10080039 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10990 NORTHSKY SQ CONTI ACTOREFOUR EASONS ROOFING PERMIT NO: 10080039
OWNER'S NAME: MARYAM SAFA
PO BO:{1668 DATE ISSUED:08/05/2010
SAN JOSE,CA 95109 PHONE NO:(408)278-0330
1ER'S PHONE: 4088888954
ff- LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class C`3 Lic.# L/ 7 ZI 0 MECH f- RESIDENTIAL F_ COMMERCIAL
�u1 Date O s
Contractor 4&f ��5..SIt JOB DESCRIPTION:RE-ROOF RMV EXISTING CEMWOOD ROOF&INSTALL
I hereby affirm that 1 am licensed under the provisions of Chapter 9 NEW
(commencing with Section 7000)of Division 3 of the Business&Professions GAF O LAND CANYON ASPHALT COMP 50YR ROOF SYSTEM,
Code and that my license is in full force and effect. STONE WOOD 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 Fl Floor Area: Valuation:$5200
permit is issued.
APPLICANT CERTIFICATION Occupancy Type:
I certify that 1 have read this application and state that the above information is APN Qumber:31640063.00
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
indemnify and keep harmless the City of Cupertino against liabilities,judgments, FERMIT 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
ands and will comply
granting of this permit. Additionally,the applicant underst
with all non-point source re ul/a� ns per the Cupertino Municipal Code,Section 80 D7A�FROM LAST CALLED INSPECTION.
9.18. �-�-- Q/IUr
Signature
Date A Issu-A by: Date:
L, OWNER-BUILDER DECLARATION
RE-ROOFS:
1 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:
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 or
will do the work,and the structure is not intended or offered for sale(Sec.7044, insp.:ction.
Business&Professions Code) Sigr ature of Applicant: "L-- Date:p
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 DISCLOSUR
Compensation,as provided for by Section 3700 of the Labor Code,for the I hr ve 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 con►pliance 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 Sal ety Code,Section 25532(x)should I store or handle hazardous material.
permit is issued. Ad iitionally,should I use equipment or devices which emit hazardous air
h
I certify that in the performance of the work for which this permit is issued,I shall cor taminants as defined by the Bay Area Air Quality Management District I will
maintain
not employ any person in any manner so as to become subject to the Worker's He Ith&Safety Code,Sections 25505,25533,rCode,Chapter 9.12 and the
and 2 534icipal
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%,ner o a horiz agent: —�Cg
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 isI h ereb 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 relating fo which this permit is issued(Sec.3097,Civ C.)
to building construction,and hereby authorize representatives of this city to enter Lr nder's Name
upon the above mentioned property for inspection purposes.(We)agree to save
Tmify and keep harmless the City of Cupertino against liabilities,judgments, L�nder's Address
and expenses which may accrue against said City in consequence of the
gru.riing 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
9.18. I 1 understand my plans shall be used as public records.
S 140
Signature_ Date Licensed Professional
CITY OF
CITY OF CUPERTINO
R-EROOF
UPERTiNO PERMIT APPLICATION
C
Date:
Address: skj
Phone
Name:
Phone
provide letter fl,om HOA
�N 0 ❑ If yes,
Yes
Phone
Fax
Contractor License #:
Uu,)CrLino Business License
Type of Roof Covering:
Proposed:
:
Existill-
tn u Built-Up roof
u Built-Up Roof Ar Asphalt Shingles
Asphalt Shingles
❑ ci Wood Shakes
Wood Shakes ❑
Wood Shingles
Lj Wood Shingles Other (Specify)
Other (Specify)' Provide I.C.C.E.S. Report 4
li umber of existing coverings ❑0 Provide Mfgr. Installation Specs.
_j To be Removed
Job, Deser'O.1cin.
Commercial ❑
,.�sldcntiat
Confirmed with Planning Dept. if
complete relevant portioi of the
ureea Building: Please
i n Dept. f
ppl-,cation or if there are any restrictions: El
6reeii Building Checklist & attach it to the a
a licable, include in plan set & the sheet index.
i _V,1!LWLt toll:
11-lave Read, Understand and Will comply with Clipertino's Tear-Off Policy:
Revised 02/05/09
CITY Of
CITY OF CUPERTINO
LaREROOF
CUPERTINO FEE SCHIE DULE
Number of Fee ID Fee Descripti Dn Fee Permit Type
Squares Group
1REROOFCOM Re-roof Commercial B 1COMMLROOF
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
IBS EISMICO Seismic Commercial B
1REROOFRES Re-roof Residential B 1SFDWLR00F
Bldg 1BCBSC
Cal Standards B ALL PERMIT TYPES
Commission Fee
1BSEISMICRE Seismic Residential B
1RER00FMRES Re-roof Multi-Family B 1MFDWLROOF
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
1BSEISMICRE Seismic Residential B
1BUSLIC Business License B
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT• E UILDING 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 Iwpertino.org
AIN#
PRO,L'Ci�ADDRESS G)�%� c> f jr.
E-MAIL
PHONE4?
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OWNER NAME A [, G
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FAX
CITY, STATE,ZIP� ,} p
STitEET i\DDRL'SS %,-�t(�V
L ENSE TYPE BUS. C# <� �
// /� LICENS NUMBER
y
CONTRACTORNAME 1� � ( 4-?� �:t Ej
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E-MAIL
COMPANI'NAME
CJ PHONE
CITY,STATEC,ZIP Com' rSl1 Z- d
STREET ADDRESS U2 V�� ` �7�•��..
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 been removed and all the dry-rotted wood has
ll be available with one hour.
)een replaced, you must call for a roof inspection. A l wilding inspector w
There are special hours for the service: 7:30 — 10:30am and 1:00 -2:30p
Pm (Friday). hurs);
7:30 — 10:30ain and
4. If plywood is installed, a plywood nailing inspection is required.
5. New roof coverings shall not be applied without first obtaining all inspection an approved approvals
aon will
the building inspector. Any roofing which is applied without first obtaining pp
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
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 aw ilable on-site to review at the time of the
inspection.
c. Proper spark arrestor installation.
7. plywood nailing inspection and the job is not ready, you will be charged to a re-
inspection fee of ll for a0. The re-inspection fee shal be paid before another inspection can be
NOTE: If you call for a
scheduled.
F -iy signature below, I certify to each of the following: am the property owner or authorized agent to ]ontfi , pro
perty owner's behalf. I un nd and agree to comply with the re-roof policy stated abveDate: �Signature of Applicant/Agent:
ReroofPolicy_2010.doe revised 04114/10
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
CUPERTINO
CONTRACTOR/ SUBCONTRACTOR LIST
PERMIT# '`
JOB ADDRESS: PHONE#
OWNER'S NAME: BUSINESS LICENSE#
GENERAL CONTRACTOR: 7CITY/ZIPCODE:
ADDRESS:
code requires all businesses working in the c ty to have a City of Cupertino business license.
*Our municipalINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
NO BUILDING FINAL OR F
TRACTOR AND ALL SUBCONTRACT QRS HAVE OBTAINED A CITY OF PERTINO
GENERAL CON q
BUSINESS LICENSE.
I am not using any subcontractors: Signature Date
i
and complete the following information:
Please check applicable subcontractors
%/ SUBCONTRACTOR
BUSINESS 1\AME 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
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Date
Owner/Contractor Signature