12060027 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10979 NORTfISHORE SQ CONTRACTOR:FOUR SEASONS ROOFING PERMIT NO: 12060027
OWNF.R'SNAMF.: SHAPIRO I'AUL J AND SAIZ-SIIAPIR PO BOX 1668 Drt'1E ISSUED:06/05/2012
OWNER'S PHONE: 4087410557 SAN JOSE.C\ 95109 PHONE NO:(408)278-0330
/LICENSED CONTRACTOR'SR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
License Class Com__ Lic.4 14?2l 0Y r r r
�`r� MECH RESIDENTIAL COMMERCIAL
Contractor P'S (L Date Jc —S�-/?—
I
1 hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION: RE-ROOF TEAR 0I717 EXISTING CAI:SI IAKF ROOFING
(commencing with Section 7000)of Division 3 of the Business&Professions SYSTEM,INSTALL 30#FELT IJNDI;RI.AYM1>N'I'AND INSTALL
Code and that my license is in full force and effect. GAF GRAND CANYON SHINGLES,COLOR:STONEWOOD CLASS A 14 ST
1 hereby affirm under penally of perjury one of the following two declarations:
I have and,,ill maimain a cenilicate 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,for the performance of the work for which this Sq.F'1 Floor Area: Valuation:$6500
permit is issued_
APPLICANTCERTIFICATION .\PN Number:31638024.00 Occupancy Type:
I cer(il)'that I have read this application and stale 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 mentioned property for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED
indenmify and keep harmless the City of 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 pemin. 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. ,, /
/2 Issued by: ✓ /t/ rL/ G� Date: 1) J
Signature Dale 1
❑ OWNER- , F:R DECLARATION
RF.-ROOF'S:
hereby affirm that 1 am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material berg installed.If a roof is
the following two reasons: installed without first obtaining an inspection.I agree to remove all new materials for
h as owner of the property.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,
Business&Professions Code) Signature of Applicant:
1,as owner of the properly,am exclusively contracting with licensed contractors to
construct(he project(Sec.7044,Business&Professions Code). ALL ROOF COVF.RIN ,.. BF.CLASS"A"OR REITER
1 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 ILV'.,\RDOIIS AIATF:RIALS DISCLOSURE
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 of(he work for which this permit is issued. California Ilealth&Safrly 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 of the Labor Code,for the performance ol'dte work for which this Safety Code,Section 25532(a)should 1 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 Qualitv Management District I will
I certify that in the perlm-mance of die work for which this permil is issued.I shall maintain compliance with the Cupertino Municipal Cade.Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534.
Compensation laws of Cali fiirnia. If.after making this certificate of exemption.I
become subject to the Worker's Compensation provisions of the Labor Code,I must Owner or aulb1f,49d a 1 t:
forthwith complywith such provisions or this permit shall be deemed revoked. ate: J e�
APPLICANT CERTIFICATIONCONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency lar the performance of swrk's
correct. I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec 3097.Cir C-)
to building construction,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned property loot inspection purposes.(We)agree to save
indemnify and keep hamdess lire 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 Additi)nally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section .\RCIIITF.C7"S DECLARATION
9 1. 1 understand my plans shall be used as public records
Signature Date Licensed Professional
CITY OF CUPERTINO
3 ITEMS OF 18 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 31638024 .00
DATE ISSUED:. . . . . . : 06/05/2012
RECEIPT #: . . . . . . . . BS000017000
REFERENCE ID # . . . : 12060027
SITE ADDRESS . . . . . : 10979 NORTHSHORE SQ
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER SHAPIRO PAUL J AND SAIZ-SHAPIR
ADDRESS P. 0. BOX 517
CITY/STATE/ZIP . . . : SARATOGA, CA 95070
RECEIVED FROM . . . . : AL DIAZ
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 14 ..00 196.00 0.00 196 .00 0.00
---------- ---------- ---------- ----------
TOTAL PERMIT 197.65 0. 00 197 .65 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 1, 185.90 AMEX
---------------
TOTAL RECEIPT 1, 185. 90
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: 10979 Nortliehore Sq DATE: 06/05/2012 REVIEWED BY: Sean
APN: BP#: 'VALUATION: $6,500
*PERMITTYPE: Minor Building,Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Duplex PENTAMATION 1SFDWLR00F
USE: PERMIT TYPE:
WORK Tear off existing cal-shake roofing system; install 30#felt underla ment and install GAF Grand Canyon
SCOPE shingles, color: Stonewood.
FEE1D ROOF AREA
s.f.
1REROOFFRES 1,400
,Nrdi. l'lnn Cheek Phunh. Hun Check Elm.. flan Check
X1,01, Prrmir Foe: Phrmb. Permir Fre: lilac Parmir Fre:
Otho r Meek Insp. Other Plumb 1nep, (hirer/ileo.hrap-
Poch. hop. P,,: Phunh. Crap. Feer Oar. Imp. 1-ce,
NOTE: This estimate does not includejeesdue to other Departments(i.e. Planning, Public Works, Fire,Sanitary Sewer District,School
District,etc. . These fees are based on the prelinddna information available and are only an estimate Contact the Dept for addh7 info.
FEE ITEMS(Fre Resohilion 11-051 F_/f 711111) FEE QTY/FEE MISC ITEMS
Plan Check Fen:
Suppl. PC Fce
Phimb.hbleoh.ililec
Permit Fee: $196.00
Rupp/. 11).g) Vee
P1 run h.Al Iech.!!i le•c
Phmih,1:4lcch.1VIec Permil Fee:
C'ansirucrion Ta.r.
Arbnilri.cuvnire Fee:
Work Without Permit? 0 Yes 0 No $0.00
ddranced Maiming Fees:
%'rare/ Docvunealalion Fees:
Stron6 Motion Fee: IBSEISMICR $0.65 Select an Administrative Item
Hide Sids Commission Fee: IBCBSC $1.00
SUBTOTALS: $197.65 $0.00 TOTAL FEE: $197.65
Revised: 05/01/2012
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
ALBERT SALVADOR, P.E.. C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE-CUPERTINO,CA 950143255
CUPERTINO (408)777-3228-FAX(408)777-3333:buildinwiMcuoertino.ora
PROJECT ADDRESS TAP=.
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PHONE E-MAIL
OwNERNAME /
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' CITY.STATE ZIP FAX
STREET ADDRESS -O . Pie
CONTRACTOR NAME LIC ENSE"fit MBER,% 08 LIC�SE- BUS.LIC.C
COMPANY NAME E-MAIL FAX
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STREET ADDRESS SO2 (�� �.Z
CII.STAT�e IPw PHONE
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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 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. Proeress Inspection is required when approximately 50%of roof covering is installed.
7. A Finale 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,fora tear-off or plywood nailing inspection and the work is not complete, you will be
charged a re-inspection fee of$126.00. There-inspection fee shall be paid before another inspection
can be scheduled.
By my signing below, 1 certify each of the following is'true: 1 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: ' Date:
Re,00lPo(iev_201 Ldoe rerieer102/16111
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REROOF PERMIT APPLICATION
�C --O!-1MUN 1Y DEVELOPMENT DEPARTMEt:T • BUILDING DIViSiON
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10300 TOkRL-AVENUE • CUPERTItJO, CA 9H)14-3255
C 777-3228.• FAX(408) 7773333• i uilding(JcunelGno cfn
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