12050227 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20112 NORTIiCREST SQ CONTRACTOR:FOUR SEASONS ROOFING PERMIT NO: 12050227
OWNER'S NAME.: SLIFERTGEORGE AND LINDA TRUST PO BOX 1668 DATE ISSUED:05/31/2012
OWNER'S PHONE: 4089963734 SAN JOSE,CA 95109 PIIONE NO:(408)278-0330
9— LICENSED CONT'RACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
License Class C ^J g Lic.0 4 7 2 o
MECH r RESIDENTIAL r COMMERCIAL r
Contractor F's(1- Dale S ^T 1^12
hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION:TEAR OFF EXISTING CAI.SI IAKF ROOFING SYSTEM,
(commencing with Section 7000)of Division 3 of the Business&Professions INSTALL 308 FELT UNDFRLAYMENTS AND INSTALL GAF
Code and that my license is in full force and effect. GRAND CANYON SHINGLES.COI.OR:SfONEWOOD
I hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate 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(his permit is issued.
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,lir the performance of the work for which this Sq.F1 Floor Area: Valuation:$6500
Permit is issued.
APPLICANT'CERTIFIC\TION APN Number:31637010.00 Occupancy Type:
I certify that I have read this application and slate that the above information is
correct. I agree to compl} with all city and county ordinances and stale 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 PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the Cityof Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. 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.
//�� Issued by ' Date:
Signature 4 / Date
❑ OWNER-EIIILDER DECLARATION
RF.-ROOFS:
hereby affirm that I am exempt from the Contractor's License Law for one of All roots shall be inspected prior to any roofing material berg installed.If a roof is
the following two reasons: installed wilhott first obtaining an inspection.I agree to remove all new materials for
I,as owner of the property,or my employees with wages as their sole compensation, inspection.
will do the work,and the Stmcturc is not intended or offered for sale(Sec 7044,
Business&Professions Code) Signature of Applicant.
I,as owner of(he property,am exclusively contracting with licensed contractors to
construct the project(Sce.7044,Business&Professions Code). ALL ROOF COVE, , GS TO BE CLASS"A"OR BETTER
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 HA"LARDOUSMAT'F.RIA SDISCLOSURE;
Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the
performance ofthe work for which(his permit is issued. California Ilealth&Safely 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 health&
Section 3700 ollhc 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 emit hazardous air
permit is issued. contaminants as defined by the Bay Area Air Qualify Management District I will
I certify that in the perfommnce of the work for which this permi(is issued,I shall maintain compliance with the Cupertino Municipal Code.Chapter 9.12 and the
not employ any person in any manner SO OS In become subject to the Worker's Health&Safely Code,Sections 25505,25533,and 25534.
Compensation laws of Cali lhrnia. If,after making this certificate of exemption,I
become subject to the Worker's Compensation provisions of the Labor Code,I must Owrued n1: q
forthwith comply wnerith such provisions or this permit shall be deemed revoked. hate:
APPLICANT CERTIFICATION CONS"1rRUC`I'ION 1 F.NDINf.AGE;NCI'
I certify that 1 have read this application and state[hal the above information is I hereby of imm that there is a construction lending agency Ibr the performance of work's
correct. I agree to comply with all city and county ordinances and state Imus relating for which this permit is issued(Sec.3097,Civ C.)
to building construction,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned Property for inspection purposes.(We)agree to save
indemnify and keep harmless the City 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.[tic applicant understands and will comply ARCIIITE:C.T'S DECLARATIONwith all non-point source regulations per the Cupertino Municipal Code,Section
9.18. 1 understand my plans shall be used as public records.
Signature Date Licensed Professional
0 REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
CUPS RTINO 10300 TORRE AVENUE-CUPERTINO,CA 95014-3255
(408)777-3228- FAX(408)777-3333-building(a.cupertino.org
PROJECT ADDRESS 2c APNa
OWNER NAME PHONE E-MAIL
08• 6
STREET ADDRESS CITY, STATE,ZIP FAX
P-o. gox s I
CONTRACTOR NAME LICENSE NUMBER^^ LIC N ETYPE BUS.LIC./
��K ��
COMPANY NAME E-MAIL FAX
Fou C e0..Z0 S 1201t,Aa
STREET ADDRESSr.( - CITY,STATE P PH
SONE
c2 ( br,.; s+ c� oSo Cu SI IL -6330
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 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/4" 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 5126.00. 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. 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 8314 and R315 of
the 2010 Califomia Residential Cade.
Signature of Applicant/Agent: Date: •S`��`�is
Roao/Pohn 2011 dnr.rrris•d 02/16111
CITY OF CUPERTINO
3 ITEMS OF 15 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 31637010.00
DATE ISSUED. . . . . . . : 05/31/2012
RECEIPT #. . . . . . . . . : BS000016963
REFERENCE ID # . . . : 12050227
SITE ADDRESS . . . . . : 20112 NORTHCREST SQ
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : SEIFERT GEORGE AND LINDA TRUST
ADDRESS . . . . . . . . . . : PO BOX 5914
CITY/STATE/ZIP . . . : INCLINE VILLAGE, NV 89450
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
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 20112 Northcrest Sq DATE: 05/31/2012 REVIEWED BY: Sean
APN: BP#: 'VALUATION: $6,500
*PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Duplex PENTAMATION 1SFDWLR0OF
USE: PERMIT TYPE: At
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
.1lech. Plan C'herk plumb. Plan Cheed /ilea:. Plan Check
bh,ch. Permit Fre: Plumb. hermit Free tiler. /mail Peo:
(hhe•r,lhrh. tarp. other Plumh Insp. [kite#-/ileo. /n..p.
Meeh./mp. Fisc•: Pluurh. hrsp. Fre: Elec.Lccp. Fee:
NOTE: This estimate does not include fees due to other Departments(Le. Planning, Public Works, Fire,Sanitary Sewer District,School
District,etc. . Thesefees are based on the prelimina information available and are only an estimate. Contact the De I or adds 7 info.
FEE ITEMS (Fee Rcsolulion 11-053 EIT. 7/1/11) FEE QTY/FEE MISC ITEMS
Plan (.'heck Fac:
.Supp/. PC Fee
I'lrnnh./ddc clL/lace
Permit Fee: $210.00
Supp/. lnsp Fee
F'lum h.hbleeh./!ilec
1'lruuh./A'leclr./ller. Permit Fee:
Consn•acNan Tax.
Admiuisir(nive Fec:
Work Without Permit? O Yes (E) No $0.00
Advanced Planning Fees:
Travel Documenluliun Fees:
SUone Mesion Fee: lessISMICR $0.65 Select an Administrative Item
Bldg Stds Commission Fee: 18CBSC $1.00
SUBTOTALS: 1 $211.65 $0.00 TOTAL FEE: $211.65
Revised: 05/01/2012
REROOF PERMITAPPLICATION
I Ili, I 1 1 ' I I : I
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE IICUPERTINO;CA 95014-3255
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