10080042 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10960 NORTHSKY SQ CON'CRACTOR:FOUR SEASONS ROOFING PERMIT NO:10080042
OWNER'S NAME: BRUCE GOLDETSKY
PO B 31X 1668 DATE ISSUED:08/05/2010
ZER'S PHONE: 4083662120
SAN LOSE,CA 95109 PHONE NO:(408)278-0330
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
License Class C"3 9 Lic.# ef 7210 MECH r RESIDENTIAL r COMMERCIAL
Contractor��/�— Date 10
_V9— 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 SRAND CANYON ASPHALT COMP 50YR ROOF SYSTEM,
Code and that my license is in full force and effect. STOT IEWOOD 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 int Floor Area: Valuation:$5200
permit is issued.
APPLICANT CERTIFICATION occupancy Type:
I certify that I have read this application and state that the above information is APPf Number:31640060.00 p y
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 sou ce egulations per the Cupertino Municipal ode,Section 180 DAYS F LAST CALLE INSPECTION.
9.18. 4i, Date 4 � Issued b
Date:
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, ins aped without first obtaining an sped' n,I agree to remove all new;tenals or
will do the work,and the structure is not intended or offered for sale(Sec.7044, ins section. _
Business&Professions Code) Dat
1,as owner of the property,am exclusively contracting with licensed contractors to Si€nature of Applicant:
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:
1 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. C:,lifornia 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 SF fety 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 maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Compensation laws of California. If,after making this certificate of exemption,I
H aalth&Safety Code,Sections 25505,25533,and 25534.
become subject to the Worker's Compensation provisions of the Labor Code,I must Owner or authorized agent:
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
ting 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 rela
to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.)
upon the above mentioned property for inspection purposes.(We)agree to save
Lender's Name
indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
is,and expenses which may accrue against said City in consequence of the
_nting of this permit.Additionally,the applicant understands and will comply
with all n7:jurce egulations per the Cupertino Municipal Code, ection ARCHITECT'S DECLARATION
9.18. /� p /� I understand my plans shall be used as public records.
Signature Date o ? !/
licensed Professional
CITY OF CUPERTINO
PERMIT RECEIPT OPERATOR: patg
3 ITEMS OF 18 COPY # : 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN 31640060 .00
DATE ISSUED. . . . . . . : 08/BSO000.L0098
10
RECEIPT #. . . . . . . . .
REFERENCE ID # 10080012
SITE ADDRESS . . . . . : 10960 vORTHSKY SQ
SUBDIVISION CUPERTINO
CITY . . . . . . . . . . . .
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : BRUCE GOLDETSKY
ADDRESS . 10960 NORTHSKY SQ
CITY/STATE/ZIP CUPER'IINO, CA 95014
RECEIVED FROM FOUR E,EASONS ROOFIN
CONTRACTOR DIAZ, ALFRED LIC # 21323
COMPANY FOUR :SEASONS ROOFING
ADDRESS . PO BO:: 1668
CITY/STATE/ZIP SAN OSE, 0CA 95109
TELEPHONE . . . . . . .
FEE ID UNIT QUANTITY AMO JNT PD-TO-DT THIS REC -----------
---------- ------- ---------
---------- ------------- 0 .00 1.00 0 .0
1BCBSC VALUATION 5, 200 . 00 1.00 0 .00 0. 60 0 .00
1BSEISMICR VALUATION 5, 200 . 00 0 .60 0 .00 182 .00 0 .00
1REROOFRES SQ FEET 14 . 00 182 .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
2-
c,TY OF
CITY OF CUP ERTINO
REROCiF
PERMIT APPLICATION
CUPERTINO
Date-
Address:
Phone 4:
Name:
V No ❑ Ifyes, provide letter from HOA
Phone 9: 6-ill
C L j r:
Fax 0"_)
Contractor License #:
Cupertino Business License &
Type of Roof Covering:
Proposed:
Existilig: ❑ Built-Up roof
j Built-Up Roof
L Asphalt Shingles ❑ Asphalt Shingles
Wood Shakes
Li Wood Shakes
L] Wood Shingles
Wood Shingles
u Other (Specify)
Other (Specify) .
Urnber of existing coverings ocr U Provide I.C.C.E S. Report
To be Removed U Provide Mfr. Installation Specs.
g
-oto Description:
_ 'y______ ___Fill Commercial
❑
e Confirmed withPlanningDept. if
if
complete relevant a
tiof th Pt Building: Please c n or if there are any restrictions: ❑Greeii Building Checklist & attach it to the pplicatio
plicable, include in plan set & the sheet index.
V�',ILLation*
1Zead, Understand and Will Comply with Capertino's Tear-Off Policy:
S,qlPaturc 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
J P E RT I N O (408)777-3228 • FAX(408)777-3333 • building c iperti�rg
AP4#
?KOIEC"l ADDRESS O^ /O '^ �
"� (O �/ E-MAIL
n PHONE.` //1
ENA � 1 � k(\ CCC✓✓✓lllFA\
CITY, STATE,ZIP
LICENSE+TYPE� BUS.?ICI# L3
LICENSE NUMBER 33
CONTRACTORNAMG ��
C`C FAX
E-MAIL
COhil'r\NY"NAivIE �1
PHONE ys
CITY,STATE,ZIP f^
STREEI'ADDRESS �Q L a M6 J
I UNDERSTAND AND AGREE TO THE FOLLOWING:
1.
The re-roof project shall comply with all applicable pro,iisions of the 2007 California Building Code.
An ins ection request shall be scheduled the day
before the inspectionte. Please call (408)777
2. p
3228 between 7:30 - 3:30pm (Mon-Fri) to schedule the next day inspection. rotted wood has
3. After the roof is torn off and the nails/fasteners have kuilding dwall ll beeavailable with one hour.
'peen replaced, you must call for a roof inspection. A buildinginspector
There are special hours for the service: 7:30 – 10:30ain and 1:00
7:30 – 10:30ain and 1:00_3:30 (Mon
( hurs);
p
m (Friday).
4. If plywood is installed, a plywood nailing inspection is required. inspection and written approvals from
5. New roof coverings shall not be applied without first ootaining allroved inspection will
the building inspector. Any roofing which is applied without
first so a propernnspecan pon can be performed.
require the removal of all new material down to the sh g
A final ins ection and approval shall be obtained from the building in fiedtor when the re-roofing is
6. p
completed. To receive a final sign-off, the following item will be vera
a. Flat roofs shall have a minimum of per foot of slope and demonstrate there is no ponding.
b. A listing from an approved testing agency shall be av,.ilable on-site to review at the time of t
he
inspection. - -
c. Proper spark arrestor installation.
NOTE: If you call for a plywood nailing inspection and the job is not ready,another, will
ecbion can be e charged o a re-
l. y —
inspection fee of$126.00. The re-inspection fee shall be paid before
scheduled.
own or authorized owner
p- -n signature below, I certify to each of the following: [ am the property eroof olicy fated abovegent to act on
Y
th property owner's behalf. I nd tand agree to corr.ply with t p d/oma
Date:
Signature of Applicant/Agent:
ReroofPolicy_2010.doe revised 04/14110
I
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
its Telephone: 408-777-3228
Fax: 408-777-3333
CUPERTINO
CONTRACTOR/ SUBCONTRACTOR LIST
4062 01
JOB ADDRESS: PERMIT#
OWNER'S NAME: PHONE#
GENERALCONTR
ACTOR: BUSINESS LICENSE#
ADDRESS: CITY/ZIPCODE:
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
NO BUILDING
FINAL ERTIN
GENERAL CONTRACTOR AND ALL SUB,CONTRACCORS HAVE OBTAINED A CITY OF CUP
BUSINESS LICENSE.
I am not using any subcontractors: Date �
Signature
Please check applicable subcontractors and complete the following information:
I
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring/ Carpeting
Linoleum /Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting/Wallpaper
Paving
Plastering
Plumbing
oofing� _
-septic Tank
Sheet Metal
Sheet Rock
Tile
Date
Owner/Contractor Signature