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10080043 CITY OF CUPERTINO B UILDING PERMIT BUILDING ADDRESS: 10950 NORTHSKY SQ CONTRACTOR:FOUR SEASONS ROOFING PERMIT NO: 10080043 OWNER'S NAME: LEONID BITMAN PO BOX 1668 DATE ISSUED:08/05/2010 QER'S PHONE: 4085551212 SAN JOSE,CA 95109 PHONE NO:(408)278-0330 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG I— ELECT I— PLUMB r License Class L Lic.# Lr / Z 2!/O /� MECH r RESIDENTIAL COMMERCIAL Contractor Date ld JOB DESCRIPTION:RE-ROOF RMV EXISTING CEMWOOD ROOF&INSTALL I hereby affirm that I am licensed under the provisions of Chapter 9 NEW (commencing with Section 7000)of Division 3 of the Business&Professions GAF GRAND CANYON ASPHALT COMP 50YR ROOF SYSTEM, Code and that my license is in full force and effect. ST014EWOOD IN COLOR 14SQ CLASS A 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 ,:t Floor Area: Valuation:$5200 permit is issued. APPLICANT CERTIFICATION anc Occu Type: I certify that I have read this application and state that the above information is APP l Number:31640059.00 Occupancy YP 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 r lations per the Cupertino Municipal Code,Section 180 DA FROM LAST CALLED INSPECTION. 9.18. Signature Date « Iss ied by: - Date: �� 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 1,as owner of the property,or my employees with wages as their sole compensation, ins ailed 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, ins)ection. C, ^ Business&Professions Code) Sif nature 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 1 ave 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. 1 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 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 cc ntaminants 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 in iintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Compensation laws of California. If,after making this certificate of exemption,I H!alth&Safety Code,Sections 25505,25533,and 25534. become subject to the Worker's Compensation provisions of the Labor Code,I must Owner o Aor' agent: forthwith comply with such provisions or this permit shall be deemed revoked. Date: (J 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 iereby affirm that there is a construction lending agency for the performance of work's to building construction,and hereby authorize representatives of this city to enter fr r which this permit is issued(Sec.3097,Civ C.) upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name --unify 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 g.....cing of this permit.Additionally,the applicant understands and will comply with all non-point ource regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION 9.18. z�l I understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CITY OF CUPERTINO RER00F C v Y E RT 1 N a PERMIT APPLICATION ---- — Date: Address: Name: �,,,..ev,ti �4 Phone #: 3t%: `des No ❑ If yes, provide letter from HOA o 3 3 e� �, Phone #: C-� -4�- " Fax#: 0 &_) - - ---:- Contractor License #: AiperLino Business License #: Z/08 I 2/,�2 3 Type of Roof Covering: F ropo sed•: L:�iy11rl": Built-Up Roof ❑ Built-Up roof Asphalt Shingles Asphalt Shingles Lj u Wood Shakes ❑ Wood Shakes W ❑ Wood Shingles Wood Shingles Other S c c if �� ❑ Other (Specify) ( p'' y) � umber of existing coverings ❑ Provide LC.C.E.S. Report m # ❑ Provide Mfgr. Installation Specs. u `I'o be Removed > l -- rte►c/ ,u`--� .lois 1)cscription: Ve --%----- Commercial ❑ 1`�>iclencial -- - — — Confirmed with_Planning Dept. if Green Building: Please complete relevant partioi� of the I Green building Checklist & attach it to the appli:.ation or if there are any restrictions: ❑ �gjplicabie, include in plan set & the sheet index. 'V'Uidation: S 20 Li 5 Kead, Understand and Will Comply with Cupertino's Tear-Off Policy: S i ;nature Revised 02/05/09 REROOF TEAR-OFF POLICY COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 JPERTINO (408)777-3228 • FAX(408)777-3333•buildin �cupertino.ora Fi1R,0),JEC1RESS APN H 10o � uCPHONEE-MAIL� � JEK NERNANIF CITY, STATE,ZIP FAX S"fRE[iT ADDRESS Lao- LICENSE NUMBER LICENSE PE BUS.LIC.N CONTRACTOR NAME tDnp 7 F7� f E-MAIL FAX COMPANY NAME A� CITY,STATE,ZIP PHONE 7 G CTRL-LT ADDRESS 17 ) I UNDERSTAND AND AGREI 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. After the roof is torn off and the nails/fasteners have been removed and all the dry-rotted wood has )een 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 - 10:302 m and 1:00 -3:30pm (Mon-Thurs); 7:30 - 10:30G.m and 1:00 -2:30pm (Friday). 4. if plywood is installed, a plywood nailing inspection 1; 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 s)'eathing 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 1/" per foot of slo)e 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. 7. NOTE: If you call for a plywood nailing inspection 2nd 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. P 1y signature below, I certify to each of the following: [ am the property owner or authorized agent to act on tli., property owner's behalf. I n stand ao agree to comply with the re-roof policy stated above. Signature of Applicant/Agent: Date: ReroofPolicy_1010.doc revised 04114110 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C O P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: PERMIT# `` PHONE# OWNER'S NAME: GENERAL CONTRACTOR: BUSINESS LICENSE# ADDRESS: CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRAcl-ORS HAVE OBTAINED A CITY OF PERTINO BUSINESS LICENSE. 71— C 1 am not using any subcontractors: Signature Date Please check applicable subcontractors and complete i he following information: f SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # i Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring/ Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting /Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date