10080044 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10940 NORTHSKY SQ CONTI;ACTOR:FOUR SEASONS ROOFING PERMIT NO: 10080044
PO BOK 1668 DATE ISSUED:08/05/2010
OWNER'S NAME: JAMES CARLOCK PHONE NO:(408)278-0330
SAN JOSE,CA 95109
NER'S PHONE: 4089967956
LICENSED CONTRACTOR'S DECLARATION BUIL!)ING PERMIT INFO: BLDG ELECT PLUMB
License Class
i Lic.# �? zea O MECH r RESIDENTIAL COMMERCIAL
Contractor Date S
JOB DESCRIPTION:RE-ROOF RMV EXISTING CEMWOOD ROOF&INSTALL
I hereby rm that I am licensed under the provisions of Chapter 9 NEW
(commencing with Section 7000)of Division 3 of the Business&Professions GAF C RAND CANYON ASPHALT COMP 50YR ROOF SYSTEM,STONI3WOOD IN COLOR 14SQ CLASS A
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 Valuation:$5200
Section 3700 of the Labor Code,for the performance of the work for which this Sq F:Floor Area:
permit is issued.
APPLICANT CERTIFICATION Occupancy Type:
I certify that I have read this application and state that the above information is APN Number:31640058.00
correct.I agree to comply with all city and county ordinances and state laws relating
to building construction,and hereby authorize representatives of this to savity to e
upon the above mentioned property for inspection purposes. (We)agreeERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
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 t80 DAY FR M LAST CALLED INSPECTION.
9.18. �e l Date: -to
Signature Signature
Date Isst ed by:
OWNER-BUILDER DECLARATION
RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs 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, inspection.tirthout first obtaining an inspection,I agree to remove all new materials or
ee
will do the work,and the structure is not intended or offered for sale(Sec.7044, � Date:W'(
Business&Professions Code) Signature of Applicant:
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: HAZARDOUS MATERIALS DISCLOSURE
I have and will maintain a Certificate of Consent to helLabo re for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the I 1 ave read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. C:Jifornia 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&
Sf fety 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 A iditionally,should I use equipment or devices which emit hazardous air
permit is issued.
I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,rCh Chapter 9.12agement rict I will
and the
not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534.
Compensation laws of California. If,after making this certificate of exemption,I01
J� O
become subject to the Worker's Compensation provisions of the Labor Code,I must C wrier or aut ize� (/
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 hereby affirm that there is a construction lending agency for the performance of work's
I
correct.1 agree to comply with all city and county ordinances and state laws relating Or 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
iriemnify 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
licant understands and will comply
_sting of this permit.Additionally,the appARCHITECT' DECLARATION
with all non-point srce regulations per the Cupertino Municipal Code,Section S
9.18. I/, understand my plans shall be used as public records.
Signature I� Date
Licensed Professional
CITY OF CUPERTINO
3 ITEMS OF 18 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: hot:
APN . . . . . . . . : 31640058 . 00
DATE ISSUED. . . . . . . : 08/05 /2010
RECEIPT #. . • . • . . • . : BS000 )11098
REFERENCE ID # . . . : 10080)44
SITE ADDRESS . . . . . : 10940 NORTHSKY SQ
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : JAMES CARLOCK
ADDRESS : 10940 NORTHSKY SQ
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : FOUR SEASONS ROOFIN
CONTRACTOR DIAZ, ALFRED LIC # 21323
COMPANY . . . . . . . . . . : FOUR SEASONS ROOFING
ADDRESS . PO BC,X 1668
CITY/STATE/ZIP . . . : SAN DOSE, CA 95109
TELEPHONE . . . . . . . . : (408) 278-0330
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- -------------
---------- ---- ------ ---------- -
1BCBSC VALUATION 5, 200 . 00 1 . 00 0. 00 1 . 00 0 .00
1BSEISMICR VALUATION 5, 200. 00 0 .60 0. 00 0 . 60 0 .00
1REROOFRES SQ FEET 14 . 00 182 . 00 0. 00 182_00 ------0_00
----
TOTAL PERMIT
183 .60 0 .00 183 .60 0 .00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-- ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
c,Ty OF
CITY OF Cl-iPERTINO
REROGF
pERMIT APPLICATION
CUPERTINO
Date:
? //0
ljo /\,ddreSS:
/0 phone —795
Name: 3.4o_ s f C)cV—
If i` Yesyes, Provide letter fr:)m HOA 5 3 c-D
No 0
Phone
Fax
Contractor License #:
Business License #:
Type of Roof Covering:
Y roposed:
till g: ❑ Built-Up roof
Built-Up Roof Asphalt Shingles
L� Asphalt Shingles E3 Wood Shakes
Wood Shakes L3 Wood Shingles
Ll Wood Shingles
Other (Specify)
Other (Specify) provide I.C.C.E.S. Report 4
;�utnber of existing coverings
c3 Provide Mf9r. Installation Specs.
u To be Removed Z/
lot) Descl* pt
i ion:
Commercial ❑
Confirmed withPlanningDept. if
complete relevant portion of the restrictions:Green Building: Please
Green Building Checklist & attach it to the application or if there are any rest if
Aicable, include in plan set & the sheet index.
v!11,1L,,atioa:
0
Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
SignatLlre
Revised 02/05/09
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT• 3UILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING O-FICIAL
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
JPERTINO
(408)777-3228 • FAX(408)777-3333• building a cupertlno.orq
/� �Yd / r7t/5�" 7PHO�
PN#
PROJEC'I'ADDRESS dE ( E-MAIL
0WNL•R ANANIE STATE,ZIP FAX
S I REGT�a.DDR)SS �. _ Q
LICENSE NUMBER /Q� LICENSE TYP BUS.LIC.N `��3
CONTRACTOR NAME �SS� ��F ,3� [ (' �?
E-MAIL FAX
COMPANY"N.ANIE
CITY,STATE,ZIP 7 P U W
f
STRELT ADD16 SS y 1
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 befor a the inspection date. Please call (408)777-
3228 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 — 10:30an and 1:00 —3:30pm (Mon—Thurs);
7:30 — 10:30an 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 sh-.athing 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 I/" per foot of slope and demonstrate there is no ponding.
b. A listing from an approved testing agency shall be ave ilable 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 a-id the job is not ready, you will be charged to a re-
inspection fee of$126.00. The re-inspection fee shalt be paid before another inspection can be
scheduled.
_ny signature below, I certify to each of the following: 1 am the property owner or authorized agent to act on
ti,,; property owner's behalf. I unders nd d a ree to com)ly with the re-roof policy staff/above.
Date:
Signature of Applicant/Agent:
ReroojPolicy_201 0.doe revised 04114110