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11040078 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10810 NORTHOAK SQ CONTRACTOR:FOUR SEASONS PERMIT NO: 11040078 ROOFING [OWNER'S NAME: REGINA SHIREY PO BOX 1668 DATE ISSUED:04/12/2011 NER'S PHONE: 4082534383 SAN JOSE,CA 95109 PHONE NO:(408)278-0330 ❑ LICENSED CONTRACTOR'S DECLARATION r y Q' BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class C' Lic.# [ 7 v f—MECH RESIDENTIAL COMMERCIAL Contractor IC5/C_ Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: RE-ROOF 14 SQUARES,REMOVE EXISTING CEMWOOD ROOF (commencing with Section 7000)of Division 3 of the Business&Professions INSTALL NEW 304 UNDERLAYMENT&GAF GRAND CANYON Code and that my license is in full force and effect. ASPHALT SHINGLES 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:$4400 1 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:31641002.00 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 DAYS FROM LAS 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 granting of this permit. Additionally,the applicant understands and will comply Issued by: Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature Date Z-//"/ 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 Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO 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) 1,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 this permit is issued. Owner or authorized agent: Date: 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 -non the above mentioned property for inspection purposes.(We)agree to save .mnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION _.,its,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 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: io kl G PERMIT# OWNER'S NAME: "-g SGS.+rc. PHONE# 2 GENERAL CONTRACTOR: BUSINESS LICENSE# ADDRESS: CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: 4< Z Signature ate Please check applicable subcontractors and complete the following information: V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring/Carpeting Linoleum/Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date 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•buildina(a)cupertino.ora PROJECT ADDRESS /�j Q• o A / � APN fi /Vu OWNER NAME (f D (J� PHONE _ 3 E-MAIL tf STREET ADDRESS CITY, STATE,ZIP PAX CONTRACTOR NAME r LICENSE NUMBER `17Z,103 7 Q LICENSE TYPE BUS.LIC.k OU( -�. /►SS ` Z, O G"3 Q COMPANY NAMEx. [LllTez �� E-MA1L�( F2 e 1 e \� STREET ADDRESS J7 CITY,STATE,,ZIP( a f-T PHONE J 7 G -3 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 shall be scheduled 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. On the day of the inspection, a building inspector will be available within one hour for either a Tear-Off Inspection or Nailing Inspection if you call again on that day between the hours specified. 3. The following inspections are required: a. 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. b. If plywood is installed, a plywood Nailing Inspection is required. c. Progress Inspection is required when approximately 50% of roof covering is installed. 4. New roof coverings shall not be applied without first obtaining all 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. 5. 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. 6. 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: Date: IV ReroofPolicy_2011.doc revised 02/16/11 REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 GUPERTINO (408)777-3228 • FAX(408)777-3333 • buildingCcDcupertino.org PROJECT.ADDRESS NO G 4_©G ,e 50 - 0 - APN# 51 1^ 4' OWNER NAME (� PHONE�2-5-3_ q 3$3 EMAIL STREET ADDRESS i CITY, STATE,ZIP FAX APPLICANT N'ANCE P ONE E-MAIL � c�et� Rzaf� ���5-23-5t,13-7 STREETADDRESS L �-1tU��`M1S -1 CITY,STATE, (:7�.4ir;(/ FA _�) 2?e- ct:?33 ❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME Q� �e LICENSE NUMBER 7 l O LICENSE TYPE BUS LIC # C V a C C. COkIPANY NAME SQc.�,� 1"�9 E-MAIL FAJ{ 0a- ? _7,^ Q b CIT ,STATE ZIP /� P ONE /i,[ STREET ADDRESS �6rI'Uq/� ST L CA � // � a�7 27k-0330 ARCHITECT/ENGINEER NAME / LICENSE NUMBER BUS.LIC.# o COMPANY N.A-ME E-MAIL FAX STREET.ADDRESS CITY,STATE,ZIP PHONE LSE OF ❑ SFD or DuplexIvtulti-Family ROOF AREA VALUATION: /YASTRUCTURE ❑ Commercial Gl, EXISTING ROOF TYPE ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES XTTFIER(SPECIFY) REVIOVE,REPLACE ,�oxES IF NO, PLYWOOD ❑ Y:" ❑ PLYWD ❑ OSB PITCH: C� ROOF ElNO #LAYERS: THICKNESS: 135/8" TYPE: ❑ CDX 12 CLASS: PROPOSED ROOF TYPE ❑BUILT-UP ROOF ;?ii(�PHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC•ES REPORT# DESCRIPTION OF WORK. CQ 4"UJCk3CJ� (2�C—" N o ir.3 -4— ti,,: 1 ��- By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to b ding nstruc ion. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED ,'a ,,' d. M oiieJSE� 4 � ` If building is associated with a Home Owner's Association,provide letter PL�tN�tiEClt x1�E QUTIN6SLI PP OVER THE COUNTER'`,: BUIL of approval from HOA. INCPLAN REVIEW Provide Planning approval to verify if there any restrictions. f ❑ EXPRESS` ❑',PLANNING PLAN REVIEW Provide copy of Manufacturer's Installation Specifications. ❑ STANDARD ❑ FIREDEPT Provide signed copy of Cupertino's Tear-Off Policy. ❑ OTHER: ReroofApp_201 1.doc revised 03/02/11