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11060023 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10832 NORTHFIELD SQ CONTRACTOR:FOUR SEASONS ROOFING PERMIT NO: 11060023 OWNER'S NAME: SCHULTZ AVIVA PO BOX 1668 DATE ISSUED:06/03/2011 01'^'ER'S PHONE: 4084462861 SAN JOSE,CA 95109 PHONE NO:(408)278-0330 G LICENNSED CONTRACTOR'S DECLA�R�ATION BUILDING PERMIT INFO: BLDG� ELECT PLUMB� License Class L / Lic.# �� ' > MECH RESIDENTIAL COMMERCIAL� Contractor Date �� ' ;' �� I hereby atrm that I am licensed under the provisions of Chapter 9 (commenc(ng with Section 7000)of Division 3 of the Business&Professions JOB DESCRIPTION:REROOF,14 SQUARES,TEAR OFF EXISTING CEMWOOD ROOF AND REPLACE WITH NEW 30#UNDERLAYMENT&GAF GRAND Code and that my license is in full force and effect. CANYON ASPHALT COMP SHINGLES,COLOR STONEWOOD,HAS I hereby affirm under penalty of perjury one of the following two declardoons: 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. 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 permit is issued. Sq.Ft Floor Area: Valuation:$4400 APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is APN Number:31637037.00 Occupancy Type: 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 indemnify and keep harmless the City of Cupertino against liabilities,judgments, PERMIT EXPIRES IF WORK IS NOT STARTED costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non-point source regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION. 9.18. i Signature! Date !^ -.5 r Issued by w""" Date: ��r OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS: the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is 1,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection. Business&Professions Code) 1,as owner of the property,am exclusively contracting with Iicensed contractors to Signature of Applicant: Date: construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER declarations: 1 have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain [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 of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material. permit is issued. Additionally,should I use equipment or devices which emit hazardous air I certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I will not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Compensation laws of California. If,after making this certificate of exemption,I Health&Safety Code,Sections 25505,25533,and 25534. become subject to the Worker's Compensation provisions of the Labor Code,I must Owner or author agent: forthwith comply with such provisions or this permit shall be deemed revoked. „ Date: / APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY 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 I hereby affirm that there is a construction lending agency for the performance of work's to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.) upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name indemnify and keep harmless the City of Cupertino against liabilities,judgments, cc and expenses which may accrue against said City in consequence of the Lender's Address I .. g of this permit.Additionally,the applicant understands and will comply wan all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION 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 31637037 . 00 DATE ISSUED. . . . . . . : 06/03/2011 RECEIPT #. . . . . . . . . BS000013651 REFERENCE ID # 11060023 SITE ADDRESS 10832 NORTHFIELD SQ SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER SCHULTZ AVIVA ADDRESS 10832 NORTHFIELD SQ CITY/STATE/ZIP . . . : CUPERTINO CA, 95014 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 4,400 .00 1. 00 0. 00 1.00 0 .00 1BSEISMICR VALUATION 4,400 . 00 0 .50 0 . 00 0 .50 0. 00 1REROOFRES SQ FEET 14 .00 182 . 00 0 .00 182 . 00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 183 .50 0 . 00 183 .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 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION DA DDRESS: 10832 northfield sq. DATE: 06/03/2011 REVIEWED BY: bobs. PN: 3 ? BP#: 1 l L ��3 "VALUATION: $4,400 'PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof PRIMARY PENTAMATION 1 SFDWLROOF USE: SFD or Duplex PERMIT TYPE: WORK tear off existing roof replace with new comp. shingles. SCOPE FEE ID ROOF AREA s.f. 1 REROOFFRES 1,400 F7 Li NOTE. These fees are based on the preliminary in ormation available and are onl an estimate. Contact the Dept-for addn'l info. FEE ITEMS (Fee Resolution 09-051 fstf' ';'!.-"I0) FEE QTY/FEE MISC ITEMS Permit Fee: $182.00 F7T= __T Work Without Permit? 0 Yes G No $0.00 i StromMotion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 Ti SUBTOTALS: $183.50 $0.00 TOTAL FEE: $183.50 Revised: 04/29/2011 i REROOF TEAR-OFF POLICY i 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•building(@cupertino.orq PROJECT ADDRESS 2 J� /_71 /„Jf'f APN# OWNER NAMEyI SV AV' -1 777L PH E / /u- STREET ADDRESS V CITY, STATE,ZIP FAX CONTRACTOR NAME Q.r LICENSE NUMBER U 7 `O Q LICENSE TYPE BUS.LIC.# COMPANY NAME dO /�_ E-MAIL�t r G�•{ O ��) O� -tI3 STREET ADDRESS rJ K`J l� CITY,STATE,`Z�IPI PHONE 6 " � -TOSP l Z 27,?G 3Q 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 detecto s are required to be installed in accordance with Sections R314 and R315 of the 2010 California Residential Code. ti Signature of Applicant/Agent: Date: ReroofPolicy_2011.doc revised 02/16/11 REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION (n 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333• building(cDcupertino.org PROJECT ADDRESSLj p 73Z fr( 1 f d d Sc�_ APN# ;31 (P '�R ��1 OWNER NAMEPHONG , A V t V s. '' ✓ (7 Z fJ 7b �O(p I E-MAIL STREET ADDRESS A_ D CITY, STATE,ZIP FAX APPLICANT NAME rte- P ONE E-MAIL 62 S 3—cx�3? STREET ADDRESS 5c)Z t-�0(+`i n '` CITY,STATE, FA 27e-a333 ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT oNTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME n �2Ye LICENSE NUMBER O LICENSE TYPE BUS.LIC.# COMPANY NAME fg,r sea K n E-MAIL FA}�` g)�-7.0 STREET ADDRESS 1 CCrSTATE ZIP P ONE �b Na/run ST. QV0bi 27g-o33a ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC.# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑ SFD or Duplex _Multi-Family ROOF AREA: VALUATION: STRUCTURE: ❑ Commercial EXISTING ROOF TYPE:: /0� BUILT-UP ROOF El ASPHALT SHINGLES 11 WOOD SHAKES ❑WOOD SHINGLES XUITMR(SPECIFY) REMOVE/REPLACE ,+ rZES IF NO, PLYWOOD ❑ %" ❑ PLYWD ❑ OSB PITCH: ROOF ❑ NO #LAYERS: THICKNE S: El TYPE: 11COX :12 CLASS: A PROPOSED ROOF TYPE: ❑BUILT-UP ROOF HALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT# DESCRIPTION OF WORK: � nn n ,.n d J 2 ieo 300-_ kc&4— ��- 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 _If building is associated with a Home Owner's Association,provide letter14 of approval from HOA. � $rJ'bAK�1AP(I _Provide Planning approval to verify if there any restrictions. Er I r®•`^ low + ]LtRF'J. t ` b Provide copy of Manufacturer's Installation Specifications. [ ST6l1VDJl'ltt? D _Provide signed copy of Cupertino's Tear-Off Policy. r x k 4�� m ReroofApp_201 1.doc revised 03/02/11