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10050058 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10843 NORTHFIELD SQ CONTRACTOR:FOUR SEASONS ROOFING PERMIT NO: 10050058 OWNER'S NAME: UNC MANAGEMENT PO BOX 1668 DATE ISSUED:05/05/2010 4ER'S PHONE: 4089963734 SAN JOSE,CA 95109 PHONE NO:(408)278-0330 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG F_ ELECT PLUMB License Class Lic.# Contractor Date �6_1 MECH RESIDENTIAL COMMERCIAL 1 hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:RE-ROOF BLDG,UNITS 10843/10853/10863/10873,RMV& (commencing with Section 7000)of Division 3 of the Business&Professions REPLC EXISTING CEMWOOD ROOF W/NEW GAF GRAND CANYON Code and that my license is in full force and effect. 50YR LOOF SYSTEM CLASS A 45SQ 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 Sq.Ft Floor Area: Valuation:$15575 permit is issued. APPLICANT CERTIFICATION APN Number:31637029.10843/10853/10863/108 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply 1S 0 DAYS FROM LAST CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Signature-----� -� �'�j Date Issued by��.�� -z - L• OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS: All roof;shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installec without first obtaining an inspection,I agree to remove all new materials for I,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Signature of Applicant: Date: 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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 HAZARDOUS MATERIALS DISCLOSURE Compensation,as provided for by Section 3700 of the Labor Code,for the I have r,-ad the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. Califorr is Health&Safety Code,Sections 25505,25533,and 25534. I will maintain I have and will maintain Worker's Compensation Insurance,as provided for by complia ice with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety C ode,Section 25532(a)should I store or handle hazardous material. permit is issued. Additioually,should I use equipment or devices which emit hazardous air I certify that in the performance of the work for which this permit is issued,I shall contami jants as defined by the Bay Area Air Quality Management District I will maintaill compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health do Safety Code,Sections 25505,25533,and 25534. 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 Owner c r aut ' dj_�t: forthwith comply with such provisions or this permit shall be deemed revoked. - Date: APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I hereby,Lffirm that there is a construction lending agency for the performance of work's correct.I agree to comply with all city and county ordinances and state laws relating for whict this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save it' 7nify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address and expenses which may accrue against said City in consequence of the grwaing of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION 9.18. I understz nd my plans shall be used as public records. SignatureDate Licensed Professional CITY OF CUPEI:TINO OPERATOR: patg PERMIT RECSIPT COPY # 1 3 ITEMS OF 3 Sec: Twp: Rng: Sub: Blk: Lct: APN 31637029 .10843/10853/10863/108 DATE ISSUED. • " 0 : BS0000-_0332 RECEIPT #. . . . . 10050058 REFERENCE ID # SITE ADDRESS 10843 NORTHFIELD SQ SUBDIVISION • • • . . CUPER'IINO CITY . . . . . . . . . . . . IMPACT AREA • • • • • • OWNER UNC W,NAGEMENT 10843 NORTHFIELD SQ ADDRESS CITY/STATE/ZIP CUPER`�INO, CA 95014 RECEIVED FROM JAMES CALDERON LIC # 21323 CONTRACTOR DIAZ, ALFRED COMPANY FOUR SEASONS ROOFING ADDRESS PO BCX 1668 : SAN ,:OSE, CA 95109 CITY/STATE/ZIP (408) 278-0330 TELEPHONE . • • • • • • REC NEW BAL THIS pivlc�UNT PD—TO—DT — ----____-- FEE ID UNIT QUANTITY -- ---------- --------- 0 . 00 -------- 0 .---------- --- —---- 00 1 .00 15, 575 .00 1 . 00 1 60 0 . 00 VALUATION 1.60 0 .00 0 . 00 1BCBSC 15, 575 .00 0 .00 585 .00 1BSEISMICR VALUATION 45 .00 585 . 00 --- ---------- --------- 1REROOFRES SQ FEET ---------- ------ 587 .60 0 .00 587 .60 0 .00 TOTAL PERMIT AMOUNT REFERENCE NUMBER—— METHOD OF PAYMENT ------_--- -------- _ ----------------- ----- 587 .60 AMEX CREDIT CARD --------------- 587 .60 TOTAL RECEIPT : VOICE ID DESCRIPTION--------- VOICE — —VOICE ID DESCRIPTION --- -------- --------------- __ -- ---------------- 602 ROOF PLYWOOD NAIL 601 ROOF TEAR OFF 605 FINAL REROOF 604 ROOF IN—PROGRESS CITY OF CITY OF CUPERTINO REROOF CUPERTI rlo PERMIT APPLICATION Date: J" APN � o Building Address: /v$Y3 _ 1 �3 - /�� Phone #: , -3-73 ( Owner's Name: vr1G ��'JP HOA: Yes No ❑ If es, rovide letter from HOA Phone #: Contractor: Fax#: 2�- ss 3 3 3 Contractor License #: Cupertino Business License #: Type of Roof Covering: :Proposed: Existing: ❑ Built_Up roof ❑ Built-Up Roof Asphalt Shingles ❑ Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other (Specify) .10f Other (Specify) rev ❑ Provide I.C.C.E.S. Report Number of existing coverings ❑ Provide Mfgr. Installation Specs. ❑ To be Removed Job Description: � '`J� C.�/9� C Irl-•�tl� �..�.z�®1'� ���_,j�S Commercial Residential Confirmed with Planning Dept. if Green Building: Please complete relevant portion of the restrictions: Green Building Checklist & a ❑ ttach it to the application or if there are any a licable, include in Ian set & the sheet index:. Valuation: S I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy: � -� Signature Revised 02/05/09 CITY OF CITY OF CUPERTINO REROOF CUPERTINO FEE SCHEDULE Number of Fee ID Fee Description Fee Permit Type Squares Group 1REROOFCOM Re-roof Commercial B 1COMMLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICO Seismic Commercial B 1RER00FRES Re-roof Residential B 1SFDWLR00F 1BCBSC Cal Bldg Standard: B ALL PERMIT TYPES Commission Fee 1BSEISMICRE Seismic Residential B 1REROOFMRES Re-roof Multi-Family B 1MFDWLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES r Commission Fee 1BSEISMICRE Seismic Residential B 1BUSLIC Business License B REROOF TEAR-OFF POLICY COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDINC OFFICIAL CUPERTINO 10300 TORRE AVENUE- CUPERTINO, CA 95014-3255 (408)777-3228 -FAX(408)777-3333 -buildin a(a)cupertino.org PROJECT ADDRESS OWNER NAME PHONE ��� '- �3� E-MAIL STREET ADD SS / 't CITY STATE,ZIP/ 9�G/ FAX CONTRACTOR NAME LICENSE NUMBER — LIL4 TY BUS.LIC# �17 COMPANY NAME E-MAIL FAX 7 Cr- STRFET ADDRESS CITY, TE,ZIP j/-� 17 PH7ONE ^ Z I UNDERSTAND AND AGRE:: TO THE FOLLOWING: 1. The re-roof project shall comply with all applicable provisions of the 2007 California Building Code. 2. An inspection request shall be scheduled the day befc re the inspection date. Please call (408)777- 3228 between 7:30 - 3:30pm (Mon-Fri) to schedule th-. next day inspection. 3. After the roof is torn off and the nails/fasteners have been removed and all the dry-rotted wood has been replaced, you must call for a roof inspection. A building inspector will be available with one hour. There are special hours for the service: 7:30 — 10:30am and 1:00 — 3:30pm (Mon—Thurs); 7:30 — 10:30am and 1:00—2:30pm (Friday). 4. If plywood is installed, a plywood nailing inspection 13 required. 5. 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. 6. A final inspection and approval shall be obtained frorrL the building inspector when the re-roofing is completed. To receive a final sign-off, the following Item will be verified: a. Flat roofs shall have a minimum of/" per foot of slope and demonstrate there is no ponding. b. A listing from an approved testing agency shall be avz.ilable on-site to review at the time of the inspection. c. Proper spark arrestor installation. 7. NOTE: If you call for a plywood nailing inspection and the job is not ready, you will be charged to a re- inspection fee of$126.00. The re-inspection fee shall be paid before another inspection can be scheduled. Tly my signature below, I certify to each of the following: I am the property owner or authorized agent to act on ie property owner's behalf. I understand and agree to comr ly with the re-roof policy stated bov . Signature of Apphcant/Age -,-= Date: '> ReroofPolicy_1010.doe revised 04114110 -M. ndoor Air Quality and Finishes 1 IAQl�ealth pts y=yes 6 1.Use LovtND-V©C Paint o 2.Use Low VOC,/eater-Based Wood Finishes 2 IACJ-lealth pts y=yes 31AaHealth is r— e� 0 3.Use Low/tdo Vl�C Adhesives p �_y " 4.Use Salvaged,Materials for Interior Finishes 3 Res)urce pts y=yes 6 5.Use Engineered Sheet Goods with no added Urea p Formaldehyde 61AQ'Health pts y=yes y 0 6.Use Exterior Grads Plywood for Interior Uses 1 lAQ Health pts y= es o 7.Seal allPlatx�or MDF 4 IAQ'Health Pis Y=YrS B.Use FSC Certified Materials for Interior Finish 4 Re:ource pts y=yes 6 9.Use Finger-Jointed or Recycled-Content Trim 1 Re:.oume pts y=yes 10.Install Arhola House Vacuum System 3 IAO/Health pts y=yes 6 H.Flooring 1.Selact FSC Certified Wood Flooring B Res)urce pts y=yes 0 2.Use Rapidly Banewahle Flooring Materials 4 Res>uma pts y=yes 3.Use Recycled Content Ceramic Tiles 4 Res)urce pts y=yes 4.Install Natural Linoleum in Place of Vinyl 5 IAC/Health pts y=yes 0 5.Use Exposed Concrete as Finished Floor 4 ReSDUMe pts y=yes 0 6.Install Racycled Content Carpet with Low VOCs 4 Resource pts y=yes 0 Total Points Availaale: 1f0 130E- 57 Total Points Project Received: - 0 0 0 G:datalprops/greenbi it fiinoguidelinestramodelersigreenpointsfinal212.()4proteoied.xls Building Department City Of Cupertino 10300 Torre Avenue Cupertino,CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS: lJ�'Y� ""/dam 3 PERMIT# L �� �,�,�,,... PHONE OWNER'S NAME: G�.�G �`�' d BUSINESS LICENSE# GENERAL CONTRACTOR: fi� CITY/ZIPCODE: /Z ADDRESS: *Our municipal code requires all businesses working in the c ty to have a City of license. BE SCHEDULED UNTIL THE NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUUPERTINO BUSINESS LICENSE. y -�;A D I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete Me following information: &/ 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 Date Owner/Contractor Signature