13040169 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:.10916 NORTHRIDGE SQ CONTRACTOR:FOUR SEASONS PERMIT NO:13040169' .
ROOFING
OWNER'S NAME: MASSIMO LANFRANCONI PO BOX 1668 DATE ISSUED:04/23/2013 .
OWNER'S PHONE: 4088738167: SAN JOSE,CA 95109 PHONE NO:(408)278-0330
❑ LENSED CONTRACTOR'S DECLARATION JOB DESCRIP'T'ION: RESIDENTIAL COMMERCIAL1
License Clas Lic.# 7: (/� I/ RE-ROOF 12 SQ-REMOVE EXISTING AND INSTALL NEW
GRAND SEQUOIA SHINGLE ROOF SYSTEM OVER
Contractor Date EXISTING
I hereby affirm that I am license rider the provisions of Chapter 9 PLYWOOD DECK CLASS A
(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:$5200
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this APN Number:31636021.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application'and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.d agree to comply with all city and county ordinances and state laws relating WIT 8 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DA OM LAST CALLED INS P CTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expe which may accrue'against said City in consequence of the
granting of rs pe it Additionally,the applicant understands and will comply Issued by: Date:
with all 96n-poV source regulations per the _ ertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature Date- :' r All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed without first ob r an inspection,I agree to remove all new materials for
inspection.
❑ OWNER-BUILDER DECLARATION 1
Signature ofApplic a:�Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1,as owner of the property,or my employees with wages as their sole compensation,
will do the woik,andthe''structure is not ihtended`or offered for sale(Sec.7044,
Business&Professions Code)
I,as owner of the property,am exclusively_contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec 7044 Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.9$of the
California Health&Safety Code,Sections 25505,25533,and 25534. I will
I hereby affirm,under penalty of perluo.one of the following three maintain compliance with the Cupertino Municipal Code$Chapter 9.12 and the
declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous
I have and will maintain a'Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain compli with the Cupertino Mun'cipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safe Code, ection 2 5,2553 an 25534.
Section,3700 of the Labor'Code,for the performance of the work for which this
permit is issued. Owner or authoriz Dat
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 CONSTRUCTION LENDING AGENCY
become subject to the'Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with'such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lender's Address
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 ARCHITECT'S DECLARATION
indemnify and keep harmless the.City of Cupertinoagainstliabilities,judgments,
costs,and expenses which may accrue against,said.City in consequence of the I understand my plans shall be used as public records.
granting of this permit.Additionally;the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION �(A
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINO (408)777-3228 FAX(408)777-3333•building(ftypertino.org
IEcrADD SS APN# 1Co02, 1
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,ran con Q7 E-MAiL
STREET ADDRESS crry.STATE,ZIP -- FAX
CONTACT NAME p PHONE 5=a E-MAIL
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❑OWNER ❑ OWNER-BUILDER ❑OWNER AGENT CONTRACTOR ❑CONTRAcToRAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACT R NAME � LCENSEaUMBER LICENSE� ��I
COMPANY NAME �E--MAH. FAX`r 94-ar 6L VW
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ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC.#
COMPANY NAME E-MAIL. FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑ SFD or Duplex Multi Family $oOF A/RiE`A� VA UATION:
57
STRUCTURE: ❑ Commercial [ p` �
EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES OTHER(SPECIFY)Q.We.,Cz�
•
REMOVEMEMACE gYES ffNO, PLYWOOD ❑ _ P rwD ❑OSB PrrCH: ROOF
NO #LAYERS: 5/8" TYPE: CDX —t—'12 CLASS: A
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ,ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER IMES REPORT#
DESCREPTION OF WORK:
do �41'il�/ Cd�t`.+ev� /'oo ,S S�C•N- �� •^���1 �w
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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 have read this
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: � Date:
SUPPLEMENTAL INFORMATION REQUIRED oTcevsE oru.Y- -
If building is associated with a Home Owner's Association,provide letter
of approval from HOA. D<oyZEt�OtiNTER ❑ Bim OMP:ANREVIEW -
Provide Planning approval to verify if there any restrictions. ,❑;EaIPxFss'- ❑ PL NNHQCPLANItEVIEK!
Provide copy of Mamtfacturees Installation Specifications. ❑ ❑ FM DEPT_ .
Provide signed copy of Cupertino's Tear-Off Policy. ❑ oR:
ReroofApp Z011.doc revised 03/16/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: DATE: 04/23/2013 REVIEWED BY: Mendez
APNt BP#: "VALUATION: 1$5,200
*PERMITTYPE: Minor BuildingPermit PLAN CHECK TYPE: Re-roof
PRIMARY PENTAMATION
USE: . SFD or Duplex PERMIT TYPE: 1 SFDWLROOF
WORK RE-ROOF 12 SQ-REMOVE EXISTING AND INSTALL NEW GRAND SEQUOIA SHINGLE ROOF
SCOPE SYSTEM OVER EXISTING PLYWOOD DECK CLASS A
FEE H) ROOF AREA
s.f.
1REROOFFRES 1,200
1lech.Plan Check Ph mb.Plan Check F_ler..Plan Check
Mc�cfr.Permit Feer I'lumh.Permit Fee: Ele, Permit Fee:
Other M ch: . Other Elec,InspIO7ler Plumh Insp
t9ech In4p.,Fee Plumb. Insp.Fee: Elec.Insp.Fee.
NOTE. This estimate does not include fees due to other Departments(i.a Planning,Public Works,Fire,Sanitary Sewer District,School
District :etc. . These ees are based on the prelimina information available and are only an estimate Contact the Dept for addn'l in d
FEE ITEMSi,(Fee Resolution 11-053 E 7� FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Suppl.1 PC Feel
PluinbAVeeh./Elee
Permit Fee $180.00
S'uppl. Msp Fee
Plurrzb':/Meeh:;EIec
P1umh,1Mecsh./Flee Permit Fee:
Construction 2:ax:
4dministrative Fee:
Work Without Permit?. ®Yes iq No $0.00
Advanced Planning Feesr
!`raj;el Documentation Fees: �
Strong Motion Fee: 1BSEISMICR $0.52 Select an Administrative Item .
Bldg StdslcominissionFee: 1BCBSC $1.00
$181.52 $0.00 $1.81.52
Revised: 04/01/2013
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•building(a)cupertino.org
PP,O.T RESS 7APN#
OWNERN PHO d49- YW E-MAIL
STREET ADDRESS CITY,STATE,ZIP FAX
CON CTOR N LIC E NUMBS LICENSE TYPE
CoNAME E-MAIL FAX
OW
STD SS CI TATE,ZIP s PHO;JE
AmTa G
I UNDERSTAND AND AGREE TO THE FOLLOWING:
1. The re-roof project shall comply with all applicable provisions of the 2010 California Codes.
2. An inspection request can be scheduled up to the day before the inspection date. Please call (408)777-
3228 from 7:30 - 3:30pm(Mon-Thurs)or 7:30 - 2:30pm(Friday)to schedule the next day inspection.
For Tear-Off and Nailing Inspections, you must also call on the day of the inspection only after that
phase of the work is completed. The building inspector will be available within one hour. Progress
and Final Inspections will be given a two hour window.
3. Tear-Off Inspection is required. Any and all dry-rotted wood shall be replaced prior to this inspection.
Unless new plywood roof sheathing is proposed throughout, all the nails/fasteners shall be either
completely knocked-down or removed prior to this inspection.
4. If plywood is installed, a plywood Nailing Inspection is required.
5. Roofing shall not be applied without first obtaining all prior 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. Progress Inspection is required when approximately 50%of roof covering is installed.
7. 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 items will be verified:
a. Flat roofs shall have a minimum of/"per foot of slope and demonstrate there is no ponding.
b. Listings from.approved testing agencies for all pre-manufactured products used shall be
available on-site to review at the time of the inspection.
c. Proper spark arrestor installation,vents painted, gutter/downspouts installed, debris removed.
8. NOTE: If you call for a tear-off or plywood nailing inspection and the work is not complete, you will be
charged a re-inspection fee of$126.00. The re-inspection fee shall be paid before another inspection
can be scheduled.
By my signing below,I certify each of the following is true: I am the property owner or authorized agent to act on the
property owner's behalf. I understand and agree to comply with the re-roof policy stated above. I also understand that
smoke detectors and carbon monoxide detectors are required to be installed in accordance with Sections R314 and R315 of
the 2010 California Residential Code.
Signature of Applicant/Agent: Date:
ReroofPo1icy_2011.doc revised 02/16/11