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10080160 CITY OF CUPERTINO BUILDING PERMIT FBUILDINGRESS: 20083 NORTHCREST SQCONT1tACTOR:FOUR SEASONS ROOFING PERMIT NO:10080160 : FARBA NABAVI PO BOX 1668 DATE ISSUED:08/23/2010 PHONE NO:(408)278-0330 SAN JOSE,CA 95109 dER'S PHONE: 4082577005 LICENSED CONTRACTOR'S DECLARATION BUIL DING PERMIT INFO: BLDG ELECT PLUMB r �� License Class Lie.# Y / I�/ 43� MECH r RESIDENTIAL r COMMERCIAL r Contractor �5/�- Date 2'3l d JOB DESCRIPTION:RE-ROOF REMOVE EXISTING CEMWWOOD ROOF& 1 hereby affirm that I am licensed under the provisions of Chapter 9 INSTALL A (commencing with Section 7000)of Division 3 of the Business&Professions NEW CLASS A COMPOSITION SHINGLE.GAF GRAND CANYON Code and that my license is in full force and effect. (COL(R)STONEWOOD 12 SQ 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 Sq F Floor Area: Valuation:$4400 permit is issued. APPLICANT CERTIFICATION Occupancy Type: I certify that I have read this application and state that the above in is APN Number:31638073.00 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 'WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION. 9.18. F1 Old Signature Date ( Issued by: Date: _a�< V OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All i oofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: I,as owner of the property,or my employees with wages as their sole compensation, instAled without first obtaining an inspection,I agree to remove all new materials or inspection. f� 6 will do the work,and the structure is not intended or offered for sale(Sec.7044, ins F Business&Professions Code) Signature of Applicant: 4 Date: I,as owner of the property,am exclusively contracting with licensed contractors to 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 DISCLOSUR Compensation,as provided for by Section 3700 of the Labor Code,for the I h rve read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. Ca Hornia Health&Safety Code,Sections 25505,25533,and 25534. I will maintain I 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 Sa ety 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 coidaminants 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 Hr attain Safety Code,Sections 25505,25533the Cupertino compliance with ,rCode,Chapter 9.12 and the and 25534icipal Copensation laws of Califomia. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must O•vner or authorized agent: 23 e1:0forthwith 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 isI 1 iereb affirm that there is a construction lending agency for the performance of work's correct.I agree to comply with all city and county ordinances and state laws relating fc r which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter L:nder's Name upon the above mentioned property for inspection purposes.(We)agree to save inify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address ,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. /t r\`Z 3110 I understand my plans shall be used as public records. Date �J/ Signatwe licensed Professional CITY OF CUPERTINO PERMIT RECEIPT OPERATOR: patg 3 ITEMS OF 18 COPY # : 1 Sec: Twp: Rng: Sub: Blk: LDt: APN . . . . . . . . : 31638073 .00 DATE ISSUED. • • • • • • : 08/23/2010 254 RECEIPT #. . . . . . • . . : 1008001/11 REFERENCE ID # • • • 160 SITE ADDRESS 20083 NORTHCREST SQ . SUBDIVISION CUPER7'INO CITY . . . . . . . . . . . . IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : FARIBA NABAVI ADDRESS . . . . . . . . . . : 20083 NORTHCREST SQ CITY/STATE/ZIP . . . : CUPER`CINO, CA 95014 RECEIVED FROM . . . . : FOUR SEASONS ROOFIN CONTRACTOR DIAZ, ALFRED LIC # 21323 COMPANY FOUR SEASONS ROOFING ADDRESS . PO BOX 1668 CITY/STATE/ZIP (408)278,0330 95109 TELEPHONE . . . . . . . FEE ID UNIT QUANTITY AMCUNT PD-TO-DT THIS REC -_NEW-BAL- ---------- ---------- ---------- 1. 00 0 .00 ---------- 0 .00 4, 400 . 00 1 .00 1BCBSC VALUATION 0 .00 0 .50 0 .00 4,4 00 . 00 . 50 0 12 . 00 1566 .00 0 .00 156 .00 -_---- _00 1BSEISMICR VALUATION 1REROOFRES SQ FEET __ -----_ -- --- ------ 157 .50 0 .00 157 .50 0 .00 TOTAL PERMIT VOICE ID DESCRIPTION VOICE ID DESCRIPTION ---------------------------- 602 ROOF PLYWOOD NAIL 601 ROOF TEAR OFF 604 ROOF IN-PROGRESS 605 FINAL REROOF CITY OF CUPERTINO FEE ESTIMATOR-BU DING DIVISION D/►TE: REVIEWED BY: ADDRESS: APN: BP#: *VALUATION: $4,400 X*PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof ENTAMATION PRIMARY Jt>3 uilding is 1 MFDWLROOF EUSE: Multi-Family Dwelling Stories Yes No PERMIT TYPE: ORK OPE FEE ID ROOF AREA sS. 1REROOFMRES 1,200 NOTE. These fees are based on the preliminary information avail zble and are on1v an estimate. Contact the Dept for addn'l info, FEE ITEMS Lffee Resolution 09-051 Eft: 7/1/10) FEE Q TY/FEE MIS(ITEMS Stippi PC 1,,cc Permit Fee: $156.00 .Stlppl. Io?tij) ��t1si�I1'�'IC?'lt;it t�zd.?� Work Without Permit? C) Yes No $0.0) Strom;Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item Bldg S� tds Commission Fee_ IBCBSC $1.G0 SUBTOTALS:` $157.`.10 $0.00 TOTAL FEE: $157.50 Revised: 8/17/2010 r , y CITY OF (_l l CITY OF CUPFjRTINO REROOF CUPERTINO PERMIT APPLICATION Date: APN # r � - "� Z 3 0 Building Address: aHOA #:Owner's Name: � �� , � ���y� U � �7_ 7pD.S'2HOA: Yes ❑ No If es, rovide letter froe #:(Ye6)'q 7 g �05 S 0 Contractor'. S s�,-�s V :ractor LicenseCupertino Business License #: ��� S' Type of Roof Covering: P�-oposed: Existing: ❑ Built-Up roof ❑ Built-Up Roof 3r-' Asphalt Shingles ❑ Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles � Other (Specify) ❑ Other (Specify) �� wd o Number of existing coverings / ❑ Provide I.C.C.E.S. Report# ;iF-To be Removed ❑ Provide Mfgr. Installation Specs. rJoDescription: ^0 Ve --Q- CA.." o� Commercial Residential �7 Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if Green Building Checklist & attach it to the appli-.ation or if there are any restrictions: applicable, include in plan set t & the sheet index. Valuation: 4 YO I Have Read, Understand and Will Comply with Ci-pertino's Tear-Off Policy: /Z Signature Revised 02/05/09 REROOF TEAR-OFF POLICY COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING O=FICIAL FMI_ 10300 TORRE AVENUE • CUPERTINO, CA 950' 4-3255 UPERTINO (408)777-3228 • FAX(408)777-3333 • buildinMupertlno.ora f NPN P Pkl JECi,kDDK1 SS aV 3 ©� 4i ,C!� s�-, �� V/ PHONr' y r c,�/ E-MAIL 70c FAX �7 CITY, STATE-ZIP � CA,/L SUS. 2)e. 2 -.�'- LICE � f✓ LICENSE NU�k c'' �Z .7 N�TC/ FAJ( 4.'*) E-MAIL PHONE CIT STATEE,ZJI 9 �6-11Z 3 3U S'rRE[:a� I UNDERSTAND AND AGREE TO THE FOLLOWING: 1. The re-roof project shall comply with all applicable previsions of the 2007 California Building Code. 2. An inspection request shall be scheduled the day before the inspection date. Please call (408)777- 32x8 between 7:30 - 3:30pm (Mon-Fri) to schedule th,; next day inspection. 3. fitter 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 — 10:30,1m and 1:00 — 2:30phurs); m (Friday). 7:30 — 10:30am and P 4. If plywood is installed, a plywood nailing inspection ,s required. �. dew 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 obtaieTngs inspection can be performed.inspection will require the removal of all new material down to the s.ieathtng so a prop p 6. A final inspection and approval shall be obtained from the building inspector when the re Ing is completed. To receive a final sign-off, the following item will be verified: a. Flat roofs shall have a minimum of '/4" per foot of slope and demonstrate there 's no ponding. b. A listing from an approved testing agency shall be a,,ailable on-site to review at the time of the inspection. c. Proper spark arrestor installation. 7. NOTE: If you call for a plywood nailing inspection and the job before early, you lelebion cane anebe o a re- inspection fee shy inspection fee of$126.00. The re- Il be para scheduled. [�,­ mysignature below, I certify to each of the following: Iam the property owner or authorized agent to act on property owner's behalf. I u er d and agree to comply with the re-roof policy stated ah ZPDate:gnature of Applicant/Agent: ReroofPolicy_20IO.doc revised 041 4,'l0