12050229 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20132 NORTHCREST SQ CONTRACTOR:FOUR SEASONS ROOFING PERMIT NO: 12050229
OWNER'S NAME: DIiOMSE NILESII A PO BOX 1668 DATE, ISSUED:05/31/2012
OWNER'S PHONE: 4083006589 SAN JOSE.CA 95109 PHONE.NO:(408)278-0330
LICENSED CONT'RACTOR'S DECLA�.RATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
License Class C41 Lie.N �72,(0? MECHr RESIDENTIAL COMMERCIAL
Contractor ps p-- Date
1 hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION:TEAR OFF EXISTING GAL-SIIAK1:ROOFING SYSTEM,
(commencing with Section 7000)of Division 3 of the Business&Professions INSTALL 30N FELT UNDERLAYM17NTS AND INSTALL GAI'
Code and that my license is in full force and effect. GRAND CANYON SHINGELS,COLOR.STONEWOOD CLASS A
1 hereby affirm under penally of perjury one of the following two declarations:
I have and will maintain a certilicale 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 permil is issued.
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 ofthe Labor Code,for the performance of the work for which this Sq.FI Floor Area: Valuation:56500
permit is issued
-
APPLICANT CERTIFICATION APN Number:31637008,00 Occupancy Type:
I certify(hal 1 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,mid hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may acerae against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this pertnit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
Signature
p_ Q�_�� Issued by: Date:
`� Date
❑ OWNER-BUILDER DECLARATION
RF:ROOFS:
hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.I f a roof is
the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
I,as owner of the properly,or my employees with wages as their sole compensation, inspection.
will do the work,and the structure is not intended or offered for sale(Sec-7044, 9
Business&Professions Cade) Signature of Applicant
Datc:SCJ f- 'Z-
h as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code).
ALL ROOF COI'ERINGS'I'O BE CLASS"A"OR BEITER
I hereby affirm under penalty of perjury one of the following three
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 read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permil is issued. California IIeallh&Safety Code.Sections 25505.25533,and 25534. 1 will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the llealth&
Section 3700 of the Labor Code,for the performance of the work for which this Safety Code.Section 25532(a)should I store or handle hazardous material.
Additionally,should I use equipment or devices which emir hazardous air
permit is issued, contaminants as defined by the Bay Area Air Quality Management District 1 will
m
I certify that in the perfotance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's llcallh&Safety Code,Sections 25505,25533,and 25534.
Compensation laws of California. If,after making this certificate of exemption,I
become subject to the Worker's Compensation provisions of the Labor Code,I must Owner or d ag% .7
�'�/'/2
forthwith comply with such provisions or this permit shall be deemed revoked. ate:
APPLICANT'CERTIFICATION �ONSTRU(TION LENDING AGF.NCI'
I certify that I have read This application and state that the above information is I hereby alTmn that there is a construction lending agency for the perfomtance of work's
correct. I agree to comply with all city and county ordinances and slate laws relating for which this pemnit is issued(Sea 3097,Civ C.)
to building cuns(mc(ion,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned properly for inspection purposes.(We)agree to save
indemnity and keep harmless the Ci(y of Cupertino against liabilities,judgments, Lender's Address
costs,and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply ARCIIITECT'S DECLARATION
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. I understand my plans shall be used as public records.
Signature Date Licensed Professional
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•buildingCa)cuoertino.org
PROJECT ADDRESS Zb132 t$ S APN-
OWNER NAME PHONE E-MAIL
e_ o -300- 4s,89
STREET ADDRESS CITY.STATE ZIP FAX
7-ot $7, Mo,46cessl
CONTRACTOR NAME LICENSE NUMBER Q LICENSE TYPE BUS,LICA
pO C-
COMPANY NAME nn //11 E-MAIL FAX
S�ASO 3 I�eOT1A
STREET ADDRESS CITY.ST E.ZIP PHONE
S02 or n S�. av Soso G'a. �iS1I? -2P-0340
1 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/<" 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, I 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 8314 and R315 of
the 2010 California Residential Code
Signature of ApplicanUAgent: Date S —3 -�
Rrrw.lPnlirr 2111 Ldw rrr w(102116111
CITY OF CUPERTINO
3 ITEMS OF 15 PERMIT RECEIPT OPERATOR: 'patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 31637008.00
DATE ISSUED. . . . . . . : 05/31/2012
RECEIPT #. . . . . . . . . : BS000016963
REFERENCE ID # . . . : 12050229
SITE ADDRESS . . . . . : 20132 NORTHCREST SQ
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . :
OWNER . . . . . . . . . . . . : DHOMSE NILESH A
ADDRESS . . . . . . . . . . : 20132 NORTHCRESTSQ
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : ,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
i
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 20132 Northcrest Sq DATE: 05131/2012 REVIEWED BY: Sean
APN: BP#: -VALUATION: $6,500
PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Duplex PENTAMATION 1SFDWLROOF
USE: PERMIT TYPE:
WORK Tear off existingcal-shake roofing system, install 30 #felt underla ments and install GAF Grand
SCOPE Canyon Shingles, color: Stonewood.
FEEID ROOFAREA
s.f.
1REROOFFRES 1,450
,llrch, Plnn Cheek Plumb. Plan ChecADec. flit Chock
,Ned,. Permit Fee: Plumb. Perron Fec: Iilu'. Permit Fee:
(hher.lfech. Insp. Other Plumb Insp. Li I Other I{lce. Lisp.
.Ndch. Irap. Fee: Plumb. hop. red: Elev.Insp. F,e.
NOTE: This estimate does not include fees due to other Departments(i.e.'Planning,Public Works, Fire,Sanitary Sewer District,School
District,eta). Thesefees are based on the prefinddna information available and are only an estimate Contact the De t or addn 7 info.
FEE ITEMS (Fee Resolulion 11-053 Elf 7/1/1/) FEE QTY/FEE MISC ITEMS
/'lair Cher/c Fcu:
.Supp/. PC Fee
/Vmnh_%,L/ecb./l ler.
Permit Fee: $210.00
.Supp/. 111sp /-'cc!
Phnnh.J,Flech./li/c•c
P1unih.1j1.1ech.1E1ec Permit Fee:
C.'unsn ierliun Tax.
.Ichni otrative Fere:
Work Without Permit? O Yes 0 No $0.00
d(Awnc-ed Plaiting Fees:
Travel Dowuncelutinn Fees:
i
Strong Motion Fcc: IBSEISMICR $0.65 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
I SUBTOTALS: $211.65 $0.001 TOTAL FEE: F $211.65
Revised: 05/01/2012
j i IZLROOF PERMIT APPLICATION
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