13050001 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10856 NORTHRIDGE SQ CONTRACTOR:FOUR SEASONS PERMIT NO:13050001 .
ROOFING
OWNER'S NAME: HEINSEN EDWARD A PO BOX 1668 DATE ISSUED:05/01/2013
OWNER'S PHONE: 9167913406 SAN JOSE,CA 95109 PHONE NO:(408)278-0330
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIALS
License Class 3 Li,.# 4( (1,200 SQ FT)TEAR OFF(E)WOOD SHAKE,INSTALL(N)
GAF GRAND SEQUOIA SHINGLE OVER(E)PLY
ContractorWae�e,4�eate > ' �
I hereby affirm that I aro licensed under the provisions of Chapter 9
(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:31636015.00 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.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 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 DAYS + ViST 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
5 // A
granting of thispermit. Additionally,the applicant understands and will compl
with all non- ' t source regulations per the upertino Municipal Code,Section
9.18.
'i I RE-ROOFS:
Signator /�`�^�" • Date)` f All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed without first obtaining an inspection,I a r e to remove all new materials for
inspection.
❑ OWNER-BUILDER DECLARATION
Signature of Applic4�& 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 work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code)
1,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 6.95 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 912 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 Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,S ons 25505,159;13 d 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized ag Date: j_( 3
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 so as to become subject to the Worker's
Compensation laws of California. It 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 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
D\
1 REROOF PERMIT APPLICATION ��
COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION
10300 TORRE AVENUE-CUPERTINO,CA 95014-3255 ^ O
CUPER (408)777-3228-FAX(408)777-3333-building0cutnertino.oro [\ ►�
PROJECT JDRESS S APN#
OWNER NAME e OJ E-MAIL
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,ST TE �j FAX
CONTACT NAME PHONE E-MAIL
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❑OWNER ❑ OWNER-BUILDER ❑OWNERAGM YCONTRACTOR ❑CONrRAcTORAGENT ❑ ARCHrrEcT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACT RNAMEUCENSENUMBERy-7a/ � IJP�I oLI ST .3
COMPANY NAME E-MAH, c 77 FAX 6' 6L VW
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ARCHTTECT/ENGINEERNAME MCENSENUMBER Ci/► BUS.LIC.#
COMPANY NAME E-MAB. FAX
STREET ADDRESS CM,STATE,ZIP PHONE
USE OF ❑ SFD or Duplex Multi-Family ;ROOF AREA: VALUATION: /y
STRUCTURE: ❑ Commercial OZ
EXISTING ROOF TYPE: ❑BUU.T-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES xMHM(SPEC M r'&W4—' W
s
REMOVE IFNO, PLYWOOD h" 13 ��PLYWD ❑OSB PITCH: ROOFRAN #LAYERS: 5/g" E: CDX :12
CLASS: A
PROPOSED ROOF TYPE: ❑BUMT-UP ROOF XASPHALT SHINGLES ❑WOOD SHAKES O WOOD SHINGLES ❑OTHER ICGES REPORT#
DESCRIPTION OF WORK:
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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 rea 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 appy 1
ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above-identied property for inspectio p
Signature of Applicant/Agent: i2� Date:
SUPPLEMENTAL INFORMATION REQUIRED oF�c�usE orur
If building is associated with a Home Owners Association,provide letter PI:aN rrc>E T RO �
of approval from HOA. v1 9lS>iCt)pNTER BUII VIM.
Provide Planning approval to verify if there any restrictions. ❑`>atrxBss. fl PLANNINGPLANREVVtf
Provide copy of Manufact rens Installation Specifications. [ Q>mza nErr
_Provide signed copy ofCupertino's Tear-OffPolicy. d OTE IMP
ReroofApp 2011.doc revised 03/16/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 10856 NORTHRIDGE SQ DATE: 05/01/2013 REVIEWED BY: MELISSA
APN: 316 36 015 BP#: "VALUATION: 1$5,200
*PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Duplex PENTAMATION 1SFDWLR00
USE: PERMIT TYPE:
WORK (1,200 SQ FT TEAR OFF E WOOD SHAKE INSTALL N GAF GRAND SEQUOIA SHINGLE OVER
SCOPE (E) PLY
FEE ID ROOF AREA
s.f.
1REROOFFRES 1,200
10
fech.Plan Check Plumb.Plan Check Elec.Plan Check
Ltec.•h.Permit Fee: Plumb.Permit Tire: Elc:c.Permit Fee:
Other Alech.Insp. Other Plumb Insp. Other Elec.Insp.
Tech.Insp.1'e Plumb. hull).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.). These ees are based on the prefinmWdina information available and are only an estimate. Contact the De t or addn'1 info.
FEE ITEMS(Fee Resolution 11-053 E . 7/1/121 FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Suphl. PCI'ee
P1urnh.1Mech.1E1ee
Permit Fee: $180.00
Suppl. Insp Fee
Plumb.i Vech./Etee
Plumb.I.Vech./Elec Permit Fee.
Construction Tar
Administrative.Fee:
Work Without Permit? 0 Yes (j) No $0.00
Advanced Planning Fees:
"Travel Documentation Fees:
Strong Motion Fee: IBSEISMICR $0.52 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
� e $181.52 $0.00 n $181.52
�` - Revised: 04/29/2013
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
P JEADORES S APN#
O NAME i P P ONE E-MAIL
ST ADD SS STA ZIP FAX
C N C Q/> LIC E MBER LIC BUS.LIC.#
J rte-- Z C
N ®�� E-MAIL FAX
STDS C STA E, 5
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 mPoode.
e detectors are quir d t stalled in accordance with Sections R314 and R315 of
the 2010 California Resid ial
Signature of Applicant/Ag _ Date:
ReroofPolicy_2011.doc revised 02/16111