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13060077 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10825 NORTHVIEW SQ CONTRACTOR:FOUR SEASONS PERMIT NO:13060077 ROOFING OWNER'S NAME: HULTMAN DONALD R PO BOX 1668 DATE ISSUED:06/10/2013 OWNER'S PHONE: 9513025203 SAN JOSE,CA 95109 PHONE NO:(408)278-0330 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIALD License Class Lic.# , D lS _ RE-ROOF 12 SQ-REMOVE EXISTING COMWOOD ROOF SYSTEM Contract Date — d — AND INSTALL NEW GAF GRAND SEQUOIA I hereby affirm that I am licensed vnde a provisions of Chapter 9 SHINGLEROOF, (commencing with Section 7000)of Division 3 of the Business&Professions CLASS A 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:31636012.00 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 80 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 DA F M 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 Issued by: Date granting of this permit. Additionally,the applicant understands and will comply with all non- .nt source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Sign Date All roofs shall be inspected prior to any roofing material being installed:If a roof is installed with fi t obtain'ng Winsp tion,I agree to remove all new materials for inspection. ❑ OWNER-BUILDER DECLARATION /' l (J � I hereby affirm that I am exempt from the Contractor's License Law for one of Signature ate: 9 r 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 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. aintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by he ealth&S et<y�Code„9alctio s 5505,25533 and 25534. I Section 3700 of the Labor Code,for the performance of the work for which this w er r authorized age Date: 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. If,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 REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228•FAX(408)777-3333•building0cupertino.org Moll", 5 A/Avinj _ _ APN# 31v 3 Lv V ( :Z �� i�w� r ��^ �✓✓ E-MAiL 1A OA S �� 'CITY ATE,ZIP FAX CONTACT NAME p PHONE ^4334E-MAH. ❑OWNER ❑ OWNER-BUILDER ❑OWNERAGENT YCONTRACTOR ❑CONTRACroRAGENT ❑ ARcHnECT ❑ENGmEm �❑l DEVELOPER ❑TENANT CONTRACT RNAME n � 5 �� U,� /J3 COMPANYNAME /G�v E-MAH. FAX(V'-5' T,� , s AD l ,sTA21t yy ARCHTTECT/ENGINEER NAME LICENSE NUMBER�t BUS.LIC.# COMPANY NAME EMAH FAX STREET ADDRESS Y,STATE,ZIP PHONE CIT USE OF ❑ SFD or Duplex MultiFamily 4FWF AREA: V LUAMON: STRUCTURE: ❑ Commercial EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHAIGLES ❑WOOD SHABFS ❑WOOD MINGLES OTIH1t(SPECIFY)(2WO., � REMOVE/REPLACE4NO YES IFNO, PLYWOOD ❑ i PLYWD ❑OSB PITCH: ROOF #LA 3Y8CIaQE93: 518 TYPE: CDX '12 CLAS : A PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER IMES REPORT# DESCRIPTION OF WORK: � �Dfi1� G',�rtwer�� rav�,.� S�C•+� �� :s�l iu.�+� rA .�..7� uO�.i /v/� �C S� OVG✓ e,��T�i1 t• 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 pro jfor inspection purposes. Signature of Applicant/Agent: �—�' ��— Date: l / SUPPLEMENTAL INFORMATION REQUIRED ols olai If building is associated with a Home Owner's Association,provide letter Itovl�resl u� of approval from HOA. ov1THF�COI71V1F1Z GPI Krtx>vw Provide Planning approval to verify if there any astrictions. rr;AlvivMGr ANBEvw —Provide copy of Manufacturer's Installation Specifications. DEPT Provide signed copy of Cupertino's Tear-Off Policy. L7 oT>rEte ReroofApp 2011.doc revised 03/16111 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 CURTYt+tQ (408).777-3228•FAX(408)777-3333•buildinga(kupertino.org APN k PROJE f _ ONE B MAII STPT ADDRESS CITY, STATE,ZIP FAX C CTORN LICENS ER LICET E C ANY � E-MAIL FAX STREE AJZDRES 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 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 I/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: Ifyou 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 and d agree to comply w' h the e-roof policy stated above. I also understand that . smoke detectors and carbo onoxi detect rs a requir to stalle ccordance with Section6 s 314 R3. 5 of the_2010 California Resid (tial C e. Signature of Applicant/Agen Date: ReroofPolicy_2012.doc revised 1017112