10080041 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10970 NORTHSKY SQ CON-RACTOR:FOUR SEASONS ROOFING PERMIT NO: 10080041
OWNER'S NAME: ROGER CHEN
PO B,3X 1668 DATE ISSUED:08/05/2010
PHONE NO:(408)278-0330
4ER'S PHONE: 4082579569
SAN.FOSE,CA 95109
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB
License Class L 9 Lic.# ! 77 t 07 MECH r- RESIDENTIAL r- COMMERCIAL
Contractor Date J Q
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 :;RAND CANYON ASPHALT COMP 50YR ROOF SYSTEM,
Code and that my license is in full force and effect. STONEWOOD IN COLOR 14SQ CLASS A
I hereby affirm under penalty of perjury one of the following two declarations:
1 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 Ft 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 API' Number:31640061.00 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 O
with all non-point source regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION.
9.18. Q
Signature Date V Id Issued by: Date:
I✓ 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, installed 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, inspection. �-
Business&Professions Code) 4��_Date: 01-r1le
1,as owner of the property,am exclusively contracting with licensed contractors to
Signature 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:
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.
Cz lifornia 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 upliance 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 in tintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Compensation laws of California. If,after making this certificate of exemption,I
Health&Safety Code,Sections 25505,25533,and 25534.
become subject to the Worker's Compensation provisions of the Labor Code,I must O vner or-author. d agent: �a
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 Lender's Name
r which this permit is issued(Sec.3097,Civ C.)
upon the above mentioned property for inspection purposes.(We)agree to save
L
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
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Muniipal C ce,Section ARCHITECT'S DECLARATION
9.18.
�f I understand my plans shall be used as public records.
Signature A/ Date "
I icensed Professional
ciTY OF
CITY OF CUPERTINO
REROOF
UPERTINO PERMIT APPLICATION
C
Date:
L(
Address:
'17 &
&
Phone
S Name: 1209 z_f- C A
Yes No ❑ if yes, provide letter from HOA
Phone #:
Fax#:
li Contractor License
ci�tino Business License #:
Type of Roof Covering:
1'roposed:
❑ Built-Up roof
Built-Up Roof
Asphalt Shingles
Asphalt Shingles Wood Shakes
Wood Shakes ❑LI Wood Shingles
Wood Shingles a Other (Specify)
/A
Other (Specify)
umber of existing coverings o Provide I.C.C.E.S. Report
To be Removed 0 Provide Mfgr. Installation Specs.
Job Description:
4
Commercial ❑
kes i dCntia1__N_?11
Greca Building: Please complete relevant portion of the
Confirmed with-Planning Dept. if
�o S.
(;reeu Building Checklist & attach it to the application or if there are any restrictions:
❑
appiicable, include in plan set & the sheet index.
VLLIuatioll:
t I i a Ve Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
Siotiatre-
Revised 02/05/09
CITY O
CITY OF CUP ERTINO
REROOF
CUPER`TINO FEE SCHEDULE
rber of Fee ID =Feeiption Fee Permit Type
Group
Squares
1REROOFCOM Re-roof Com :rcial B 1COMMLROOF
m
1BCBSC Cal Bldg Stand ards B ALL PERMIT TYPES
Commission F-�e
1BSEISMICO Seismic Comn►ercial B
1REROOFRES Re-roof Resid:ntial B 1SFDWLROOF
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
1BSEISMICRE Seismic Resicential B
1RER00FN4RES Re-roof Mutt t-Family B
1MFDWLROOF
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
IBS EISMICRE Seismic Residential B
1BUSLIC Business Lic ense B
'a REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT• BJILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OF=1CIAL
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
,PERTINO
(408) 777-3228 FAX(408)777-3333•building cupertino.orq
♦ APV k
PROJEC!'ADDRESS G /�99L- /
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PHONE Q�/ O E-MAIL
OWNER NAMEqz-
CITY, STATE,ZIP FAX
SIF.EL:T ADDRESS
LICENSE NUMBER F
� SE TYBUS.LIC.# Z
cONTRAcroR NAME eTYPE
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E-MAIL FAX
COti1PANtiJAME CITYPHO
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,STATE,Z�jSTREETADDRESS 5sa 'p d33v
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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 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 boen 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 — 10:30arr 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 sheathing 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 per foot of slope and demonstrate there is no ponding.
b. A listing from an approved testing agency shall be avai able 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 an,i 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: I t,m the property owner or authorized agent to act on
tl�, property owner's behalf. I rstand d agree to comply with the re-roof policy stated above.
Date:
Signature of Applicant/Agent:
RerooJPolicy_2010.doe revised 04114110
Building Department
u
City Of Cupertino
10300 Torre Avenue
Cupertino,CA 95014-3255
- Telephone: 408-777-3228
i
Fax: 408-777-3333
CUPERTINO
CONTRACTOR/ SUBCONTRACTOR LIST
i
TINESS
IT# U �
JOB ADDRESS: E#
OWNER'S NAME: LICENSE#GENERAL CONTRACTOR: /ZIPCODE:
ADDRESS:
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
L BE SCHEDULED UNIL THE
NO BUILDING FINAL OR FINAL OCCUPANCY INS PECTION(S) WILpERTINO
GENERAL CONTRACTOR AND ALL , UBCONTRAC'iORS HAVE OBTAINED A CITY OF CU
BUSINESS LICENSE.
I am not using any subcontractors: Signature Date
Please check applicable subcontractors and complete he following information:
I
SUBCONTRACTOR BUSINESS NAMEBUSINESS LICENSE #
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
Date
Owner/Contractor Signature