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11050176 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20174 NORTHGLEN SQ CONTRACTOR:FOUR SEASONS ROOFING PERMIT NO: 11050176 OWNER'S NAME: SUSAN M TACKE PO BOX 1668 DATE ISSUED:05/20/2011 0"NER'S PHONE: 4082577847 SAN JOSE,CA 95109 PHONE NO:(408)278-0330 L LICENSEgD CONTRACT�O7R'S DECLARATION BUILDING PERMIT INFO: BLDG f— ELECT f— PLUMB r License Class �_ � ` Lic.# � /�l MECH r RESIDENTIAL COMMERCIAL Contractor Date,5'—� d"r-� —/ ereby affi at I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REROOF,14 SQ,REMOVE EXISTING CEMWOOD ROOF (commencing with Section 7000)of Division 3 of the Business&Professions AND t m license is in full force and effect. INSTALL NEW 30#UNDERLAYMENT&GAF GRAND CANYON --- ASPHALT SHINGLES,COLOR:STONEWOOD,HAS EXISTING I hereby affirm under penalty of perjury one of the following two decla ati I have and will maintain a certificate of consent to self-insure for Worke ' Compensation,as provided for by Section 3700 of the Labor Code,for t performance of the work for which this permit is issued. 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 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:31641058.00 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 re ulati the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION. 9.18. �`' Sign re Date. �CXC:) Issued by: 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) I,as owner of the property,am exclusively contracting with licensed contractors to Signatur Applicant: Date: construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three AL INGS TO BE CLASS"A"OR BETTER 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 Section 3700 of the Labor Code,for the performance of the work for which this compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& 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 e, ec 1 A5,25533,and 25534. become subject to the Worker's Compensation provisions of the Labor Code,I must �� forthwith comply with such provisions or this permit shall be deemed revoked. caner or autrtz a / r 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 a 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 perm d(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, and expenses which may accrue against said City in consequence of the Lender's Address ng of this permit.Additionally,the applicant understands and will comply waw 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 REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO. CA 95014-3255 CUPERTINO (408)777-3228 • FAX(408)777-3333• buildinq(EDcuoertino ong \ P ROJECTDDRESS ;0/7(/ • D/7 /►ro C� }�� ^ APN N / /V / J s AME TZ? ` !� C PHONE v �� E-MAIL DRESS CITY, STATE,ZIP �I FAX APPLICANT NAME P G 7 E-MAIL STREET ADDRESS CITY,STATE, F ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT 3ZCONTPLACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME n LICENSE NUMBER ire Ll o LICENSE TYPE BUS.LIC.s COMPANY NAME E-MAIL ' STREET ADDRESS ( �� w �� F �'�� J S6 Karn in �3 T. C STATE ZIP n C`l P 040 -a�3QS0..-79 ARCHITECT/ENGINEER NAME LICENSE NUMBER s^t BUS.LIC.# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑ SFD or DuplexAlulti-Family ROOF AREA: VALUATION: STRUCTURE: ❑ Commercial / l GO EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES l7rI R(SPECIFY) REMOVE/REPLACE LES ffNO, /J<9��C� �PLYWOOD ❑ %i' ❑ PLYWD ❑ OSB PITCH: ❑ q YE ROOF : ❑ 58�. P : ❑ :12 A PROPOSED ROOF TYPE: ❑BUI,T-UP ROOF HALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT N FDESCRIYMnON WORK: CAO 1„� G� By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on therop 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 orty eco ply with all applicable local ordinances and state laws relating to b ' ing 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 letter ' x Q µWas of approval from HOA. ° .' 01111. - -Provide Planning approval to verify if there any restrictions. b �M _Provide copy of Manufacturer's Installation Specifications. a t y#. i;k t;7dI A1W " ' Provide signed copy of Cupertino's Tear-Off Policy. ReroofApp_2011.doc revised 03/02/11 t i REROOF TEAR-OFF POLICY its 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(d),cupertino.org PROJECT ADDRESS AFN# OWNER NAME PHONE E-MAIL STREET ADDRESSCITY, STATE,ZIP FAX CONTRACTOR NAME �J U( LICENSE NUMBER (/ I Q LICENSE TYPE BUS.LIC.# 17 COMPANY NAME dt G�� /�J � E-MAIL ` { c _7 t ll (.� �t�Cr�� s .lie � o�.2 78-cs�33 STREET ADDRESSCITY,STATE,ZIP 6L C�-3 0SP ` Z PHONE n 79-o3_3 36 I UNDERSTAND AND AGREE TO THE FOLLOWING: .G 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%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 installedin accordance with Sections R314 and R315 of the 2010 California Residential Code. Signature of Applicant/Agent: Date: d ReroofPolicy_2011.doc revised 02/16/11 j CITY OF CUPERTINO 3 ITEMS OF 15 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 31641058. 00 DATE ISSUED. . . . . . . : 05/20/2011 RECEIPT #. . . . . . . . . : BS000013520 REFERENCE ID # . . . : 11050176 SITE ADDRESS . . . . . : 20174 NORTHGLEN SQ SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . : OWNER . . . . . . . . . . . . : SUSAN M TACKE ADDRESS . . . . . . . . . . : 20174 NORTHGLEN 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 r 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 a