11060101 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20074 NORTHWIND SQ CONTRACTOR:FOUR SEASONS ROOFING PERMIT NO: 11060101
OWNER'S NAME: BARTLETT JOYCE E PO BOX 1668 DATE ISSUED:06/13/2011
OWNER'S PHONE: 4082559247 SAN JOSE,CA 95109 PHONE NO:(408)278-0330
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT F PLUMB
License Class C 3 Lic.# `f G MECH f— RESIDENTIAL f COMMERCIAL I
Contractor C Date / y t
JOB DESCRIPTION:REROOF,14 SQUARES,REMOVE EXISTING CEMWOOD
1 hereby affirm that I am licensed under the.provisions of Chapter 9
ROOF
(commencing with Section 7000)of Division 3 of the Business&Professions AND INSTALL NEW,30#UNDERLAYMENT&GAF GRAND
Code and that my license is in full force and effect. CANYON ASPHALT SHINGLES-HAS EXISTING PLYWOOD
I hereby affirm under penalty of perjury one of the following two declara
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 thy,
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
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:31638057.00 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. �!
Signature Date /C(.�� Issued by: Date:
F 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
I,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) ' Date: —/
I,as owner of the property,am exclusively contracting with licensed contractors to Signature Applicant:
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""authorized agent:
forthwith comply with such provisions or this permit shall be deemed revoked. Date: / Y _ r�
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,
C, nd expenses which may accrue against said City in consequence of the Lender's Address
g, g of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION
9.18.
I understand my plans shall be used as public records.
Signature Date
Licensed Professional
CITY OF CUPERTINO
3 ITEMS OF 18 PERMIT RECEIPT OPERATOR: TraciC
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN 31638057 . 00
DATE ISSUED. . . . . . . : 06/14/2011
RECEIPT #. . . . . . . . . BS000013753
REFERENCE ID # . . . : 11060101
SITE ADDRESS 20074 NORTHWIND SQ
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER BARTLETT JOYCE E
ADDRESS 20074 NORTHWIND SQ
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-0552
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
ADDRESS: 20074 Northwind DATE: 06/13/2011 REVIEWED BY: TRACIC
APN: 31638057 BP#: *VALUATION: 1$4,400
*PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Duplex PENTAMATION 1SFDWLR00F
USE: I PERMIT TYPE:
WORK reroof, 14 squares, remove existing cemwood roof and install new, 30# underla ment & GAF grand
SCOPE canyon asphalt shingles - has existing plywood deck. Color Stonewood.
FEE ID ROOF AREA
s.f.
1REROOFFRES 1,400
NOTE: These fees are based on the preliminary in ormation available and are only an estimate. Contact the Dept for addh7 info,
FEE ITEMS (Fee Resolution 09-051 E f 7,1:70) FEE QTY/FEE MISC ITEMS
( 0"'Ci4 !,
F71
Permit Fee: $182.00
Work Without Permit? O Yes E) No $0.00
i
Strom Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
E31d« Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $183.50 $0.00 TOTAL FEE: $183.50
Revised: 04/29/2011
�fai
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 - buildingcd' cupertino.org
PROJECT ADDRESS TAPN#
OWNER NAME PHONE E-MAIL
STREET ADDRESS CITY, STATE,ZIP FAX
CONTRACTOR NAME / LICENSE NUMBER [/� Q Q LICENS&TYPE BUS.LIC.#
CG SPANY tiA�tE +{ ' /� E-MAIL
STREET ADDRESS A CITY,STATE,ZIP7
d T'. ['� (O ( Z PHONE Ce
i1 / G �3o
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.
Signature of Applicant/Agent: Date:
RerogJPo1icy_2011.doc revised 02/16/11
REROOF PERMIT APPLICATION O
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION O\
10300 TORRE AVENUE •CUPERTINO, CA 95014-3255
GUPERTINO (408)777-3228• FAX(408)777-3333-buildingecuaertino.ora
PROJECT ADDRESS L}V-7(--I , 'ir ` APN k
O
WNER NAMEE `) fV ' 'MA xy•7 901( � E-MAIL
STREET ADDRESS t'' R (� f�� CITY, STATE,ZIP ^ FAX
APPLICANT NAME
�A7 f TO
) -3—n:;):3 E-MAIL
STREET ADDRESS�O Z TVf l�,T A -TCITY,STATE, 4rL-�vg.Q c4i-•4b7,</ F Z-le-033
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT 3XCONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME e n �Ye LICENSE NUMBER O LICENSE TYPE BUS.LIC.k
COMPANY NAME ( i E-MAIL F A n
G va. (r•�1 iL jf
33
MEET ADDREsssb,Z !^4T". c STATETt
ZIP
ARCHI7E.CT/E*IGINEER NAME LICENSE NUMBER BUS.LIC.k
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑ SFD or Duplex 114Ulti-Family ROOF AREA: VALUATION:
STRUCTURE ❑ Commercial ao
If
EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES R(SPECIFY)
REMOVE/REPLACE FNO, PLYWOOD . ❑ PLYWD OSBPITCH: ROOF
IZ El C1 /8" ❑ A
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF .2�MHALT SHINGLES 11WOOD SHAKES ❑WOOD SHINGLES 13OTHER ICC-ES REPORT k
DESCRIPTION OF WORK: � n
30
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 ' ing nstruc on. 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 letter
of approval from HOA. =BUMDRiQ k
e r,�rsaAfi+- 10-
Provide Planning approval to verify if there any restrictions. t is
Birk GFLAZtR>i;.VJIERr
_Provide copy of Manufacturer's Installation.Specifications. w '�
_ Provide signed copy of Cupertino's Tear-Off Policy.
ReroofApp_2011.doc revised 03/02/11