11040077CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10800 NORTHOAK SQ
OWNER'S NAME: PARDINI EMIO J AND ELLEN M TRU
NER'S PHONE: 4089962470
❑ LICENSED CONTRACTOR'S DECLARATION
License Class 3 Lic. # 7 2-10
O
Contractor I /2 Date Z ��
I hereby affirm that I am 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.
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.
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
to building construction, and hereby authorize representatives of this city to enter
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
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Signature Date l 7,///`�
LJ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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)
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
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.
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.
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
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.
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
to building construction, and hereby authorize representatives of this city to enter
noon the above mentioned property for inspection purposes. (We) agree to save
.mnify and keep harmless the City of Cupertino against liabilities, judgments,
,sts, 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 -point source regulations per the Cupertino Municipal Code, Section
9.18.
Signature Date
CONTRACTOR: FOUR SEASONS PERMIT NO: 11040077
ROOFING
PO BOX 1668 DATE ISSUED: 04/12/2011
SAN JOSE, CA 95109 PHONE NO: (408)278-0330
;
BUILDING PERMIT INFO: BLDG
BLDG ELECT PLUMB
MECH i RESIDENTIAL COMMERCIAL
JOB DESCRIPTION: RE -ROOF 14 SQUARES, REMOVE EXISTING CEMWOOD
ROOF
INSTALL NEW 30# UNDERLAYMENT & GAF GRAND CANYON
ASPHALT SHINGLES
Sq. Ft Floor Area: I Valuation: $4400
APN Number: 31641001.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 PAY -SAF PERMIT ISSUANCE OR
180 DAY CALLED INSPECTION.
Issued by Date: Z
RE -ROOFS:
All roofs shall be inspected prior to any roofing materia emg installed. If a roof is
installed without first obtaining an inspection, I agree to re ve all new materials for
inspection.
Signature of Applicant: A& e�'— Date: L !�
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sections, 255505, 25533, and 25534. /
Owner or authorized agent: X (/t e:. Date:
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Add
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
CUPERTINO
CONTRACTOR / SUBCONTRACTOR LIST
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
JOB ADDRESS: /0,?60
Ivor fk0"� Sa-
PERMIT # 116 "L
OWNER'S NAME: o
PHONE # — Z G
GENERAL CONTRACTOR:
)11-10,15 PC—
BUSINESS LICENSE #
ADDRESS:
CITY/ZIPCODE:
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:f Z l
Signature Date
Please check applicable subcontractors and complete the following information:
V
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring / Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner / Contractor Signature
ate
CITY OF CUPERTINO
3 ITEMS OF 12 PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 31641001.00
DATE ISSUED.......: 04/12/2011
RECEIPT #.........: BS000013159
REFERENCE ID # ...: 11040077
SITE ADDRESS .....: 10800 NORTHOAK SQ
SUBDIVISION ......
CITY .............. CUPERTINO
IMPACT AREA ......
OPERATOR: SylviaM
COPY # : 1
OWNER ............: PARDINI EMIO J AND ELLEN M TRU
ADDRESS ..........: 10800 NORTHOAK SQ
CITY/STATE/ZIP ...: CUPERTINO CA, 95014-0523
RECEIVED FROM ....: FOUR SEASON ROOFING
CONTRACTOR .......: DIAZ, ALFRED LIC # 21323
COMPANY ..........: FOUR SEASONS ROOFING
ADDRESS ..........: PO BOX 1668
CITY/STATE/ZIP ...: SAN JOSE, CA 95109
TELEPHONE ........: (408)278-0330
FEE ID UNIT
QUANTITY
AMOUNT
PD -TO -DT
THIS REC
NEW BAL
-----------------------
1BCBSC VALUATION
----------
4,400.00
----------
1.00
----------
0.00
----------
1.00
----------
0.00
1BSEISMICR VALUATION
4,400.00
0.50
0.00
0.50
0.00
1REROOFRES SQ FEET
14.00
182.00
0.00
182.00
----------
0.00
----------
TOTAL PERMIT
----------
183.50
----------
0.00
183.50
0.00
VOICE ID DESCRIPTION
-------- ----------------------------
309 EXTERIOR LATH
601 ROOF TEAR OFF
VOICE ID DESCRIPTION
-------- ----------------------------
311 SCRATCH COAT
602 ROOF PLYWOOD NAIL
604 ROOF IN -PROGRESS 605 FINAL REROOF
CITY OF CUPERTINO
F FF.F ESTIMATOR — BUILDING DIVISION
im,ADDRESS:
10800 northoak sq.
DATE: 04/12/2011
REVIEWED BY: bob s.
APN:
BP#:
"VALUATION: $4,400
'PERMIT TYPE: Minor Building Permit
PLAN CHECK TYPE: Re -roof
PRIMARY SFD or Duplex
USE:
PENTAMATION 1SFDWLR00F
PERMIT TYPE:
WORK
remove existing shake replace with comp shingles.
SCOPE
FEE ID ROOF AREA
s.f.
1 REROOFFRES 1,400
NOTE: These fees are based on the pretiminary information available and are only an estimate Contact the Dept for aaan 't into.
FEE ITEMS (Fee Resolution 09-051 F,'f': 1.-'1OZ FEE QTY/FEE MISC ITEMS
Permit Fee: $182.00
Work Without Permit? 0 Yes E) No $0.00
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldgr Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $183.50 $0.00 TOTAL FEE: $183.50
Revised: 01 /15/2011
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(a7cupertino.org
PROJECT ADDRESS / O ? ol
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APN #
OWNER NAMEI O
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PHONE C), _ V
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E-MAIL
STREET ADDRESS )
CITY, STATE, ZIP
FAX
CONTRACTOR NAME
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LICENSE NUMBERl 7 / o Q
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LICENSxF TYPE
BUS. LIC. #
COMPANY NAME a�
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E-MAIL (
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STREET ADDRESS
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CITY, STATE, ZIP`
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PHONE
27f -� 3a
I UNDERSTAND AND AGREE TO THE FOLLOWING:
The re -roof project shall comply with all applicable provisions of the 2010 California Codes.
2. An inspection request shall be scheduled 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.
On the day of the inspection, a building inspector will be available within one hour for either a Tear -Off
Inspection or Nailing Inspection if you call again on that day between the hours specified.
3. The following inspections are required:
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.
b. If plywood is installed, a plywood Nailing Inspection is required.
c. Progress Inspection is required when approximately 50% of roof covering is installed.
4. New roof coverings shall not be applied without first obtaining all 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.
5. 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-site to review at the time of the inspection.
Proper spark arrestor installation.
6. 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 monoxide detectors are required to be installed in accordance with Sections R314 and R315 of
the 2010 California Residential Code.
Signature of Applicant/Agent: Date:
CUPERTINO
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(cDcupertino.org
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PROJECT ADDRESS /0
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OWNER NAME J �
PHONE
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E-MAIL
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STREET ADDRESS- p
CITY, STATE, ZIP
FAX
APPLICANT NAND
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E-MAIL
STREET ADDRESS
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CITY, STATE,
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME e� 0 2 Gre c
LICENSE NUMBER
&10
SE TYPE
712
BUS LIC. #
COMPANY NAME n / I
E-MAIL
FAX �/_G `� �
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STREET ADDRESS
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PHONE
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.aRCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC. #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ SFD or Duplex Multi -Family
ROOF AREA:
VALUATION'.
STRUCTURE. ❑ CommercialIYA
41
Gly
EXISTING ROOF TYPE ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES XD -MMR (SPECIFY)
!PITCH:
REMOVE!REPLACE >1:J ES
IF N0,
PLYWOOD ❑ '/ , 11PLYWD
❑ OSB
12
ROOF
A
13 NO
#LAYERS
THICKNESS: C35!8"
TYPE ❑ CDX
CLAS
PROPOSED ROOF TYPE ❑ BUILT-UP ROOF ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER
ICC -ES REPORT #
DESCRIPTION OF WORK.
�; 1 j � �O � � r.. �,-r',✓�.Y c,�c�C.�Y -' � cz,1'C'/ I t � � .i'�
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. 1 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 b ding ppristruction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Apphcanv'.AgenL Date:
SUPPLEMENTAL INFORMATION REQUIRED
` Y` q Off(C
:USEONi;Y"
P NCHECKTX'E+"
i;0UTjNGSLIP `
_ If building is associated with a Home Owner's Association, provide letter
Of approval from HOA.
GVER THE COUNTER
BUILDING PLAN REVIEW
Provide Planning approval to Verify if there any restrictions.
y�
❑ EXPRESS
❑ PLANNIIVGPLAN REVIEW
_ Provide copy of Manufacturer's Installation Specifications.
❑ STA]lDARD >
❑ "IiiEDEPT
Provide signed copy of Cupertino's Tear -Off Policy.
❑ OTHER:
ReroofApp_201 1. doc revised 03/02111