10080163 CITY OF CUPERTINO BUILDING PERMIT
CONTR+CTOR:FOUR SEASONS ROOFING PERMIT NO: 10080163
BUILDING ADDRESS: 20113 NORTHCREST SQ PO BOX 1668 DATE ISSUED:08/23/2010
OWNER'S NAME: THEODORE A LEICHER SAN JOSE,CA 95109 PHONE NO:(408)278-0330
iER'S PHONE: 4082539594
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB r
7 Z MECH r RESIDENTIAL COMMERCIAL
License Class Cr � Lic.#_�
j/'2 Date /V JOB DESCRIPTION:RE-ROOF REMOVE EXISTING CEMWWOOD ROOF&
Contractor
licen
se
under the provisions of Chapter 9 INSTAL L A
I hereby affirm that I am
NEW CLASS A COMPOSITION SHINGLE.GAF GRAND CANYON
(commencing with Section 7000)1force and effect.f Division 3 of the Business&Professions (COLOI_)STONEWOOD 12 SQ
Code and that my license is in full
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 Valuation:$4400
Section 3700 of the Labor Code,for the performance of the work for which this Sq Ft Floor Area:
:J
permit is issued.
APPLICANT CERTIFICATION Occupancy Type:
I certify that I have read this application and state that the above information is
APN Plumber:31638076.00
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
PENT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may accnie against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply
with all non-point sou a regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTIO
9.18. /,� Date:
L..-� Date Issued by:
Signature
OW
❑ NER-BUILDER DECLARATION RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of All r>ofs 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, installed without first obtaining an inspection,I agree to remove all new materials or
ins xtion.
will do the work,and the structure is not intended or offered for sale(Sec.7044, p' Date.
Business&Professions Code) Sigr ature of Applicant:
1,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: HAZARDOUS MATERIALS DISCLOSURE
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 I h;the read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. Ca ifornia Health&Safety Code,Sections 25505 Chapter 9.12 and the Health&,25533,and 25534. 1 will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by
coy npliance with the Cupertino Municipal Code,
Sa ety Code,Section 25532(a)should I store or handle hazardous material.
Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air
permit is issued. Chapter Dist and the
I certify that in the performance of the work for which this permit is issued, m�intain compliance with h the Cupertino Municipal Code,Air Quality
Chapteragement District I will
not employ any person in any manner so as to become subject to the H4 alth&Safety Code,Sections 25505,25533,and 25534.
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 O.Niter or auth ' ed gc'Ilt: ayl?,-J
forthwith comply with such provisions or this permit shall be deemed revoked.
Date:
ENCY
APPLICANT CERTIFICATION CONSTRUCTION LENDING AG
I certify that I have read this application and tate at the above information is
I iereby affirm that there is a construction lending agency for the performance of work's
sth
correct.I agree to comply with all city and county ordinances and state laws relating fi 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
mify and keep harmless the City of Cupertino against liabilities,judgments, I ender'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 fans shall be used as public records.
9.18. nle 1 understand my p
Date_ '!
Siature Licensed Professional
gn
CITY OF CUPERTINO
PERMIT RECEIPT OPERATOR: patg
3 ITEMS OF 18 COPY # : 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 31638076 .00
DATE ISSUED. . . . . . . : 08/23/2010
RECEIPT #. . . . . . . . . BSOOOC11254
REFERENCE ID # 10080363
SITE ADDRESS 20113 NORTHCREST SQ
SUBDIVISION . . . . . . .
CITY CUPER-INO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : THEODORE A LEICHER
ADDRESS : 20113 NORTHCREST SQ
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM FOUR 3EASONS FRED ROOICN# 21323
CONTRACTOR . . . . . .
COMPANY FOUR SEASONS ROOFING
ADDRESS . PO BOX 1668
CITY/STATE/ZIP SAN JOSE, CA 95109
TELEPHONE . . . . . . . . : (408) 278-0330
FEE ID UNIT QUANTITY AMCUNT PD-TO-DT THIS REC- _-NEW_BAL-
---------- -------------
----------
---- ------ ----------
-------
00
1BCBSC VALUATION 4, 400 . 00 1 .00 0 . 00 1 . 00 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 -- - -
TOTAL PERMIT
157 .50 0 .00 157 .50 0 .00
METHOD OF PAYMENT AMOUNT -REFERENCE
-NUMBER--
---------------
CHECK 945 .00 :#010036
---------------
TOTAL RECEIPT 945 . 00
VOICE ID DESCRIPTION
VOICE ID DESCRIPTION ____________________________
----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
CITY OF CUPE ftTINO VISION
FEE ESTIMATOR- DING
DI REVIEWED BY:
DATE:
ADDRESS: *VALUATION: $4,400
BP#:
APN:
PLAN CHECK TYPE: Re-roof NTAMATION
*PERMIT TYPE: Minor Building Permit 1 MFDWLROOF
Building is Yes No PERMIT TYPE:
PRIMARY Multi-Family Dwelling >3 Stories C
USE:
WORK
SCOPE
FEE ID ROOF AREA
s.L
1 REROOFMRES 1,200
of?ttJ7 f-, i'c'y_
t�lfrf'i'�1�1ltti; hr"")
{1I;;.' l,,';h, :;,f: i./✓c' lF}_r7 i'2e:
he reliminar in ormation available and are onlyan estimate. Contact the De tor addn'l in o.
NOTE: These ees are based on t FEE QTY/FEE MISC ITEMS
FEE ITEMS (Fee Resolution 09-051 Fft 7%1110
Mal", ! F.
tr i
$156.00
Permit Fee:
tjttitt�(z_':l sf. t� 'L�t�
i t?t7,4'il2tC�H?;, �a
,'iEC3tLb/lfzFll�'c3-fc'tt 1e'C'. $
O.00
Work Without Permit? Yes
Q No
I't`cs 'J I3c7r2 ,rz tttt�tiOt1 `'`` Select an Administrative Item
Stron�)r Motion Fee:
I BSEISWCR $0.50
30SC $1. 157.50
Bldg Stds Commission Fee: IBCB0.00 TOTAL
SUBTOTALS: $157.50 $ Revised: 8/17/2010
CITY OF `
CITY OF CUPERTINO
REROOl+
CUPER
TING PERMIT APP
_7LI��ATION
Date: Z3 /0
Building Address: Q l 13 S G.
Phone
Owner's Name: --� � ,�.� 1'.0j„2/ ��� — 2�� �
HOA: Yes ❑ No ❑ If es, rovide letter fro n �A Phone#:(wok ? 'v33C
Contractor: —x333
Fax#:
ContractoLicense #:
Cupertino Business License #: .2 3 23 7,2/
'type of Roof C overing:
Pr oposed:
Existing: ❑ Built-Up roof
❑ Built-Up Roof 370- Asphalt Shingles
❑ Asphalt Shingles ❑ Wood Shakes
❑ Wood Shakes ❑ Wood Shingles
❑ Wood Shingles ❑ Other (Specify)
Other (Specify) wO ❑ Provide I.C.C.E.S. Report#
Number of existing coverings Z ❑ Provide Mfgr. Installation Specs.
vr--To be Removed
li1�i �
Job Description: �DVe. G,4-� CAO"Cti( o
^/�> �r'e. �t.. .�g
deo"(
l �
Commercial
Residential
Tete relevant portion of the Confirmed with Planning Dept- if
Green Building. Please comp ❑
Green Building Ch
ecklist & attach it to the application or if there are any restrictions:
a licable, include in Plan set
t & the sheet index.
Valuation: Z/ L
00
IHave Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
Signature
Revised 02/05/09
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
Ll 10300 TORRE AVENUE • CUPERTINO, CA 95C 14-3255
-UPERTINO
(408)777-3228 • FAX(408)777-3333 • building �cupertino.orq
PR.OILCl.ADDkESS • / o r 4,
C��, APN H
/ ✓� j PHONr ��UE-MAIL
�W
/ G�� CITY, STATE zia ' FAXk
LICENSE NUMBER LICEN�TYg BUS.�IC/H
E-MAIL FAX �
COMP.A:NY ti'A.ME
CIT STATE
95/lZ U330
I UNDERSTAND AND AGREE; TO THE FOLLOWING:
1. The re-roof project shall comply with all applicable prDvisions of the 2007 California Building Code.
2. An inspection request shall be scheduled the day before the inspection date. Please call (408)777-
322S between 7:30 - 3:30pm (Mon-Fri) to schedule the next day inspection.
3. After 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 — 10:30:im 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 )btaining 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. tinal inspection and approval shall be obtained fror i the building inspector when the re-roofing is
completed. To receive a final sign-off, the following item will be verified:
Flat roofs shall have a minimum of/" per foot of slcpe 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.
NOTE: If you call for a plywood nailing inspection ind 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.
my signature below, I certify to each of the following: I am the property owner or authorized agent to act on
property owner's behalf. I u er nd and agree to comply with the re-roof policy stated ab vP
Date:
S12nature of Applicant/Agent:
ReroofPolicy_2010.doc revised 04114,'10