13040168 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10896 NORTHRIDGE SQ CONTRACTOR:FOUR SEASONS PERMIT NO:13040168
ROOFING
OWNER'S NAME: HUNTSMAN ANN J AND.O L PO BOX 1668 DATE ISSUED:04/23/2013
OWNER'S PHONE: 4087321962 SAN JOSE,CA 95109 PHONE NO:(408)278-0330
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIALS
License.Glas Lic.# RE-ROOF 12 SQ-REMOVE EXISTING AND INSTALL NEW
GRAND SEQUOIA SHINGLE ROOF SYSTEM OVER
Contractor ADate C(,2�> EXISTING
I hereby affirm that am licensed under de 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:31636019.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT XPIRES IF WORK IS NOT STARTED
correct.I 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 D OM LAST CALLED INSPECTION.
indemnify and keep harmless the City,of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply Issued by Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9:18.
RE-ROOFS:
Sign I Date All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed without first obtaini inspection,I agree to remove all new materials for
inspection.
❑ OWNER-BUILDER DECLARATION
Signature of Applicant
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.
I,as owner of the property,or my employees with wages as their sole compensation,
will do thework,.and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code) .
I,as owner of the property,am exclusively contracting withlicensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. I will
I hereby affirm under penalty of perjury 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 compliance with t lino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code tion 505;772 ::3/, 5 3
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized age Date:�r
permit is issued.
I certify that in the performance of the work for which this permit is issued,I shall
not employ any person in any manner sous to become subject to the Worker's
Compensationlaws of California: If,aftermaking 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
forthwithcomply 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 Cupertino against liabilities,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
191 COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINO (408)777-3228-FAX(408)777-3333•buildinq0cupertino.or4ALA Q'I
PROJE AD N#3 !co 3 c-O G l en
O NAME PHO (' !/ b Z E-MATL
STREET ADDRESS STA 21P FAX
6/
CONTACT NAME PHONE E-MAIL
a
S RrT'�I- �T• STA F >��/ 0S
T 1 .crt. " � S//Z t�3
❑OWNER ❑ OWNE2BUHDER ❑OWNER AGENT kCo=ACTOR ❑comRACTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACT R NAME LICE _SEa 0& LIc3TPE ri �
COMPANY NAME E-MAIL C: 7' FAX
c�333
p/ op
5 A iry� rJ�' sTa ���
ARCMTECT/ENGINEER NAME LICENSE NUMBER BUS.LIC.#
COMPANY NAME E-MAH. FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑ SFD or Duplex Multi-Family ,ROOF AREA: VALUATION:
STRUCTURE: ❑ Commercial G
EXISTING ROOF TYPE: ❑BUH.T-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES OTHER(SPECIFY)QWea1,W
REMOVE/REPLACE YE5 IF NO, JPLYWOOD • ❑ PLYWD ❑OSB PITCH: ROOF
N #LAYERS: 5/8" I TYPE: fiLCDX :12 CLASS: A
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT#
DESCRIPTION OF WOE
By my signature below,l 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: /��c�r� _ Date:
SUPPLEMENTAL INFORMATION REQUIRED OFFICE-USE ONLY
If building is associated with a Home Owner's Association,provide letter PLnNeo�c[c TveE Bovrrn�sLtr,
of approval from HOA. ❑ 0VE1VTiIE-COUNTKW:; ❑ BUIIAINGPLAN3tEVIEW
Provide Planning approval to verify if there any restrictions. [] F„rnuxec ❑ Pr ANNMG PLAN REVJLW
Provide copy of Manufacturer's Installation Specifications. ❑ STANDARD ❑ FM DEPT
Provide signed copy of Cupertino's Tear-Off Policy. ❑ oz�R:
ReroofApp 2011.doc revised 03/16111
l;:tiCT
$ 181.521 $0.00 $181.52
Revised: 04/01/2013
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: DATE: 04/23/2013 REVIEWED BY: Mendez
APN: BP#: `'VALUATION: 1$5,200
*PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY PENTAMATION
SFD or Duplex 1SFDWLROOF
USE: PERMIT TYPE:
WORK. RE-ROOF 12 SQ-REMOVE EXISTING AND INSTALL NEW GRAND SEQUOIA SHINGLE ROOF
SCOPE SYSTEM OVER EXISTING PLYWOOD DECK CLASS A
FEE ID ROOF AREA
s.f.
1REROOFFRES 1,200
Xleck Plan Check: Plumb.Plan Check Elec.Plan Check
Mech.Permit Fee, Plumb.Permit Fee: Elec.Permit Fee:
Lf,","h.
Alech.Insp. Other Plumb Insp. Other Elec.InspInsp.Fee: Plumb.Insp.Fee: Elec.Insp.Fee:
NOTE:This estimate does'not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). Thesefees are'based on the prelindna information available and are only an estimate Contact the De t or addn'1 info.
FEE ITEMS (Fee Resolution 11-053 E . 711112) FEE QTY/FEE MISC ITEMS
Plan Cheek.Fee '
Szi,6p1. PC Fee:..
f''1umb�h.,lllec
Permit.Fee: $180.00
:Silp'1, in Fled-
P1urnbAVech. Etc c.
Plumb,/Meeh.lElec Pc r"7 Fee;
0jrzstrz1e1 l 01 ncia�
A''dmin(s tr ative.Fee.-
Work Without Permit? 0 Yes Q No $0.00
i
Advanced Planning Fees:
Travel hobwnentation Fees: .
Strong Motion Fee 1BSEISMICR $0.52 Select an Administrative Item
Bldg Stds'Commission Fee: IBCBSC $1.00
$181.52 $0.00 $181.52
Revised: 04/01/2013
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
ALBERT SALVADOR, P.E.,C.B.O.,BUILDING OFFICIAL
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINO
(408)777-3228•FAX(408)777-3333•building(a-)cupertino.org
PR ECT RESS s APN#
G
O RNAME PH ` -73y E-MAIL
STREET ADQI S q CI ,STATE, P' AW q / FAX
w a
CO CTOR E LICENSE NUMBER LICENSE TYPE BUS.LIC.#
C ANY NA E-MAIL FAX
MAC—
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 I/"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:
ReroofPolicy_2011.doc revised 02/16/11