11030135 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10953 NORTHSKY SQ CONTRACTOR:FOUR SEASONS ROOFING PERMIT NO: 11030135
OWNER'S NAME: NICK KAO PO BOX 1668 DATE ISSUED:03/29/2011
OWNER'S PHONE: 3109958475 SAN JOSE,CA 95109 PHONE NO:(408)278-0330
❑ LICENSED CONTRACTOR'S DECLARATION 9
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class 4f Lic.# 41?a2lG
l
Contracto � Date a MECH f— RESIDENTIAL r— COMMERCIAL
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:RE-ROOF REMOVE EXISTING CEMWOOD ROOF&
(commencing with Section 7000)of Division 3 of the Business&Professions INSTALL A
Code and that my license is in full force and effect. NEW CLASS A COMPOSITION SHINGLE GAF GRAND
CANYON(COLOR-STONEWOOD)12SQ
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:31640048.00 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.
nature T a e
g Issued by• Date:
Si
C 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)
1,as owner of the property,am exclusively contracting with licensed contractors to Signature f AppI' t:
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
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(x)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
forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized ng�y t: Z�y
L.�—•---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"ork'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,
cost, and expenses which may accrue against said City in consequence of the Lender's Address
gr ;of this permit.Additionally,the applicant understands and will comply
wit,,...i 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 13 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 31640048 . 00
DATE ISSUED. . . . . . . : 03/29/2011
RECEIPT #. . . . . . . . . : BS000013023
REFERENCE ID # . . . 11030135
SITE ADDRESS . . . . . : 10953 NORTHSKY SQ
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . . NICK KAO
ADDRESS . . . . . . . . . . : 10953 NORTHSKY 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 12 . 00 156. 00 0. 00 156. 00 0.00
---------- ---------- ---------- ----------
TOTAL PERMIT 157.50 0. 00 157.50 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
CITY OF CUPERTINO
30/3-
REROOF
C U P E RTI N O PERMIT APPLICATION
APN #
Building Address: Date:
/o Fs3 Alor41451y S6t
Owner's Name: ` Phone #: .�
�7
HOA: Yes No If yes, provide letter from HOA
Contractor: r., �e Sc�..�S �A, `FSC_ Phone #: —v33a
Fax#:
Cupertino Business License #: Contractor License #:
-2�3�3 7,?-/a 8
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles 3?0-Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
;` Other (Specify) 6e,-, uio o ❑ Other (Specify)
Number of existing coverings / ❑ Provide I.C.C.E.S. Report #
�!r--To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description: r'�!J v2 ��;5 .� �,� �,�,� �h
(-.,`.4s!e- �4-tom- r Gk--,
Residential - Commercial
Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if
Green Building Checklist & attach it to the application or if there are any restrictions: ❑
applicable, include in plan set & the sheet index.
Valuation: o a
y yoo
I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
Signature
Revised 02/05/09
n-
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
Mal
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
CUPERTINO
(408) 777-3228 • FAX(408)777-3333 • building 6d.cupertino.org
PRGJECT;�DDItE55APN I
0`,ti.\E t NML I/ PHONT' ' E-NIAIL
S;;,,I: r I)D}t1 SsQ CITY, STATE,QIP �t Q FAXC4
C0NTIL-% !0K NT, IE �VT
LICENSE NUt�E����^I LICEY TY`3PE BUS .N
CO,NIPANY NANIE E-MAIL FAX
03s�
ST tE4 DS_ C STATE,Z Z PHONE
I UNDERSTAND AND AGREE TO THE FOLLOWING:
1. The re-roof project shall comply with all applicable provisions of the 2007 California Building Code.
2. An inspection request shall be scheduled the day before the inspection date, Please call (408)777-
3228 between 7:30 - 3:30pm (Mon-Fri) to schedule the next day inspection.
3. Atter the roof is torn off and the nails/fasteners have been removed and all the dry-rotted wood has
been replaced, you must call for a roof inspection. A building inspector will be available with one hour.
There are special hours for the service: 7:30 — 10:30am and 1:00 — 3:30pm (Mon—Thurs);
7:30 — 10:30am and 1:00 —2:30pm (Friday).
4. If plywood is installed, a plywood nailing inspection is required.
5. 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.
6. 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 item will be verified:
a. Flat roofs shall have a minimum of per foot of slope and demonstrate there is no ponding.
b. A listing from an approved testing agency shall be available on-site to review at the time of the
inspection.
c. Proper spark arrestor installation.
T NOTE: If you call for a plywood nailing inspection and the job is not ready, you will be charged to a re-
inspection fee of$126.00. The re-inspection fee shall be paid before another inspection can be
scheduled.
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on
the property owner's behalf. I u er nd and agree to comply with the re-roof policy stated abrvP .
,.Iature of Applicant/Agent: Date:
ReroofPolicy_20/0.doc revised 04/14;10
REROOF TEAR-OFF POLICY
is COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
CUPERTINO 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228• FAX(408)777-3333•building(cDcupertino.ong
PROJECT ADDRESS ; C' �7 \ APN#
OWNER NAME/,_ C J j PHONE 7 (�� ^ -MAIL
STREET ADDRESS CITY, STATE,ZIP FAX
CONTRACTOR NAME_)41 4�.�� 41-1 CENSE N M�E�.,�D LICEt$E T PE BUS.LIC.#
COMPANY NAME V'"/ E-MAIL ` FAX
STREkLADDRES . C % CIT E,ZIP Q S/G>7 PHONE.__
G- I UNDERSTAND AND AGREE TO THE FOL/LOWING:
I. The re-roof project shall comply with all applicable provisions of the 2007 California Building Code.
2. You must schedule all needed inspections a minimum of one day before the requested inspection date.
Please schedule inspections online or call (408)777-3228 between 7:30-3:30 (Mon-Fri).
3. Tear-off roof inspection is required. Please call for tear-off inspection after the roof is torn off and all
the nails/fasteners have been removed. Any and all dry-rotted wood shall be replaced prior to this
inspection. A building inspector will be available within one hour.
There are special hours for this service: 7:30 — 10:30am and 1:00—3:30pm (Mon—Thurs);
7:30 — 10:30am and 1:00—2:30pm (Friday).
4. If plywood is installed, a plywood nailing inspection is required.
5. In-Progress roof inspection is required. Call for an in-progress roof inspection to verify building is
weather tight after installation of approximately 25% of the roofing material.
6. New roof coverings shall not be applied without first obtaining all inspections 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.
7. A final inspection and approval shall be obtained from the building inspector when the re-roofing is
complete. 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 must 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.
8. 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 state abcyve.
Signature of Applicant/Aget rte'"" '— X45 Date: 3 ���
ReroofPolicy_2010.doc revised 05/17/10