13060021 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10917 NORTHRIDGE SQ CONTRACTOR:FOUR SEASONS PERMIT NO:13060021
ROOFING
OWNER'S NAME: SAFA MITRA PO BOX 1668 DATE ISSUED:06/04/2013
OWNER'S PHONE: 4089963734 SAN JOSE,CA 95109 PHONE NO:(408)278-0330
❑
JOB DESCRIPTION: RESIDENTIAL ElS
COMMERCIAL
LICENSED CONTRACTOR'S DECLARATION
RE-ROOF 10 SQ-REMOVE EXISTING ROOF SYSTEM AND
License Class Lic.# `�
INSTALL NEW GAF GRAND SEQUOIA,CLASS A
Contractor Date —
I hereby affirm that I am licensed u r the provisions of Chapter 9
(commencing with Section 7000)of ivision 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 Valuation:$5500
performance of the work for which this permit is issued. Sq.Ft Floor Area:
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:31636025.00 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 0 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 177LLED INSPIrindemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the Issued by Date
granting of this permit. Additionally,the applicant understands and will comply
with all no .nt source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signa Date All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed without first ng an inspection,I a r to remove all new materials for 3
inspection. n /`
❑ OWNER-BUILDER DECLARATION /
I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applic
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 the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code) HAZARDOUS MATERIALS DISCLOSURE
1,as owner of the property,am exclusively contracting with licensed contractors to
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 main mpliance with the Cupertino Municipal Code,Chapter 9.12 and
the H th Safety Se ns 2 ,255 x{125534.
I have and will maintain Worker's Compensation Insurance,as provided for by ��jj�� T�
Section 3700 of the Labor Code,for the performance of the work for which this Date:" •
Own o a o zed agent:
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 CONSTRUCTION LENDING AGENCY
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 I hereby affirm that there is a colending 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
construction(See.
n 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
I
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION Ob
90300 TORRE AVENUE-CUPERTINO,CA 95014-3255 UCUPERTiNO (408)777-3228•FAX(408)777-3333•building(ftuoertino.org 0.�
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USE OF ❑ SFD or Duplex Multi-Family ;ROOF RE VALUATtON:
STRUCMF: ❑ Commercial 1 S
EXISTING ROOF TYPE: ❑BUI,T-UP ROOF ❑AsmALT SH mms ❑WOOD sHAKEs ❑WOOD smuGLEs AOTI ER(SPECIFY)awo."'A�
REMOVEMEPLACEYES IFNO, PLYWOOD h^ ❑ PLYwD ❑O36 FrfCH: �/ .i2 ROOF A
4NO !H CDX —f7�—
PROPOSED ROOF TYPE: ❑BUR.T-UP ROOF ASPHALT MMGLES ❑WOOD SHAKES ❑WOOD SEWGLES ❑OTHER ICC-ES RMRT#
DESCRIPTION OF WORK:
C eGYlf e^W /'00'l S S�Sss+�- MGl iia Oct.,.-
By my signature below,I certify to each of the following: I am the properly owner or authorized agent to act on the property owner's behalf. I have read this
application and the information T have provided is eonect. 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 ApplicandAgent: eA-�+S Date-. l(�• •f
SUPPLEMENTAL ROOBMATION REQUIRED
If building is associated with a Home Owner's Association,provide letter "
of approval from HOA-
Provide
OA Provide Planning approval to verify if there any restrictions. [']
Provide copy of Manufachuces;Installation Specifications. [] s nrmAn ;
Provide signed copy of Cupertino's Tear-Off Policy. oataatt
ReroafApp_2011.doc revised 03/16/11
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REROOF TEAR-OFF POLICY
yy; COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE-CUPERTINO,CA 95014-3255
CCJPIrkTfko
(408).777-3228•FAX(408)777-3333•building aacupeltino.orCl
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I UNDERSTAND .AND AGREE TO THE FOLLOWING.
L - The re-roof project shall comply with all applicable provisions of the 2010 California Codes.
2. An inspection request can be scheduled uta 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 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. To.receive 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-rsite to review at the time of the inspection.
c. Pro per 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 re u* d o be installed in accordance with Sections R314 and R315 of
the 2010 California Residential
Signature of Applicant/Agent: Date:
ReroofPol icy_2012,doc revised 10/7/12
NORTHPOINT HOMEOWNERS ASSOCIATION
Northpoint Homeowners
Association
10880 Northpoint Way April 23, 2013
Cupertino, CA 95014
P i i:408-996-3734
FX:408-996-0226
City of Cupertino
UNG Community
Management
6840 Via Del Oro
Suite 2.65
San.Jose, CA 96119 Re: Roofs
P H: 408-7_29-6000
FX: 408-229-6001
To whom it may concern;
Northpoini: Homeowners Association has contracted Four Season's
Roofing to install new GAF Grand Sequoia Roof Shingles on homes
here at Northpoint.
Sincerely,
Linda Starnes
On Site Manager
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