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10070107 CITY OF CUPERTIN O BUILDING PERMIT BUILDING ADDRESS: 11011 NORTHSKY SQ CONTRACTOR:FOUR SEASONS ROOFING PERMIT NO: 10070107 OWNER'S NAME: NANCY RODRIGUEZ PO BOX 1668 DATE ISSUED:07/15/2010 ✓NER'S PHONE: 4082830261 SAN JOSE,CA 95109 PHONE NO:(408)278-0330 ❑ LICENSED CONTRACTOR'S DECLARATIONr BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class �^ � ic.#� ��a MECH F RESIDENTIAL (_ COMMERCIAL Contractor Date f r l 6 I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:RE-ROOF RMV EXSTNG CEMWOOD ROOF&INSTALL A (commencing with Section 7000)of Division 3 of the Business&Professions NEW COMP SHINGLE.GAF GRAND CANYON Code and that my license is in full force and effect. CLASS ) (COLOR)STONEWOOD 12SQ 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. Sq.Ft Floor Area: Valuation:$4400 APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is APN Number:31640001.00 Occupancy Type: 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. Ad itionall , e applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non-po source ulation r the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION. 9.18. -•�, 7 \L Lc) Signature Date Issued by� �� Datef�/ JU u OWNER-BUILDER DECLARATION l 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 I,as owner of the property,or my employees with wages as their sole compensation, installed without first obtairu g n pec' 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) �(� L0 I,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: Date: construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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 performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain Section 3700 of the Labor Code,for the performance of the work for which this compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& 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 1 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 maintain comp an a with the Cupertino Municipal Code,Chapter 9.12 and the Compensation laws of Califomia. If,after making this certificate of exemption,I Health&Safe C de,Sections 25505,25533,and 25534. 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. Ow r�utimdt: Date: 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 hereby 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 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 -unify and keep harmless the City of Cupertino against liabilities,judgments, ,and expenses which may accrue against said City in consequence of the Lender's Address granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION 9.18. I understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO FEE ESTIMATOR-- BUILDING DIVISION ADDRESS: DATE: REVIEWED BY: APN: BP#: *VALUATION: 1$4,400 *PERMIT TYPE: Minor Building Permit L?.N CHECK TYPE: Re-roof PRIMARY SFD or Duplex S TOTAL APPLICATION 1 R3SFDADD/REM USE: ROOF AREA: 1,200 f TYPE: a a OO 3U FEE ID 1RERCOFFRES NOTE: Thesefees are based on the preliminary information L vailable and are only an estimate. Contact the De t or addn'l info, FEE ITEMS Fee Resolution 09-051 Fff' "1.,0<Ij FEE QTYIFEE MISC ITEMS Permit Fee: $15E.00 Work Without Permit? Q Yes 0 No $0.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg, Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $157.50 $0.00 TOTAL FEE.-T $157.50 Revised: 6/30/2010 CITY OF CUPERTINO 2 ITEMS OF 10 PERMI`C RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Bl::: Lot : APN . . . . . . . . : 316=40001 . 00 DATE ISSUED. . . . . . . : 07,/15/2010 RECEIPT #. . . . . . . . . : BS000010874 REFERENCE ID # . . . : 10070107 SITE ADDRESS . . . . . : 11011 NORTHSKY SQ SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : NANCY RODRIGUEZ ADDRESS . . . . . . . . . . : 11011 NORTHSKY SQ CITY/STATE/ZIP . . . : CU:?ERTINO, CA 95014 RECEIVED FROM . . . . : F01JR SEASONS ROOFIN CONTRACTOR . . . . . . . : DIAZ, ALFRED LIC # 21323 COMPANY . . . . . . . . . . : FO1JR SEASONS ROOFING ADDRESS . . . . . . . . . . : PO BOX 1668 CITY/STATE/ZIP . . . : SAN JOSE, CA 95109 TELEPHONE . . . . . . . . : (408) 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 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF CITY OF -D —7 0 1 Cj_7 CITY OF CUPERTINO REROOF C U P E RTI N O PERMIT APPLICATION APN # Date: 711 Building Address: `f // 0 // 6rf�Sy ' Owner's Name: f _e Z Pone # 7 HOA: Yes No El If Yes, rovidf! letter from HOA Contractor: �� s ,�� ,,,,C� Phone 3 0 Fax#: W�279--0333 Cupertino Business License #: Contractor License #: Type A Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles 3r-�-Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ;r Other (Specify) r►t wo o cop ❑ Other (Specify) Number of existing coverings ❑ Provide I.C.C.E.S. Report # vF—To be Removed ❑ Provide Mfgr. Installation Specs. Job Description: " ve N C�✓ C�4 S S �%4 f �, Pc'S t �o G.r.1 S 12- �� C'4"--,V p cAJ Residential - Commercial El Green Building: Please complete relevant portion of the Confirmed with-Planning Dept. if Green Building Checklist & attach it to tt.e application or if there are any restrictions: ❑ applicable, include in plan set & the sheet index. Valuation: XC00 I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy: Signature Revised 02/05/09 REROOF TEAR-OFF POLICY COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION ALBERT SALVADOR, P.E., C.B4O., BUILDING OFFICIAL C U P E RT I N O 10300 TORRE AVENUE - CUPERT NO, CA 95014-3255 (408)777-3228 - FAX(408)777-33:,3 - building(cDcupertino.orq PROJECT.,DURESS +t-' �D- APN# 0). VER N.�.NlE t 1 /j PHONr 27 o '220- E-MAIL CIT STATE 7,1PFAC y, '9, 6-111111, CONIR.-\C":'OR N.A'IE LICENSE N'1 LICEXY BUS.Imo.I/k-!�)Z- Jr COMPANY NANIE E-N AIL PAX 4"V 033 S ittL'D RES$' n/ �j CIT LST TE,Z,p 9 5 � PHONE I UNDERSTAND ANIS AGREE TO THE FOLLOWING: 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. Atter the roof is torn off and the nails/fasten!rs have been removed and all the dry-rotted wood has been replaced, you must call for a roof inspel;tion. 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 inspection is required. 5. New roof coverings shall not be applied with)ut 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 fcllowing item will be verified: a. Flat roofs shall have a minimum of/" per fcot 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 ins;)ection 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 following: 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. e Signature of Applicant/Agent: Date: ReroofPolicy_2010.doe revised 04114 10 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: d /VSItG PERMIT# OWNER'S NAME: PHONE #1609 O Z30 GENERAL CONTRACTOR. ,2.,Seo<&pN cO BUSINESS LICENSE# ADDRESS: CITY/ZIPCODE: .5 ,-T-, *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL O CUP Y INSP ION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND AL SUB O TRACT S HAVE OBTAINED A CITYWPERTINO BUSINESS LICENSE. t 1 � I am not using any subcontractors: — 7- Signature Date Please check applicable subcontractors and complete the following information: j/ 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 Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date