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11060193 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20055 NORTHWIND SQ CONTRACTOR:FOUR SEASONS ROOFING PERMIT NO: 11060193 OWNER'S NAME: BENNINGER DORIS I TRUSTEE PO BOX 1668 DATE ISSUED:06/22/2011 0111NER'S PHONE: 4082573747 SAN JOSE,CA 95109 PHONE NO:(408)278-0330 L LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class ` .7� Lic.# t�r� >l / MECH F RESIDENTIAL COMMERCIAL Contractor Date JOB DESCRIPTION:REROOF,14 SQUARES,TEAR OFF EXISTING AND I hereby arm that l am licensed under the provisions of Chapter 9 REPLACE (commencift with Section 7000)of Division 3 of the Business&Professions WITH COMPOSITION SHINGLES Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarr Ens: [have and will maintain a certificate of consent to self-insure for Workef s Compensation,as provided for by Section 3700 of the Labor Code,for tFie performance of the work for which this permit is issued. [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.Ft Floor Area: Valuation:$4400 permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is APN Number:31638006.00 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. / y/ \ L 7 Signature Date t � f Issued b % ,- Date: 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 licensed contractors to Signature of Applt: Date: (� construct the project(Sec.7044,Business&Professions Code). " ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I 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 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 I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain 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 autporized agent: l 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 mrk'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, C' and expenses which may accrue against said City in consequence of the Lender's Address ,g of this permit.Additionally,the applicant understands and will comply WILI,all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION 9.18. [understand my plans shall be used as public records. —ture Date Licensed Professional CITY OF CUPERTINO 3 ITEMS OF 18 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 31638006 . 00 DATE ISSUED. . . . . . . : 06/22/2011 RECEIPT #. . . . . . . . . : BS000013860 REFERENCE ID # . . . : 11060193 SITE ADDRESS . . . . . : 20055 NORTHWIND SQ SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER BENNINGER DORIS I TRUSTEE ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-0549 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 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 1, 101. 00 #010978 --------------- TOTAL RECEIPT 1, 101.00 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: 20055 northwind sq. DATE: 06/21/2011 REVIEWED BY: bobs. APN: ( BP#: VALUATION: $4,400 PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof PRIMARY PENTAMATION 1SFDWLROOF USE: SFD or Duplex PERMIT TYPE: WORK tear off replace with comp shingles. SCOPE FEE ID ROOF AREA s.f. 1 REROOFFRES 1,400 T7 17 NOTE: These fees are based on the preliminary in ormation available and are only an estimate. Contact the Dept-for addn'l info. FEE ITEMS (Fee Resolution 09-051 t;ff.' 1.;10) FEE QTY/FEE MISC ITEMS Permit Fee: $182.00 Work Without Permit? O Yes E) No $0.00 Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item B1dgStds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $183.501 $0.00 TOTAL FEE: $183.50 Revised: 04/29/2011 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-buiIding cDcuoertino.ofQ PpILOJECr ADDRESS No ��-� S� 'FNPHONE E•MAII. NAME -Do O�� S Ick� n 1 -s` CfrY, STATE,ZIP FAX S1'REEi ADDRESS LICENSE NUMBER �/ /Q Q L KENS TYPE BUS.LIC.N CONTRACTOR NAME ` ` (J �V COMPANY NAME E-MAIL at /'_.,_ /� a� C.7"&.00.2 78- 33 CrfY,STATE``ZMIP�Q��J T� ` Z PHONE �f 79-6310 STREET ADDRESS b �L 3 l� 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 witlim 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 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. 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 shallbe 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 8315 of the 2010 California Residential Code. Signature of Applicant/Agent. Date: _-Z Za ReroofPolicy 2011.doc revised 02/16/11 S REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION 10300 TORRE AVENUE-CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228-FAX(408)777-3333-building6cuDertino.om \ PROJECT ADDRESS �,n� C44C"lir j GWNER NAME e 6 C �' e AI�� a OTIC n Cr — 7 EMAIL STREET ADDRESS _] CITY,�STATE,ZIP FAX APPLICANT NAME ` C n PliONE 3� 3 E-MAIL STREET ADDRESS 5O Z CITY,STATE, - G*-• Az<, F 503 ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT AONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEvELoPER ❑7ENANr CONTRACTOR NAME ,e LICENSE ER Ll O LICENSE TYPE BUS.LIC.N d[p COMPANY NAME r E-MAIL F F2A?9 STREET ADDRESS 6 n,i 57" STATE z� C•q--- l /!Z G oS,Z79'-10330 ARCHTTECT/ENGINEER NAME LICENSE NUMBER BUS.LIC.N COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑ SFD or DuplexfiA ultl-Family ROOF AREA: VALUATION: STRUCTURE: ❑ Commercial / EXMING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES XMIRER(SPECIFI) REMOVE/REPLACE WXES I IF NO. PLYWOOD . ❑ %- ❑ _ PLYWD ❑OSB PITCH Z=0 ROOF ❑ . 13ITYPEw 11 CDX :12IMASSM A PROPOSED ROOF TYPE: ❑BUILT-UP ROOF HALT SHINGLES 13OD SHAKES WOC3 WOOD SHINGLES ❑OTHER ICC-ES REPORT N DESCREPTION OF WORK: e 3 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 ' ing nstruc'on. I authorize representatives of Cupertino to enter the above-identill prope for inspection purposes. Signature of Applicant(Agent Date: ZO Q SUPPLEMENTAL INFORMATION REQUIRED _If building is associated with a Home Owner's Association,provide letter of approval from HOA. Pro vid .Planning approval to verify if there any restrictions. ide copy of Manufacturer's Installation Specifications. _Provide signed copy of Cupertino's Tear-Off Policy. ReroojApp 2011.doe revised 03/02/11