10060211 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10905 NORTHVIEW SQ CONTRACTOR:FOUR SEASONS ROOFING PERMIT NO: 10060211
OWNER'S NAME: BRIAN ENG&NANCY POON PO B:)X 1668 DATE ISSUED:06/30/2010
NER'S PHONE: 4089961709 SAN JOSE,CA 95109 1 PHONE NO:(408)278-0330
/�►LI SED CONTICAC OR'S D/E�CLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB r
License Cl s l� Lic• e" MECH r RESIDENTIAL COMMERCIAL
Contract ate
I hereby affirm that I am licensed un er the provisions of Chapter 9 JOB DESCRIPTION:TEAR OFF EXISTING ROOF INSTALL 30LB FELT&A
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.
I have and will maintain Worker's Compensation Insurance,as provided for by Sq.F t Floor Area: Valuation:$4400
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. � D
r APN Number:31636004.00 Occupancy Type:
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 PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We)agree to save
indemnify and keep ha ess the City o rtino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and e p nses whi may accrue gainst id City in consequence of the [80 DAYS FROM LAST CALLED INSPECTION.
granting of s permit. ditionally, a applic t understands and will comply
with all -point sourc egulations p r the Cu ertino Municip Code, ection �J
9.1 Issued 6y:_ Date: (�'
Signat ate
❑ OWNER-BUILDER DECLARATION RE-RO S:
All r Hofs shall be inspec prior o y roofin mate al being installed.If a roof is
I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first o ining i pection, agre to remove all new materials for
the following two reasons: inspxtion.
I,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044, Signature of Appli Date: 30
Business&Professions Code) —
I,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).
I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the
Compensation,as provided for by Section 3700 of the Labor Code,for the Cal forma Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
performance of the work for which this permit is issued. corr pliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
I have and will maintain Worker's Compensation Insurance,as provided for by Safi•ty Code,Section 25532(a)should I store or handle hazardous material.
Adc.itionally,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 con:a 'Hants as efined by t ay Area Air Quality Management District I will
permit is issued. mai n comp nce with t e 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 Hes t &Safe ode,Sec ons 2 05,25533,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 er or sit rued ager .30
become subject to the Worker's Compensation provisions of the Labor Code,I mu ate:
forthwith comply with such provisions or this permit shall be deemed revoked. —
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION I he reby 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,vhich this permit is issued(Sec.3097,Civ C.)
correct.I agree to comply with all city and county ordinances and state laws relating Leu der's Name
to building construction,and hereby authorize representatives of this city to enter
unman the above mentioned property for inspection purposes.(We)agree to save LeiLder's Address
unify a keep less the City ertino against liabilities,judgments,
�. and xp uses hi may accru again t said City in consequence of the ARCHITECT'S DECLARATION
granting s pe 't. dditionally,the ap licant understands and will comply
with all -points u e regulations er a Cupertino Municip Code,Section I uu.derstand my plans shall be used as public records.
9.18.
Licensed Professional
Signa Date ��
CITY OF CUPERTINO
2 ITEMS OF 10 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 316360 )4 .00
DATE ISSUED. . . . . . . : 06/30/2010
RECEIPT #. . . . . . . . . BS000010747
REFERENCE ID # 10060211
SITE ADDRESS 10905 NORTHVIEW SQ
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER BRIAN ENG & NANCY POON
ADDRESS . 10905 NORTHVIEW SQ
CITY/STATE/ZIP CUPER'IINO, CA 95014
RECEIVED FROM FOUR SEASONS ROOFIN
CONTRACTOR DIAZ, ALFRED LIC # 21323
COMPANY FOUR c,EASONS ROOFING
ADDRESS . PO BOX. 1668
CITY/STATE/ZIP . . . : SAN JOSE, CA 95109
TELEPHONE (408) :;78-0330
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 :_56 .00 0 .00 156_ ------
00 0_00
----
TOTAL PERMIT
L57 . 00 0 . 00 157. 00 0 .00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- - ----
CHECK 785 . 00 #)09796
---------------
TOTAL RECEIPT 785 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-- ---------------------------- -
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
CITY OF
CITY OF CUPERTINO
REROOF
CUPERTINO PERMIT APPLICATION
Date:
Building Address: "
Owner's NameCT � p Phone #:
HOA: Yes ei, provide letter fi•om HOA
Contractor: Phone #:
0,' ' , cUc� <�� Fax#: ,.. az
Cupertino Business License #: Contractor License #:
1 �j Z. . .�
Type of Roof Covering:
Existing: F roposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles X Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other (Specify) S HA( ❑ Other (Specify)
Number of existing coverings / ❑ Provide I.C.C.E.S. Report#
�{ To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description: S`(`l,� kg-� -
L�s
Residential Commercial ❑
Green Building: Please complete relevant portion of the Confirmed with-Planning Dat. if
Green Building Checklist & attach it to the application or if there are any restrictions:
applicable, include in plan set & the sheet index.
Valuation: 2�,
I Have ad, Un ers and andill Co ply with Cupertino's Tear-Off Policy:
Revised 02/05/09
I
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
CUPERTINO
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
;
(408) 777-3228 • FAX (408)777-3333 • buddirg(a)cupertino.orq
_ APN N
C
rl Gc v ' \ PHONE ! MAIL
�l L 17 ti E-[
CITY, STATE,jlr i v 6 P=BX` N,a
LICENSE NUN / LICENS TYPE BUS.LIC,4
E-MAIL FAX 4
��--S � 3s3Ov2' o�'i2i2 cif• CIT� srATE,zPHONE
I UNDERSTAND AND AGREE TO THE FOLLOWING:
fie rc-roofproject shall comply with all applicable p-ovisions of the 2007 California Building Code.
_. A inspection request shall be scheduled the day before the inspection date. Please call (40g)777-
S 'L -cen 7:30 - 3:30pm (Mon-Fri) to schedule tl.e next day inspection.
:`le roof is torn off and the nails/fasteners havE been removed and all the dry-rotted wood has
replaced, you must call for a roof inspection. A building inspector will be available with one hour.
_!'Iher , are special hours for the service: 7:30 — 10:30im and 1:00 — 3:30pm (Mon —Thurs);
7:30 — 10:30im and 1:00 — 2:30pm (Friday),
l i hi;wood is installed, aplywood nailing inspection s required.
roof coverings shall not be applied without first obtaining all inspection and written approvals from
wilding inspector. Any roofing which is applied without first obtaining an approved inspection will
re�luire the removal of all new material down to the sheathing so a proper inspection can be performed.
6. final inspection and approval shall be obtained fror-i the building inspector when the re-roofing is
;.ompletcd. To receive a final sign-off, the following item will be verified:
F;at I-oofs shall have a minimum of/" per foot of slope and demonstrate there is no ponding.
d. A listing from an approved testing agency shall be available on-site to review at the time of the
r?spedtion.
Proper spark arrestor installation.
NU'I Eif you call for a plywood nailing inspection End 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.
rn -SI. below, 1 certify to each of the following: i am the property owner or authorized agent to act on
.;� property owner's behalf. 1 understand and agree to com)ly with the re-roof policy stat/ed a ove.
Sig-n rur� of Applicant/Agent: ------- Date: /C�
ReroofPolicy ?OlO.doc rewszd 04 ;; il
INPUT . 1ADIHeafth
M.Indoor Air Quality and Finishes
1.Use Low/No-VOC Paint 1 IAQ/liealth pts y=yes 0
2.Use Low VOC,Water-Based Wood Finishes 2 IAQA iealth pts y=yes 0
3,Use Lovw/No VOC Adhesives 3 IAQ/I iealth pts y=yes 0
4.Use Salvaged Materials for Interior Finishes 3 Resc urce pts y=yes
5.Use Engineered Sheet Goods with no added Urea
Formaldehyde 6 IAQ/iealth pts y=yes 0
6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/-Iealth pts y=yes 0
7.Seal all Exposed Particleboard 4r MDF 4 IAQ/�Iealth, pts y=yes 0
e.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes 0
9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y=yes 0
10.Install Whole House Vacuum System 3 IAQ'Health pts y=yes
1 1 1
N.Flooring
1.Select FSC Certified Wood Flooring 6 Reso irce pts y=yes 0
2.Use Rapidly Renewable Flooring Materials 4 Reso irce pts y=yes 0
3.Use Recycled Content Ceramic Tiles 4 Reso irce pts y=yes 0
4.Install Natural Linoleum in Place of Vinyl 5 IAQ/-iealth pts y=yes 0
5.Use Exposed Concrete as Finished Floor 4 Reso-orce pts y=yes 0
6.Install Recycled Content Carpet with Low VOCs 4 Rese-irce pts y-yes 0
1 1 1
Total Points Available: 1 1401 1301--- 571
Total Points Project Received: 0 01 —
� .; IQ—
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