10060210CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10895 NORTHVIEW SQ
CON'RACTOR: FOUR SEASONS ROOFING
PERMIT NO: 10060210
OWNER'S NAME: HAROLD WOOLSEY
PO BOX 1668
DATE ISSUED: 06/30/2010
1ER'S PHONE: 6232497533
SAN .IOSE, CA 95109
PHONE NO: (408)278-0330
LICENSED CO ACTOR'S DECLARATION
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Cla — L
r RESIDENTIAL r— COMMERCIAL
Contractor Date ��
MECH
JOB DESCRIPTION: TEAR OFF EXISTING ROOF INSTALL 30LB FELT & A
I hereby affirm that I am licensed under the provisions of Chapter 9
LIFE] IME COMP CLASS A 12SQ
(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.
Sq. Ft Floor Area:
Valuation: $4400
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.
S� L�
APN Number: 31636005.00
Occupancy Type:
APPLICANT CERTIFICATION k .
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
]HERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for ins ection purposes. (We) agree to save
indemnify and keep ha ss the City Cu rtino against liabilities, judgments,
'WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs, and ex uses w ch may accnr agains said City in consequence of the
$Q DAYS FROM LAST CALLED INSPECTION.
permit ditionally the ap icant understands and will comply
granting of Ad
with all non- int sou a r9gulations er th Cupertino Municipal Code, ection
C'G—w
'
9.18.
Issued by: Date:
�� 6
Signature Date
g
RE -110 F
U OWNER -BUILDER DECLARATION
All n )ofs shall bei ected onto any roofi g in erial being installed. If a roof is
I hereby affirm that I am exempt from the Contractor's License Law for one of
insta led without ft obtai g inspectio I a ee to remove all new materials or
the following two reasons:
inspc ction.
1, as owner of the property, or my employees with wages as their sole compensation,
Date. / 0
.7
will do the work, and the structure is not intended or offered for sale (Sec.7044,
Sign rture of App r
Business & Professions Code)
—
1, as owner of the property, am exclusively contracting with licensed contractors to
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
construct the project (Sec.7044, Business & Professions Code).
HAZARDOUS MATERIALS DISCLOSURE
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
I ha /e read the hazardous materials requirements under Chapter 6.95 of the
Compensation, as provided for by Section 3700 of the Labor Code, for the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
performance of the work for which this permit is issued.
com Aiance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
I have and will maintain Worker's Compensation Insurance, as provided for by
Safety Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
Section 3700 of the Labor Code, for the performance of the work for which this
contaminants a efined by t y Area Air Quality Management District I will
permit is issued.
mamt comp a ce with t C ertino Municipal Code, Chapter 9.12 and the
I certify that in the performance of the work for which this permit is issued, I shall
Hea. Safe ode, Sec ' ns 5505, 25533, and 25534.
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
1 r or au rized agen t _ � 1
Date: �i V
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.
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION
I her eby affirm that there is a construction lending agency for the performance of work's
I certify that I have read this application and state that the above information is
for which this permit is issued (Sec. 3097, Civ C.)
correct. I agree to comply with all city and county ordinances and state laws relating
Lender's Name
to building construction, and hereby authorize representatives of this city to enter
upon the above mentiono property for ins ection purposes. (We) agree to save
Lender's Address
inify a eep h less the City up ino against liabilities, judgments,
ar..ptiy acc against aid City in consequence of the
ARCHITECT'S DECLARATION
grantingonal) ,the app)' ant understands and will comply
with alllatio per th upertino Municip Code, Section
I un ierstand my plans shall be used as public records.
9.1
/ - 0
Date lA
Licimsed Professional
Sign
2 ITEMS OF 10
CITY OF CUEERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Iot:
APN ........: 31636(05.00
DATE ISSUED.......: 06/30/2010
RECEIPT #......... BS000010747
REFERENCE ID # ...: 10060:10
SITE ADDRESS 10895 NORTHVIEW SQ
SUBDIVISION ......
CITY CUPER'..'INO
IMPACT AREA ......
OWNER ............: HAROLD WOOLSEY
ADDRESS 10895 NORTHVIEW SQ
CITY/STATE/ZIP ...: CUPERCINO, CA 95014
OPERATOR: patg
COPY # : 1
RECEIVED FROM ....: FOUR ;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
QUANTITY
AMO JNT
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
CITY OF CUPERTINO
REROOF
PERMIT APPLICATION
t 0(,::)U 0:;0,3
APN # �,
Date: .
Building Ad est �-
Owner's Name:OU) C�) Lc�
Phone #:
HOA: Yes R�No ❑ If Yes, provide letter from
HOA
Contractor:
Phone
�Llkj
r
Fax
Cupertino Business License #: -
ZZ ,
Contractor License:
H 4�1
Type of Roof Covering:
Existing: Proposed:
❑ Built -Up Roof
❑ Built -Up roof
❑ Asphalt Shingles
Asphalt Shingles
❑ Wood Shakes
❑ Wood Shakes
❑ Wood Shingles
❑ Wood Shingles
(Specify) �°(_- _ ffA V__r5
❑ Other (Specify)
uOther
mber of existing coverings
❑ Provide I.C.C.E.S. Report #
❑ To be Removed
❑ Provide Mfgr. Installation Specs.
Job Description: �'1 ti? ( (�> ��-A( 1
�� A
Residential
-_
Commercial ❑
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: �.
I Hav �ead, U derstand 'd Will Com y-v�ith Cu])ertino's Tear -Off Policy:
Signature
Revised 02/05/09
,�UPERTINO
REROOF TEAR -OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE • CUPERTINO, CA 9014-3255
(408) 771-3228 • FAX (408) 777-3333 - buildinc ja cupertino.org
__- ANN n
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t4 cl t C: l C` �C�' x-� PF{UNE C _ _> E-MAIL
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LICENSENUMBERL(CENS TYPE BUS. Li�CN.q�1 Z�
E-MAIL .3 S 3
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CIT ' STATE, ZI
I UNDERSTAND AND AGRE H TO THE FOLLOWING:
li� rc-ruof project shall comply with all applicable povisions of the 2007 California Building Code.
Arlspection request shall be scheduled the day before the inspection date. Please call (408)77-;7-
? be t��een 7:30 - 3:30pm (Mon -Fri) to schedule tt e next day inspection.
Anter the roof is torn off and the nails/fasteners hav( been removed and all the dry -rotted wood has
boon replaced, you must call for a roof inspection. A building inspector will be available with one hour.
"i l,lere 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).
T l t' pi � wood is installed, a plywood nailing inspection Is required.
roof coverings shall not be applied without first obtaining all inspection and written approvals from
[ibuilding inspector. Any roofing which is applied without first obtaining an approved inspection \�ill
rc�i�;ire the removal of all new material down to the sleathing so a proper inspection can be performed.
final inspection and approval shall be obtained from the building inspector when the re -roofing is
cur7pleted. To receive a final sign -off, the following item will be verified:
Fi a roufs shall have a minimum of/" per foot of slc pe and demonstrate there is no ponding.
o .is1!I,, from an approved testing agency shall be M ailable on-site to review at the time of the
c. Proper spark arrestor installation.
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
.4,11odillod
my signature below, I certify to each of the following: 1 am the property owner or authorized agent to act on
propt2rt_�, owner's behalf. I understand and agree to comply with the re -roof policy stated aove.
Date: 3e - ��'-- - --
ReroofPohcy_ 010.doc revse(1 04 r,' I i.)
1. Use Low/No-VOC Paint
1 IAQ'Health pts
y=yes
2. Use Low VOC, Water -Based Wood Finishes
2 IAQ'Health pts
y=yes
3. Use Low/No VOC Adhesives
3 IAQ'Health pts
y=yes
4. Use Salvaged Materials for Interior Finishes
3 Resource pts
y=yes
5. Use Engineered Sheet Goods with no added Urea
4 Resource pts
y=yes
Formaldehyde
61AQ'Health pts
y=yes
6. Use Exterior Grade Plywood for Interior Uses
1 IAQ Health pts
y=yes
7. Seal all Exposed Particleboard or MDF
4 IAQ'Health. pts
y=yes
8. Use FSC Certified Materials for Interior Finish
4 Res Durce pts
y=yes
9. Use Finger -Jointed or Recycled -Content Trim
1 Res)urce pts
y=yes
10. Install Whole House Vacuum System
3 IAC/Health pts
y=yes
N. Flooring
1. Select FSC Certified Wood Flooring
8 Reso irce pts
y=yes
2. Use Rapidly Renewable Flooring Materials
4 Reso irce pts
y=yes
3. Use Recycled Content Ceramic Tiles
4 Reso irce pts
y=yes
4. Install Natural Linoleum in Place of Vinyl
5 IAQ/Health pts
y=yes
5. Use Exposed Concrete as Finished Floor
4 Resource pts
y=yes
6. Install Recycled Content Carpet with Low VOCs
4 Resource pts
y=yes
Total Points Available:
G:data/progs/greenbuildn%
0
1401 130 57
1— _01 01 0
�_ (I Gt_ 11-0
12.04protectedAs