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11050057 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10984 NORTHSEAL SQ CONTRACTOR:FOUR SEASONS ROOFING PERMIT NO: 11050057 OWNER'S NAME: NIELSON DORRIS F AND PATRICK A PO BOX 1668 DATE ISSUED:05/10/2011 C""ER'S PHONE: 8185911979 SAN JOSE,CA 95109 PHONE NO:(408)278-0330 U LICENSED CONTRACTOR'S DECLARATIONr BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# _ MECH RESIDENTIAL COMMERCIAL Contractor Date I here affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:RE-ROOF REMOVE EXISTING CEMWOOD ROOF,INSTALL (commencing w� Section 7000)of Division 3 of the Business&Professions 30LB FELT UNDERLAYMENT&GAF GRAND CANYON ASPHALT Code and that my license is in full force and effect. SHINGLES OVER EXISTING SUBSTRATE.COLOR STONEWOOD. 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. 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:31640035.00 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 DAM LAST CALLED INSPECTION. 9.18. s Signature_ t Le:g Date Issued by: Y FRO� S ` Ol 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) I,as owner of the property,am exclusively contracting with licensed contractors to Signature of int: Dater 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: 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 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 wner orized a � 1 forthwith comply with such provisions or this permit shall be deemed revoked. O -�' 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 wrk'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 ig of this permit.Additionally,the applicant understands and will comply wi,.,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 REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 (408)777-3228 • FAX(408)777-3333 • building(cDcupertino.org CUPERTINO PROTECT ADDRESS O Cp` APN# ( o OWNER NAME ? E-MAIL STREET.ADDRESS n1C r1 / �J^'IBJ /, M� _/ C[TYdT�Q zIb <SCS 6 A�T . FAX APPLICANT NAME a�10 r W 1L l0 U/ PHONE E-MAIL (e ® AZa,('e G S 3��3 STREET ADDRESSrO Z ` f�i^ CITY,STATE, FA ❑ Ze OWNER ❑ OWNER-BUILDER ❑ OWNER AGENTONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER 11DEVELOPER 1:1TENANT CONTRACTOR NAME n LICENSE NUMBER LICENSE TYPE BUS.LIC n erxo le,.-zYes 4-C71,16 COMPANY NAME r SQAvt- n / t E-MAIL FA �F)� STREET ADDRESS,,-6 f (SrH T._ CITY.STATE ZIP ( ^ /� � rO O6) ARCHITECTENGINEER NAME LICENSE NUMBER 7 BUS.LIC.# O COMPANY NAME E-MAIL- FAX STREET ADDRESS CITY,STATE,ZIP PHONE LSE OF ❑ SFD or Duplex _Multi-Family ROOF AREA VALUATION. STRUCTURE ❑ Commercial / ,do EXISTING ROOF TYPE. ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES R(SPECIFY) RENIOVE,REPLACE >1::YES IF NO, PLYWOOD ❑ '/, ❑ PLYWD ❑ OSB !!!!PITCH: ROOF 13 NO #LAYERS: THICKNESS: ❑ 5/8', TYPE: ❑ COX i 2 CLASS: A PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ;Z<9PHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT# DESCRIPTION OF WORK. n 1 S Color"for 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 nstruction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED w p "" .# ol�xiceu ANL i' `- ' _ If building is associated with a Home Owner's Association,provide letter ' PL... iCKTXPE " • ROU TING SLIP ' of approval from HOA. ❑..oVERTHE-CQUNTER „ ❑ BUILDINGPLANREVIEW Provide r Planning approval to verify If there any restrictions. EXPRESS ❑' PLANNING PLAN REVIEW _ Provide copy of Manufacturer's Installation Specifications. ❑ STANDARD ❑ 'FIRE DEPT Provide signed copy of Cupertino's Tear-Off Policy. ❑ OTH' ER: ReroofApp_2011.doc revised 03/02/11 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 • building(c1�cupertino.org PROJECT ADDRESS APN# OWNER NAME PHONE E-MAIL STREET ADDRESS CITY, STATE,ZIP FAX CONTRACTOR NAME / LICENSE NUMBER /Q Q LICENSrF TYPE BUS.LIC.# 4U� lea ` Q G COMPANY NAMEt J,fez / �r� E-MAIL�( � �2 ( O _ 3 STREET ADDRESS N• CITY,STATE,ZIP Gym_ O � y PHONE 79 -G3��jj T1. G 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. O l Signature of Applicant/Agent: Date: ReroojTo1icy_2011.doc revised 02/16/11 CITY OF CUPERTINO 3 ITEMS OF 9 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 31640035. 00 DATE ISSUED. . . . . . . : 05/10/2011 RECEIPT #. . . . . . . . . BS000013409 REFERENCE ID # . . . : 11050057 SITE ADDRESS . . . . . : 10984 NORTHSEAL SQ SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : NIELSON DORRIS F AND PATRICK A ADDRESS . . . . . . . . . . : 10984 NORTHSEAL 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 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 550.50 #010888 --------------- TOTAL RECEIPT 550 .50 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