10070110I I CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10991 NORTHSKY SQ
OWNER'S NAME: ROY BENJAMIN
JER'S PHONE: 4085170230
00 LICENSED CO RACTOR'S DEECLARATION
License Class ' it Lf �o� t (`S ,� 1
Contractor Date ( J�y
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business & Professions
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
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION
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
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,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Add ortally, the applicant understands and will comply
with all non -point source re lati ns p Cupertino Municipal Code, Secti
9.18. Q
Signature Date
�/
❑ OWNER -BUILDER DECLARATION
CONTRACTOR: FOUR SEASONS ROOFING PERMIT NO: 10070110
PO BOX 1668 DATE ISSUED: 07/15/2010
SAN JOSE, CA 95109 PHONE NO: (408)278-0330
BUILDING PERMIT INFO: BLDG r— ELECT r— PLUMB
MECH r— RESIDENTIAL r— COMMERCIAL r—
JOB DESCRIPTION: RE -ROOF RMV EXSTNG CEMWOOD ROOF & INSTALL A
NEW
CLASS A COMP SHINGLE. GAF GRAND CANYON
(COLOR)STONEWOOD 12SQ
Sq. Ft Floor Area: I Valuation: $4400
APN Number: 31640005.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: Date -
v
I hereby affirm that I am exempt from the Contractor's License Law for one of RE-RO S:
the following two reasons: All roofs shall be inspected pri r to any roofs g ateria ng installed. If a roof is
I, as owner of the property, or my employees with wages as their sole compensation, installed without first obtains an inspectio , agree move all new materials for
will do the work, and the structure is not intended or offered for sale (Sec.7044, inspection.
Business & Professions Code)
1, as owner of the property, am exclusively contracting with licensed contractors to Signature of Applicant: Date:
constrict the project (Sec.7044, Business & Professions Code).
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
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
permit is issued.
I certify that in the performance of the work for which this permit is issued, I shall
not employ any person in any manner so as to become subject to the Worker's
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
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
1 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
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
:nify and keep harmless the City of Cupertino against liabilities, judgments,
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 Municipal Code, Section
9.18.
Signature Date
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by t Bay Area Air Quality Management District I will
maintain com ce with th upertino Municipal Code, Chapter 9.12 and the
Health & Code, Sects 25505, 25533, and 25 34.
Owner or a thorize agent: S
Date•
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
2 ITEMS OF 10
CITY OF CUPERTINO
PERMI" RECEIPT
Sec: Twp: Rng: Sub: Bl}:: Lot:
APN ........: 31640005.00
DATE ISSUED.......: 07,'15/2010
RECEIPT #......... BS0)00010874
REFERENCE ID # ...: 10070110
SITE ADDRESS .....: 10991 NORTHSKY SQ
SUBDIVISION ......
CITY CUERTINO
IMPACT AREA ......
OWNER ............: ROY BENJAMIN
ADDRESS 10991 NORTHSKY SQ
CITY/STATE/ZIP ...: CU:?ERTINO, CA 95014
OPERATOR: patg
COPY # : 1
RECEIVED FROM ....: F01JR SEASONS ROOFIN
CONTRACTOR .......: DIAZ, ALFRED LIC # 21323
COMPANY ..........: FOiJR SEASONS ROOFING
ADDRESS PO BOX 1668
CITY/STATE/ZIP ...: SA1 JOSE, CA 95109
TELEPHONE ........: (4)8)278-0330
FEE ID UNIT
QUANTITY AMOUNT
PD -TO -DT
THIS REC
NEW BAL
----------
-----------------------
1BCBSC VALUATION
--------------------
4,400.00 1.00
----------
0.00
----------
1.00
0.00
1REROOFRES SQ FEET
12.00 156.00
0.00
156.00
----------
0.00
----------
TOTAL PERMIT
----------
157.00
----------
0.00
157.00
0.00
METHOD OF PAYMENT
-----------------
CHECK
TOTAL RECEIPT :
AMOUNT
---------------
785.00
---------------
785.00
VOICE ID DESCRIPTION
-------- ----------------------------
601 ROOF TEAR OFF
REFERENCE NUMBER
--------------------
#009834
VOICE ID DESCRIPTION
-------- ----------------------------
602 ROOF PLYWOOD NAIL
604 ROOF IN -PROGRESS 605 FINAL REROOF
CITY OF CUPERTINO
rm--7 FEE ESTIMATOR -- BUILDING DIVISION
VI
di
ADDRESS:
I DATE:
MISC ITEMS
REVIEWED BY:
APN:
I BP#:
`VALUATION: 1$4,400
'PERMIT TYPE: Minor Building Permit
PLAN CHECK TYPE:
Re -roof
PRIMARY SFD or Duplex
USE:
TOTAL
ROOF AIREA:
1,200
S f
APPLICATION
TYPE: 1 R3SFDADD/REM
xW
as
cc
C-)
0 f j`._.
�:
NOTE. These fees are based on the Dreliminary information iwailable and are only an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 09-051 Eff/T 1.,09)
FEE
QTY/FEE
MISC ITEMS
Permit Fee:
$156.00
ic
0 f j`._.
Work Without Permit? 0 Yes No
$(.00
Strong Motion Fee: IBSEISMICR
$(.50
Select an Administrative Item
131d.- Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$157.50
$0.00 TOTAL FEE:
$157.50
Revised: 6/30/2010
m
CITY OF
CITY OF CUPERTINO
F:EROOF
CUPERTINO PERMIT APPLICATION
APN #
Ll o
Date:
71
Building Address:
Owner's Name: Y (?� i /0
Phone #: S� j 7 — 0,-)—,3 0
HOA: Yes No 0 If Yes, providc letter from HOA
Contractor:r e� 62
Phone #: (6% 7 g —v33 0
Fax
Cupertino Business License #:
213 23
Contractor License #:
F
Type of Roof Covering:
Existing: Proposed:
❑ Built -Up Roof ❑ Built -Up roof
❑ Asphalt Shingles -;e-Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
;r Other (Specify) uwo o cool ❑ Other (Specify)
Number of existing coverings �❑ Provide I.C.C.E.S. Report #
.vr--To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description: ^o ve r-- 4--
.v G✓ Cr4 , S `ice �. �vS t � �o.. S L �'K s ► e — 61'roOd'� C.k( 0 cJ
ef'o r) 5 cDo0-�
Residential - Commercial 17
Green Building: Please complete relevant portion of the Confirmed with.Planning Dept. if
Green Building Checklist & attach it to the application or if there are any restrictions: ❑
applicable, include in plan set & the sheet index.
Valuation: � b
y C/00
I Have Read, Understand and Will Comply with Cupertino's Tear -Off Policy:
Signature
Revised 02/05/09
REROOF TEAR -OFF F'OLICY
COMMUNITY DEVELOPMENT DEFARTMENT • BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE • CUPERTM, CA 95014-3255
(408) 777-3228 • FAX (408) 777-33:3 - building(@cupertino.org
PROJEUI-WDRESS %1-Y 49 4?/r
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COMPANY NAME
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I UNDERSTAND AND AGREE TO THE FOLLOWING:
The re -roof project shall comply with all appl.cable provisions of the 2007 California Building Code
2. An inspection request shall be scheduled the lav before the inspection date, Please call (408)777-
3228 between 7:30 - 3:30pm (Mon -Fri) to scl- edule 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 — 10:30am and 1:00 — 3:30pm (Mon — Thurs);
7:30 - 10:30am and 1:00 - 2:30pm (Friday).
4. If plywood is installed, a plywood nailing ins-)ection is required.
�. 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 1/" per fo )t of slope 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 and 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.
By my signature below, I certify to each of the folk wing: I am the property owner or authorized agent to act on
the property owner's behalf. I urWerd and agree; to comply with the re -roof policy stated above.
mature of Applicant/Agent: -- Date:
ReroofPolicy_2010.doc revised 04114/10