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13050051 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10894 NORTHVIEW SQ CONTRACTOR:FOUR SEASONS ROOFING PERMIT NO:13050051 OWNER'S NAME: DIETZGEN JOSEPH.E AND JAN M PO BOX 1668 DATE ISSUED:05/07/2013 OWNER'S PHONE: 4083683422 SAN JOSE,CA 95109 PHONE NO:(408)278-0330 ❑ LICENSED CONTRACTOR'S DECLARATION Y��/�� BUILDING PERMIT INFO: BLDG ELECT r— PLUMB License Class _ Lic.# C MECH I— RESIDENTIAL r— COMMERCIAL Contractor Date 7 I hereby affirm that I am licensed u er the provisions of Chapter 9 JOB DESCRIPTION:RE-ROOF 65 SQ,TEAR OFF REPLACE WITH NEW COMP. (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'twfl;c�eclarations: 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:$7000 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. -- - APN Number:31636057.00 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 PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save WI'T'HIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION. costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply with all non- nt source regulations per the ertino Municipal Code,Section Issued by . ., Date: Signa 9.18. Date/ ,r� RE-ROOFS: ❑ OWNER-BUILDER DECLARATION All roofs shall be inspected prior to any roofing material being installed.If a roof is installed without first obtaining an inspection,I agree to remove all new materials for I hereby affirm that I am exempt from the Contractor's License Law for one of inspection. the following two reasons: I,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date: will do the work,and the structure is not intended or offered for sale(Sec.7044, 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 read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain Compensation,as provided for by Section 3700 of the Labor Code,.for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by 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 as defined by the Bay Area Air Quality Management District I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Heal Safety Code,Sec'ons 255 ,25533 and 25534. 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 wor�aor d Compensation laws of California. If,after making this certificate of exemption,I 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 I hereby affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.) I certify that I have read this application and state that the above information is Lender's Name 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 Lender's Address upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION costs,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands:and will comply I understand my plans shall be used as public records. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Licensed Professional Signature Date LaRER®OF PERMIT APPLICATION 4 COMMUNITY DEVELOPMENT DEPARTMENT a BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUI�ER„d,l101® (408)777-3228-FAX(408)777-3333•—bLiiidinq@cLitLe,-,ing.org "Ri�jr.'�!, /` .s1 F APN#�V `Y ' ✓ �" 0((%J NAME �Y/ ,PHO E-MAIL ft mt C��h I STREET ADDRESS Cl ,STATE, P \ FAX CONTACT NAME PHONE E-MAIL T �jge- hL dr _—: s � _ZDRj�Jte'�it� �T• d C s� �0/ F �C1 ❑OWNER ❑ OWNER-BUILDER ❑'OWNERAGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER /❑ DEVELOPER ❑TENANT CONTRACT RNAM `. L;VXU M,; COMPANY NAME tY E-MAIL �a FFAA(X(V O�L f& S AD ESS O LC STATE PHONE®JI) ARCHRECT/ENGINEER NAME LICENSE NUMBER BUS.LIC.# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE or USE OF ❑ SFD or Duplex Multi-Family ROOF AREA: VALU ON: STRUCTURE: ❑ Commercial EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES OTHER(SPECIFY)awelaelel REMOVE/REPLACEYES IFNO, PLYWOOD /" ❑ _ PLYWD ❑OSB PITCH: ROOF ❑NO # YERS: �: 5/8" TYPE: CDX '12 CLASS: PROPOSED ROOF TYPE: ❑BUILT-UP ROOF XASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT# DESCRIPTION OF WORK: p .✓c �Gl'll�l� Cd�rtwcr�� i'ao�`" ,� .5��- a.,✓�� 4-3 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 co ply with all applicable local ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above-identi d pr erty for inspection purposes. Signature of Applicant/Agent: �� P'� Date: SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY If building is associated with a Home Owner's Association,provide letter AN CHECK TYPE ROUTING SLIP of approval from HOA. OVER-THE-COUNTER ❑ BURDINGPLANREVIEW Provide Planning approval to verify if there any restrictions.. ❑ EXPRESS ❑ PLANNING PLANREVIEW Provide copy of Manufacturer's Installation Specifications. ❑ STANDARD ❑ FIRE DEPT Provide signed copy of Cupertino's Tear-Off Policy. ❑ OTHER: ReroofApp 2011.doc revised 03116111 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 (408)777-3228•FAX(408)777-3333• building a0cupertino.org PRO I APN 9 E MAII STREET ADDRESS 7 CITY STATE, FAX co GTO N LICENS R y� LI S BUS.L Q c G., C N E-MAL FAX (S72 —4A= I S ET D P 1 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 one business day before the requested inspection date. Please call (408) 777-3228.from 7:30-3:30pm (Mon-Thurs) or 7:30-2:30pm(Friday)to schedule 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. 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 pro osed 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:. Roofingshall 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 illrequire the removal of all new material down to the sheathing so a proper inspection can be performed. 6.' .A Final Inspection and approval shall be obtained from the building inspector when the re-roofing is completed. Toreceive a final sign-off,the following items will be verified: a. Flat roofs shall have a minimum of 1/4"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.. .7. NOTE: If you call far a tear-off or plywood nailing inspection and the work is not complete,you will be charged.a re-inspection fee. 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 rnonoxi ectors are requ. d o be installed in accordance with Sections R314 and R315 of the 2010 Califomia Residential Signature of ApplicanVAgent: Date: ReroofPo1rcy_2012.doc revised 10/7/12