11070209 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10912 NORTHFIELD SQ CONTRACTOR:FOUR SEASONS PERMIT NO: 11070209
ROOFING
OWNER'S NAME: GELPHMAN MYRNA PO BOX 1668 DATE ISSUED:07/27/2011
NER'S PHONE: 4083660700SAN JOSE, CA 95109 PHONE NO:(408)278-0330
LICENSED CONTRACTOR'S DECLARATION rJ� f—
[� Q� BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class G-3 Lie.# '`-1?_%0 0 r r— iy
�� MECH RESIDENTIAL COMMERCIAL
Contractor Ou TZ •U
I hereby affirm that I am licensed under the prov ons of Chapter 9 JOB DESCRIPTION: RE-ROOF 14 SQUARES,TEAR OFF EXISTING CEMWOOD
ROOF,INSTALL 30LB FELT AND GAF GRAND CANYON COMP
(commencing with Section 7000)of Division 3 of the Business&Professions CLASS A
Code and that my license is in full force and effect.
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 this permit is issued. Sq.Ft Floor Area: Valuation:$4800
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 APN Number:31637045.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DA F Nt LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the /7 /f'//
granting of this permit. Additionally,the applicant understands and will comply Issued by: Date: / ,fes
with all non-point source regulations per the Cupertino Municipal Code,Section 104
9.18.
�- I RE-ROOFS:
Signature Date All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
U OWNER-BUILDER DECLARATION —7-Z-7
t 1 '
Signature of Applic te: l l
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: ALL ROOF COVE O BE CLASS"A"OR BETTER
I,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&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. I will
I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which thisOwner or authorized agent
permit is issued. • Date:�i-
I certify that 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 Worker's
Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lender's Address
I 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 building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION
,mnify and keep harmless the City of Cupertino against liabilities,judgments,
.s,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
CITY OF CUPERTINO
3 ITEMS OF 12 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 31637045 . 00
DATE ISSUED. . . . . . . : 07/27/2011
RECEIPT # . . . . . . . . . BS000014207
REFERENCE ID # . . . : 11070209
SITE ADDRESS . . . . . : 10912 NORTHFIELD SQ
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : GELPHMAN MYRNA
ADDRESS . . . . . . . . . . : 10912 NORTHFIELD SQ
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-0514
RECEIVED FROM . . . . : FOUR SEASONS
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 4, 800 . 00 1 . 00 0 . 00 1 . 00 0 . 00
1BSEISMICR VALUATION 4, 800 . 00 0 . 50 0 . 00 0 . 50 0 . 00
1REROOFRES SQ FEET 14 . 00 196 . 00 0 . 00 196 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 197 . 50 0 . 00 197 . 50 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
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
CUPERTINO 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228• FAX(408)777-3333•buildingQ)cugertino.org
PROJECT ADDRESS FN#
OWNER NAME PHONET E-MAIL
STREET ADDRESS CITY, STATE,ZIP FAX
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC.#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
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 I/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 an R315 of
the 2010 California Residential Code.
Signature of Applicant/Agent: Date: 7
z -7
ReroofPolicy_201 1.doe revised 02/16/11
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 R '
CUPERTINO (408)777-3228• FAX(408)777-3333•building(ftuoertino ora
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PROJECT ADDRESS 1 M / . `0 r�^ eta(
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OWNER NAME V •vl t`u1 0\,_ 1 C_.1{
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STREET ADDRESS CITY,STATE,ZIP
FAX
CONTACT NAME
PHONE EMAIL
STREET ADDRESS
CITY,STATE,ZIP FAX
[3 OWNER ❑ OWNER-BUIL DER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME �r G a_rJ_ LICENS MB
COMPANY NAME R
-I �i O LICENSE TYPE/ 3 7 BUS.LIC.#
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•C SQ�.3 E-MAIL FAX
STREET ADDRESS 4s-G Z 4c R CITY,STATE,ZIP PHOj1F,t,T` � \`yyO
^
ARCHITECT/ENGINEER NAME LICENSE NUMBER
BUS.LIC.#
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY,STATE,ZIP PHONE
USE OF ❑ SFD or Duplex 1 .Kmulti-Family ROOF AREA:
T VALUATION:
STRUCTURE: ❑ Commercial
EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES /Y
SFHER(SPECIFY) CQM w _�_�J
REMOVE/REPLACE ES IF NO. PLYWOOD ❑ /," ❑ PLYWD ❑OSB PITCH: G OGCJ�
❑ N #LAYERS: THICKNES ❑5/g ROOF
TYP ❑ DX L A
PROPOSED ROOF TYPE. ❑BUILT-UP ROOF ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER
ICC-ES REPORT#
DESCRIPTION OF WORK: � O^ n �`�� 1
IY Ic 1KcS44^ OR-#%,W oe-)CD �c7F �►� Sia
N S o t Fe�C 6 t-7- ted- o , C& 5 i "
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By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on therop
application and the information I have provided is correct. I,have read the Description of Work and verify it is accurate. l agree torty ecomply awith all applicable local
ordinances and state laws relating to buil nstructi I authorize representatives Of Cupertino to enter the above-ide ified prope y for ins ction u
Signature of Applicant/Agent: �� Pe P rposes.
Date:_ -7 /
/�
SUPPLEMENTAL INFORMATION REQUIRED
OFIPIC$USE ONLY
—If building is associated with a Home Owners Association,provide letter PLAN'CHECKTYPE
of approval from HOA. ROUTING SIdP
❑ OVER-THE-COUMR ❑ BUILDING FLAN REVIEW
_Provide Planning approval to verify if there any restrictions.
❑ EXPRESS ❑ PLANNING PLAN REVIEW
_Provide copy of Manufacturer's Installation Specifications.
❑ STANDARD ❑ F=DEPT
_Provide signed copy of Cupertino's Tear-Off Policy.
ReroofApp_2011.doc revised 03/16/11