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10070111' CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 11001 NORTHSKY SQ CONTRACTOR: FOUR SEASONS ROOFING PERMIT NO: 10070111 OWNER'S NAME: BETTY J MEYER PO BOX 1668 DATE ISSUED: 07/15/2010 NER'S PHONE: 4085180321 SAN JOSE, CA 95109 PHONE NO: (408)278-0330 LICENSED CONTRACTOR'S DECLARATION r— uu ^^ License Class ''- c. # L( e�� (0!9� BUILDING PERMIT INFO: BLDG ELECT PLUMB � MECH RESIDENTIAL COMMERCIAL Contractor Date � � �� 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 CLASS A COMP SHINGLE. GAF GRAND CANYON Code and that my license is in full force and effect. (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 Sq. Ft Floor Area: Valuation: $4400 permit is issued. APPLICANT CERTIFICATION APN Number: 31640003.00 Occupancy Type: 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, PERMIT EXPIRES IF WORK IS NOT STARTED costs, and expenses which may accru ainst said City in consequence of the granting of this pe t. Additionall t applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non -point rce regula ' r the Cupertino Municipal Code, Section 180 DAYS FROM LAST CALLED INSPECTION. 9.18. Signature Date t0 f Issued bye l - Date: CJ 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 an 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 obtai g an i p I agr to remove all new materials for will do the work, and the structure is not intended or offered for sale (Sec.7044, inspection. r f Business & Professions Code) 11 11 q 1, as owner of the property, am exclusively contracting with licensed contractors to Signature of Appli 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 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 maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Compensation laws of California. If, after making this certificate of exemption, I Health & afety C e, ections 25505, 25533, and 25534. become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such or this shall be deemed revoked. Owne authorize e provisions permit 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 mify 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. 1 understand my plans shall be used as public records. Signature Date Licensed Professional 2 ITEMS OF 10 CITY OF CUPERTINO PERMI`C RECEIPT Sec: Twp: Rng: Sub: B1:;: Lot: APN ........: 31,340003.00 DATE ISSUED.......: 07/15/2010 RECEIPT #.........: BS)00010874 REFERENCE ID # ...: 10)70111 SITE ADDRESS .....: 11001 NORTHSKY SQ SUBDIVISION ...... CITY .............. CUERTINO IMPACT AREA ...... OWNER ............: BETTY J MEYER ADDRESS ..........: 11,)01 NORTHSKY SQ CITY/STATE/ZIP ...: CUERTINO, CA 95014 OPERATOR: patg COPY # : 1 RECEIVED FROM ....: F01JR SEASONS ROOFIN CONTRACTOR .......: DIAZ, ALFRED LIC # 21323 COMPANY ..........: FOUR SEASONS ROOFING ADDRESS ..........: PO BOX 1668 CITY/STATE/ZIP ...: SAN JOSE, CA 95109 TELEPHONE ........: (408)278-0330 FEE ID UNIT QUANTITYAMOUNT 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 -------- ---------------------------- 601 ROOF TEAR OFF VOICE ID DESCRIPTION -------- ---------------------------- 602 ROOF PLYWOOD NAIL 604 ROOF IN -PROGRESS 605 FINAL REROOF CITY OF CUPERTINO F_7 FEE ESTIMATOR -- BUILDING DIVISION NOTE: These fees are based on the Preliminary information available and are onlv an estimate. Contact the Dent for addnl info. FEE ITEMS (Yee Resolution 09-051 Eff''71,111/09) ADDRESS: I DATE: MISC ITEMS REVIEWED BY: APN: BP#: r7 *VALUATION: 1$4,400 ';,PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re -roof PRIMARY or Duplex USE: TOTAL ROOF AREA: $156.00 S.f. APPLICATION PPLICATION 1R3SFDADD/REM TYPE: �4 w g 96 00 U NOTE: These fees are based on the Preliminary information available and are onlv an estimate. Contact the Dent for addnl info. FEE ITEMS (Yee Resolution 09-051 Eff''71,111/09) FEE QTY/FEE MISC ITEMS _T I ri r7 Permit Fee: $156.00 Work Without Permit? 0 Yes 0 No $0.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bld� Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $157.50, $0.00TOTAL FEE: 1 $157.50 1 Revised: 6/30/2010 wifm .41 CITY OF CUPERTINO CITY OF CUPERTINO REROOF PERMIT APPLICATION 100-7 C\ APN # (�P Date: 7 1�r��� Building Address: 00 luo4/ 4 �s Owner's Name:� �� � Q e Phone #: ,you . �,vS-d32 HOA: Yes No If Yes, provide letter from HOA Contractor: r e� s T ,��—�,.�cr Phone #:(W),9?,? —0530 Fax #: WQ.27,F--0333 Cupertino Business License #: .213 z3 Contractor License #: Type A Roof Covering: Existing: Proposed: a Built -Up Roof a Built -Up roof ❑ Asphalt Shingles 3;r4 Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles Other (Specify)o co� ❑ Wood Shingles ❑ Other (Specify) Number of existing coverings �_ ❑ Provide I.C.C.E.S. Report # ;zF—To be Removed ❑ Provide Mfgr. Installation Specs. Job Description: t -o ve I`5-44 /u) C2A, 4-` Nr�.� Criss ``�9-�' C�•^�P�st'ew ��.�`Kgte- Cir'`( 0 �T��� C -A cn)©o-� Residential - Commercial Green Building: Please complete relevant portion of the Confirmed with -Planning Dept. if Green Building Checklist & attach it to tt a application or if there are any restrictions: ❑ applicable, include in plan set & the sheet index. Valuation: `�DO 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.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE • CUPERT NO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-33:3 - building (a.cupertino.orq p;,. JcC i :,UUIZESS //00/ r s-K5r-41 0`,oNERiJ. SIC y ! %%boy y� PHONt - �J( T I `i V ( vc L r� CIT`', STATE T,IP OCrOak 6+ CONTRAC'l'OK NA IE LICENSE NUMBER CO,\iPANY NAME EAIL 7�i U/• I c�i APN N E -NI A I L J et LICEXY - 9 5//Z I UNDERSTAND AND AGREE TO THE FOLLOWING: FAX sus0aq� �� FAX 7 '� y�-- ossa PHONE p 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- 32218 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. 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 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 follc wing: I am the property owner or authorized agent to act on the property owner's behalf. I uq4erskand and agree; to comply with the re -roof policy stated above. Signature of Applicant/Agent: --- Date: �C �d ReroofPolicy_2010.doe revised 0.1114,110