12060024 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10949 NORTHSHORE SQ CONTRACTOR:POUR SEASONS ROOFING PERMIT NO: 12060024
OWNER'S NAME: SKINNER IIARVEY K PO BOX 1668 DA'Z'E ISSUED:06/052012
OWNER'S PHONE: 4084461190 SAN JOSE,CA 95109 PRONE.NO:(+08)178-0310
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r r ELECT PLUMB r
License Class C. -. Lic.q 4*7 2 10` r r r
Z MECH RESIDENTIAL COMMERCIAL
Contractor VS 1` Date-s-i
1 hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: RLROOF TEAR OPT EXIS"PING CAI.-SI IAKE ROOFING
(commencing with Section 7000)of Division 3 of the Business&Professions SYSTEM,INSTALL 30k FELT UNDERLAYMP.NT AND INS'1'ALI-
Code and that my license is in full force and effect. GAF GRAND CANYON SIiINGLIS.COI-OWSI'ONEWOOD CLASS A I y
I hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to sclf-insure for Worker's
Compensation,as provided for b} Section 3700 of the Labor Code,for the
performance of the work fin which this permit is issued.
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,Ibr the performance of the work for which this Sq.FI Floor Area: Valuntion:$6500
permit is issued,
APPLICAN'r CERTIFICATION APN Number:31638027.00 Occupancv Type:
I cenify(hat I have read this application and state that the above information is
coffee(. I agree(o comply 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 propen) for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED
iosts,adexpenfy and ses harmless the City of Cupertino against liabilities,judgments. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may accrue against said City in consequence of the
granting ollhis 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.
1� 6-S' Issued by: "/i�A� �T�/!Z Date:
Signature Date
a
El OWNER-111IILDER DECLARATION
RE:ROOFS:
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 being installed.If a roof is
the fallowing Iwo reasons: installed wi(hora first obtaining an inspection.I agree to remove ail new materials for
I,as owner of the proper,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 Applimin Datc6— S - fe—
I,as owner of the properly,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). ALI,ROOF COVERINGSTO 13E:CLASS"A"OR BETTER
1 hereby affirm under penally of perjury one of the following three
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's ILV,ARDOIIS MATERIALS 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 the work for which this permit is issued. California Ileallh&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 Ilealth&
Section 3700 of(tic Labor Code.I'or the performance of the work for which this Safety Code,Section 25532(1)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 Qualily Management District I will
I cenify that in the performance 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 Ilealth&Safety Code,Sections 25505,25533,and 25534,
Compensation Imvs mf California. If.after making this certificate of exemption,1
become subject to(he Worker's Compensation provisions of the Labor Code,I must Owner th�d ent: �s /
Forthwith comply with such provisions or this permit shall be deemed revoked. ate:
CONSTRI ICI'ION LENDING AGENCY
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is I hereby affirm that there is a constretion lending agency for the performance of nark's
correct.I agree to comply with all city and county ordinances and state laws relating for which[his 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,the applicant understands and will comply ARCIIITF-CT:S DECLARATION
with all non-point source regulatiams per the Cupertino Municipal Code,Section
9.18. 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 . . . . . . . . : 31638027 . 00
DATE ISSUED. . . . . . . : 06/05/2012
RECEIPT #. . . . . . . . . BS000017000
REFERENCE ID # . . . : 12060024
SITE ADDRESS . . . . . : 10949 NORTHSHORE SQ
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER. . . . . . . . . . . . . : SKINNER HARVEY K
ADDRESS. ... . . . . . . . : 10949 NORTHSHORE SQ
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
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 19.6.00 0 .00 196 . 00 0.00
---------- ---------- ---------- `----- ----
TOTAL PERMIT 197.65 0. 00 197 . 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: 10949 Northshore Sq DATE: 06/05/2012 REVIEWED BY: Sean
APN: BP#: 'VALUATION: $6,500
=PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Duplex PENTAMATION 1SFOWLROOF
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.
FEE ID ROOFAREA
s.f.
1REROOFFRES 1,400
,l/eeh. Plan Cheek Plumb. Plan Chcc6 l7er.. Plan Owek
,Nrcb. Permit Fee: Phmth. Permit Fre: Elec. I'eivnit Fee:
(Oilier llerh. ln.ap. Other Plumb/n.,p. Ocher/filer. hrsp. Li I
,4hrh. hr,p. Per: Plumb lu.,p. re" /ilei. lam.l•2r.'
NOTE: This estimate does not includejees due to other Departments(i.e.Planning,Public Works, Fire,Sanitary Sewer District,School
District,eta). These fees are based on the prelimina in ormation available and are only an estimate Contact the De t or addn7 info.
FEE ITEMS (Fee Resolation11-053 Gn' 7/1/1 U FEE QTY/FEE MISC ITEMS
Plein Chuck Fee:
Supp/. PC Fee
!'bunh./,1/ec.11.ililec
Permit Fee: $196.00
Suppl. hrsp Fee
PhonhJj1,1ech./Glee
1'lunth.Gblecll.%/i(ec Pernlil Fee:
Construction Tile:
Arlininisirotirr Fee,
Work Without Permit? O Yes (E) No $0.00
,ldvenicedPhumingFees:
"!'roved Uoumnentr+Nun Fees:
i
Strove Motion Fce: IBSEISMICR $0.65 Select an Administrative Item
I31de Sids Commission Fee: IBCBSC $1.00
SUBTOTALS: 1 $197.65. $0.00 TOTAL FEE: $197.65
Revised: 05/01/2012
REROOF TEAR-OFF POLICY
2 COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O.. BUILDING OFFICIAL
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERTINO
(408)777-3228• FAX(408)777-3333•buildinaCa)cuoertino.oro
PROJECT ADDRESS •� APN a
O sib Sty/.
OWNERNAME PHONE EMAIL
STREET ADDRESS CITY. STA ZIP FAX
6 0 l'~s X0 . ., Tb
CONTRACTOR NAME LICENSE NUM ER L 7 BUS,LIC-P
COMPANY NAME C
E-MAIL G ,-f FAX
J.
STREET ADDRESS
5`a2 ,r �L CITY�$IATE.ZIP ,C C4• �r/'2 PHONE
T „--S 178-03Yo
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 1/4" 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$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. 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 R314 and R315 of
the 2010 California Residential Code.
Signature of Applicant/Agent: Dale: ` �'�
Hann/Pulier 2011.dnc wvoc,102/1611/
Zc> 44) v ( . ...
REROCP PERMIT APPLICATION
COMMUNl'fY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
I :.
�^ X0300 TOR RE"AVE NUE •CUPERTUJO, CA 95014-3255
C IJPERTING (408) 77---228.• FAX (408)777-3377 • buildinn(((Drvl &111110 Gra
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