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 R314 and R315 of
the 2010 California Residential Code.
Signature of Applicant/Agent: Dale: 0 -,10 -� za
Re, 17'olirr 201Ldoc rcrised OJ16111
CUPERTINO
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228, - FAX (408) 777-3333 - buildina0cupertinti.or
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