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10080161 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20093 NORTHCREST SQ #CONT?ACTOR:FOUR SEASONS ROOFING PERMIT NO: 10080161 X 1668DATE ISSUED:08/23/2010 OWNER'S NAME: GREGORY BROOK PHONE NO:(408)278-0330 VER'S PHONE: 6509171207 SSE,CA 95109 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT F PLUMBFr- r License Class Lic.# / L1+t'�o MECH RESIDENTIAL COMMERCIAL r Contractor Date JOB DESCRIPTION:RE-ROOF REMOVE EXISTING CEMWWOOD ROOF& I hereby affirm that I am licensed under the provisions of Chapter 9 INSTP LL A (commencing with Section 7000)of Division 3 of the Business&Professions NEW CLASS A COMPOSITION SHINGLE.GAF GRAND CANYON (COL<►R)STONEWOOD 12 SQ Code and that my license is in full force and effect. 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 FAPN t Floor Area: Valuation:54400 permit is issued. APPLICANT CERTIFICATION Occupancy Type: 1 certify that I have read this application and state that the above information is Number:31638074.00 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 sours regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION. 9.18. � Date Z) Isst ed by: Date: Signature [� OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All-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, instilled without first obtaining an inspection,I agree to remove all new materials or will do the work,and the structure is not intended or offered for sale(Sec.7044, insl-ection. Business&Professions Code) Sig mature of Applicant: -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 DISCLOSURE Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain I have and will maintain Worker's Compensation Insurance,as provided for by co npliance 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 H taltain compliance Safety CodeSections h the Cupertino Munand 25534e,Chapter 9.12 and the Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must Owner ora rite agent: (j/��/� forthwith 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 is I iereby 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 Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save nify 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. 1 understand my plans shall be used as public records. Si WI !� Date Zia/� Licensed Professional gnatttre CITY OF CUEERTINO 3 ITEMS OF 18 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: I,ot: APN . . . . . . . . : 31638074 .00 DATE ISSUED. . . . . . . : 08/23,'2010 RECEIPT #. . . . • • . . . : BS000o11254 REFERENCE ID # . . . : 10080:_61 SITE ADDRESS 20093 NORTHCREST SQ SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERPINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : GREGORY BROOK ADDRESS : 20093 NORTHCREST SQ CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM FOUR SEASONS ALFRED ROOICN# 21323 CONTRACTOR . . . . . . COMPANY . . . . . . . . . . : FOUR SEASONS ROOFING ADDRESS : PO BCX 1668 CITY/STATE/ZIP . . . : SAN LOSE, 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 .0 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 ------ _ _ - ------ -- ----------- - -- ---------- __ 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF CITY OF CUPI RTINO FEE ESTIMATOR—BUI]�DING DIVISION DA"E: REVIEWED BY: ADDRESS: *VALUATION: $4,400 APN: BP#: Re-roof PLAN CHECK TYPE: of *PERMIT TYPE: Minor Building Permit PENTAMATION 1 MFDWLROOF PRIMARY Buildina is Yes No PERMIT TYPE: Multi-Family Dwelling >3 Stories USE: WORK SCOPE FEE ID ROOF ARE?. s.L 1REROOFMRES 1,200 e based on the relimina in ormation availeble and are onl an estimate. Contact the De t or addn'1 in o. NOTE: These ees ar FEE QTY/FEE MISC ITEMS FEE ITEMS (Fee Rcsoh{tion 09-051 Fff 7/1/10) f h,w 0w, Sl,ppl. I I'It.7DZlT..':�IccJ1, 11-7c(_ P/al; ( P1cck. $156.00 Permit Fee: 'f;(t:( 'oil Work Without Permit. Yes E) No 0.0-3 IL 1 t' 77"'� -}fti'I{Itii'11l;lilE)}7 t''�• Select an Administrative Item Strong Motion Fee: IBSEISMICR $0•`'0 Idg, Stds Cormnission Fee: IBcasc $1.()0 SUBTOTALS: $157.:10 $0.00 TOTAL FEE: $157.50 Revised: 8117/2010 CITY OF CITY OF CUPERTINO E21REROOF CUPERTINO PERMIT APPLICATION Date: /� \ x //3 /0 APN # i+ j �✓ Oq v ` Building Address: ©0� 3 dry aHOA Owner's Name: � � ort j �HOA: Yes ❑ No ❑ If es rovide letter fro033�Contractor: rov : F��.27,F'0333actor License #: Cupertino Business License #: 3 23 �/� 8 Type of Roof Covering: E Proposed: Existing: ❑ Built-Up roof ❑ Built-Up Roof Asphalt Shingles ❑ Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles 71 Other (Specify) �-�.� wo� � ❑ Other (Specify) / ❑ Provide I.C.C.E.S. Report# Number of existing coverings ❑ Provide Mfgr. Installation Specs. ,vr--To be Removed �0 ve Job Description: 4: 5. J �vr�.� Crams ��d.� g i�- ,4 tom-- Cir ~`'`I eA Residential 12 — Commercial Confirmed with Planning Dept. if rGGreen een Building: Please complete relevant portion of the _ Building Checklist & attach it to the application or if there are any restrictions: applicable, include in plan set & the sheet index. Valuation: 4 yD0 I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy: Signature Revised 02/05/09 REROOF TEAR-OFF POLICY COMMUNITY DEVELOPMENT DEPARTMENT - B JILDING DIVISION .. ALBERT SALVADOR, P.E., C.B.O., BUILDING OF'-ICIAL 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 U P E RT I N (408)777-3228 • FAX(408)777-3333 • buildin cupertin ..ora AINM PROIECT:\DDfLESS ��� �� ����- ' PHON7G E-MAIL /7 —12v7 FAX( — { J CITY, STATE_IP /'_i! Li`.��._ LICENS`TY BUS.LIC,N�Z� LICENSE NUMBER C_ FAX E-MAIL PHONE CIT STATE,ZI 9 ,5/�Z U3.30 STaEEO'�KL5 � , �' I UNDERSTAND AND AGREE TO THE FOLLOWING: - project of the 2007 California Building Code. 1. The re-roof p Ject shall comply with all applicable previsions request shall be scheduled the day befor e the inspection date, Please call (408)777- 2. An inspectionq 3225 between 7:30 - 3-.30pm (Mon-Fri) to schedule the next day inspectid all the dry-rotted wood has ;. Atter the roof is torn off and the nails/fasteners have building lding insp etor will be available with one hour. been replaced, you must call for a roof inspection.'here ares ecial hours for the service: 7:30 — 10:30am and 1:00 _2..30p (Friday). _m (F day) burs); p 7:30 — 10:30am and 1:00 P 4, if plywood is installed, a plywood nailing inspection i,; required. coverings shall not be applied without first obtaining all inspection and written approvals from 5. Ntew roof c d lied without first obtaining an approved inspection will the building inspector. Any roofing which is app proper ins inspect can be performed. require the removal of all new material down to the s1 Bathing so a pinspectorppwhen the re-roofing is 6. A final inspection and approval shall be obtained fron the building rified: completed. To receive a final sign-off, the following item will be veis no ponding. a. Flat roofs shall have a minimum of I/4" per foot of slcpe and demonstrate there gency shall be a,,ailable on-site to review at the pon of the b. A listing from an approved testing a inspection. c. Proper spark arrestor installation. you will be charged to a re- l. NOTE: If you call for a plywood nailing inspnd ection al beh e jaid before another ins ection can be inspection fee of$126.00. The re-inspection fee sho 1 scheduled._ ent r n signature below, I certify to each of the following: :::ho:: propertyof olicy fated ah authorized owner or f_ to act on t Y property owner's behalf. I un er nd and agree to cop Date: Zy - Si nacurc of Apphcant/Agent: ReroofPolicy_2010.doc revised 04,'l 4il0