13050045 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20081 NORTHWOOD DR CONTRACTOR:FOUR SEASONS ROOFING PERMIT NO: 13050045
OWNER'S NAME: NINA KLEPAC PO BOX 1668 DATE ISSUED:05/07/2013
OWNER'S PHONE: 4084463356 SAN JOSE,CA 95109 PHONE NO:(408)278-0330
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic.# / _
MECH r— RESIDENTIAL r— COMMERCIAL�
Contracto tSdkf/f f C Date4100,
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:RE-ROOF 39 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 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:$5000
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:31637063.00 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 WITHIN 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-po' source regulations per the Cupertino Municipal Cod Section Issued by: Date:
9.18.
Signatu Date
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. 1 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
nd
I certify that in the performance of the work for which this permit is issued,I shall Healt Safety Code,Sections 25505,25533,a /55�
not employ any person in any manner so as to become subject to the Worker's r or u oriz t
Compensation laws of California. If,after making this certificate of exemption,I Dat
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,
costs,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION
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
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT.BUILDING DIVISION!
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPi RTINO (408)777-3228-FAX(408)777-3333.bllildingCa ctltseriino.org
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CONTACT NAMEPHONE E-MAIL
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❑OWNER ❑ OWNER-BUILDER ❑.OWNER AGENT YCONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CO RNAM LICENSE MBER
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COMPANY NAME E-MAIL FAX
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ARCHITECT/ENGINEER NAME LICENSSEE UNUMBBER Com°➢ BUS.LIC.#
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STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑ SFD or Duplex Multi-Family ROOF AREA- VALUATION:
STRUCTURE: ❑ Commercial 4�
EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINES OTHER(SPECIFY) 11�1
REMOVE/REPLACE YES IFNO, PLYWOOD ❑ PLYWD ❑ OSB PITCH: 'y® ROOF
❑NO # YERS: �: 5/8” TYPE: CDX —#—'12 CLASS:
PROPOSED ROOF TYPE: ❑BUH.T-UP ROOF ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT#
DESCRIPTION OF WORK: ,
de �tXi1�1�t C�ortw� i'ao ,y' .S P �
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 OFFICE USE ONLY
If building is associated with a Home Owner's Association,provide letter LAN CHECK TYPE ROUTING SLIP
of approval from HOA. OVER-THE-COUNTER. ❑ BUH:DING PLANREVIEW
Provide Planning approval to verify if there any restrictions. ❑ EXPRESS ❑ PLANNING PLAN REVIEW
Provide copy of Manufacturer s Installation Specifications. D STANDARD ❑ FtRE DEPT
Provide signed copy of Cupertino's Tear-Off Policy. D OTHER:
ReroofApp_2011.doe revised 03116111
.. r
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 a(�.cupertino.crc
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EMAP.
STREET ADDRESS CITY, STATE,ZIP FAX
CO CTO K LICEN5J�R �� LI S EUS. . 2 .
C N E-MAM FAX
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-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 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 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 xemoyal of all new material down to the sheathing so a proper inspection can be performed.
6.' .A Final liispection 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%"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 ori-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 for 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 monoxi ectors are requ. d o be installed in accordance with Sections R314 and R3.5 of
the-2010 California Residential
Signature of Applicant/Ager rt: Date:
ReroofPo1icy_2012.doc revised 10/7/12