07050197 / 77777777777.7 777777777777777, �
CITY OF CUPERTINO
BUILDING DIVISION PERMITJL�T( R
—' PERMIT NO.
BUILp(A{('S214ES$LORTHGLEN SQ FOUR SEASONS ROOFING 07050197
L'S G E �J PERMIT ISSUE DATE
OWNER'S NAME:
NORTHPOINT HOME OWNERS ASSOC P 0 BO,: 1210 05/21/2007
SANITARY NO. CONTROL NO.
_)NE:
ABUILDING PERMIT INFO
ARCHITECT/ENGINEER:
REROOF--REMOVE (E) ROOF SYS BLDG ELECT PLUMB MECH
!0 p LICENSED CONTRACTOR'S DECLARATION ,r ^_r^^r T _T
iv F- I hereby affirm that I am licensed under provisions of Chapter 9(commencing ^ " Jtab DeseriptiOn
z w with Section 7000)of Division 3 of the Business and Professions Code,and my license is
t y in full farce and a ec
? License Class Lic.A 1 L
E^p Dam Contracto p -
ARCHITECTS DEC RATI
i z a 1 understand my plans shall be used as public records
)yU
'
U.ti Licensed Professional
J OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
p O following reason.(Section 7031.5,Business and Professions Code:Any city or county
which requires a permit to construct,alter•improve,demolish,or repair any structure
o Z} prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation
_< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapmr9 Sq.Ft.Floor Area
t- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
i that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not more than five hundred dollars($500).
❑1,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections
and Professions Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for sale.If.
however,the building or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑I•as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044.Business and Professions Code:)The Contractor's Eo-
cene Law does not apply to an owner of property who builds or improves Ihemon.and.
who contracts for such projects with a contracter(s)licensed pursuant to the contractor's
License Law.
C]I am exempt under Sec. B&P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
❑I have and will maintain a Certificate of Consent to self-insure for Workees Compen-
sation,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 required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Wor is Compensation Insurance carrier and Policy number are:
I , 1-,,.. Policy No.kl?--41i:.�yc4 ii DI i
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars($100)
or less.)
I certify this in the performance of the work for which this permit is issued.I shall not
employ any person in any manner so as to become subject to the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
Oforthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
p;> the work for which this permit is issued(Sec.3097,Civ.C.)
W A Lenders Name
aLender's Address
U 0 1 certify 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
0 U building construction,and hereby authorise representatives of this city to enter upon the
W above-mentioned properly for inspection purposes.
a (We)agree to save,indemnify and keep harmless the City of Cupertino against
,Fy to liabilities,judgments,costs and expenses which may in any way accrue against said City
U Z in consequence of the granting of this permit. Date S�-v`
►- APPLICANT UNDERSPSN
D WILL COMPLY WITH ALL NON-POINT Issued by:
TIORe-roofsSignatt m ofApplicant/C DamT of F.00f
ATERIALS DISCLOSURE Type
Will the applicant or future building occupant store or handle hayardous material
as defined by the Cupertino Municipal Code.Chapter 9.12•and the Health and Safety
Code.Section 25532(a)? J/ All roofs shall be inspected prior to any roofing material being installed.
El Yes L7 No
If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes CK.
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 25505.25533 and 25534.1 understand that if the building
does not currently have a tenant that it is my responsibility to notify the occupant of the
rcyuircm s which or to issuance of a Certificate of Occupancy. Signature of Applicant Date
!T/ 1 J All roof coverings to be Class"B"or better
Owner or authorizeJ agent Date
CITY OF CUPERTINO
2 ITEMS OF 8 PERMIZ RECEIPT OPERATOR: suew
COPY # 1
Sec: Twp: Rng: Sub: Blk : Lot:
APN 31E41043 . 00
DATE ISSUED. . . . . . . : 05/21/2007
RECEIPT # . . . . . . . . . BSC00001399
REFERENCE ID # . . . : 07C50197
SITE ADDRESS 20:24 NORTHGLEN SQ
SUBDIVISION
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER NOF.THPOINT HOME OWNERS ASSOC
ADDRESS . . . . . . . . . .
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-0520
RECEIVED FROM . . . . : FOLrR SEASONS ROOF
CONTRACTOR DI12, ALFRED LIC # 21323
COMPANY FOUR SEASONS ROOFING
ADDRESS . . . . . . . . . . : P 0 BOX 1210
CITY/STATE/ZIP . . . : ALl,MO, CA 95407
TELEPHONE . . . . . . . . : (4(18) 278-0330
FEE ID UNIT QUANTITY ILMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- -- -------- ---------- ---------- ----------
BPERMFEE VALUATION 3, 000 . 00 83 . 16 0 .00 83 . 16 0. 00
BSEISMICRE VALUATION 3, 000 .00 0.50 0 .00 0 .50 0. 00
----------- ---------- ---------- ----------
TOTAL PERMIT 83 .66 0.00 83 . 66 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 660 . 74 006871
---------------
TOTAL RECEIPT 660.74
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
Aria,
Community Development Department
Building Division
Ci of Cupertino
City p
10300 Torre Avenue
CITY 0- Telephone: (408)777-3228
U P E TIN 0 Fax: (408)777-3333
Building Department
Subject- Re-roofing policy for the City of Cupertino
1. Prior to permit issuance,you must ag•ee to comply with 1997 UBC Standards
and manufacturers specifications on r�-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 b-zilding inspector when the re-roofing
is completed.
3. All roofs shall be inspected prior to ar y 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 mE terial down to the sheathing,
so a proper City inspection can be per'ormed.
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:
Job Site Address:
Roofing Company Name:
A plicant's Signature:
Greg teel
Building Official
Revised 1/30/03
Printed o-i Recycled Paper
CITY OF CUPERTINO
Rl_�,ROOF
CITY OF RMIT APPLICATION FORM 705-01 V
CUPEf�TINO PE
APN # Date:
Building Address: _
Owner's Name: Phone#:
Contractor: Phone 4: License#:
Contact: Phone 4f: Cupertino Business License#:
2,70— o33v I ,� / 3 2 3
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ig''Asphalt Shingles
❑ Wood Shakes LI Wood Shakes
❑ Wood Shingles C3 Wood Shingles
2--Other(Specify) ❑ 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 Com ly With :�u ertino's Tear Off Policy:
Job Description:
Residential Commercial [l
Fire Zone: Yes ❑ No ❑ Confirmed with Planning DeFt. if
there are any restrictions: E
Cost of Project: TVDe of Cons xuction: --;z� Occupancy group:
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERIVIFEE Bid- Permit Fees BUILDING
BENERGY Ener BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING