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10040151 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10803,10813,10823,10833 NORTHFIELD SQ CONTRACTOR:FOUR SEASONS ROOFING PERMIT NO: 10040151 OWNER'S NAME: UNC COMMUNITY MANAGEMENT PO BOX 1668 DATE ISSUED:04/23/2010 NER'S PHONE: 4089963734 SAN JOSE,CA 95109 PHONE NO:(408)278-0330 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r— PLUMB r— License Class 7R Lic.# v / MECH f— RESIDENTIAL f— COMMERCIAL Contracto,,,--,-'> Date y'2� I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:RE-ROOF TOWNHOUSES 10803,10813,10823,10833;RMV& (commencing with Section 7000)of Division 3 of the Business&Professions RD ROOF WITH NEW GAF GRAND CANYON SOYR C ROOF OF SYYSTEMSTEM CLASS A 46SQ 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 Sq.Ft Floor Area: Valuation:$21000 permit is issued. APPLICANT CERTIFICATION APN Number:31637033.10803/13/23/33 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 180 DAYS FROM LAST CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. d�� /p Issued by: Date: Signature — Date u OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installed 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(Scd.7044, Signature of Applicant: Date: Business&Professions Code) I,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 1 hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE 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 I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Safety Code,Section 25532(a)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall maintain 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&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 or authorized agent: forthwith comply with such provisions or this permit shall be deemed revoked. �-�—��C'' � nArp•_ � CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is I hereby affirm 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 which 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 mnify 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 granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. I understand my plans shall be used as public records. Signature��l `y�r� Date 7 Licensed Professional CITY OF CUPERTINO PERMIT RECEIPT OPERATOR: patg 3 ITEMS OF 4 COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 31637033 .10803/13/23/33 DATE ISSUED. . . . . . . : 04/23/2010 RECEIPT # . . . . . . . . . BS000010258 REFERENCE ID # 10040151 SITE ADDRESS 10803, 10813, 10823, 10833 NORTHF SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER UNC COMMUNITY MANAGEMENT ADDRESS 10803 10813 10823 10833 NORTHF CITY/STATE/ZIP CUPERTINO, CA 95014 RECEIVED FROM D AES ALFREDAMELIC # 21323 CONTRACTOR . . . . . . COMPANY FOUR SEASONS ROOFING ADDRESS PO BOX 1668 CITY/STATE/ZIP SAN OSE,0CA 330 95109 TELEPHONE FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC- --NEW-BAL ---- ---------- ------ ---------- ------ 0 .00 1 . 00 0 . 00 1BCBSC VALUATION 21, 000 . 00 1. 00 0 . 00 2 .10 0 . 00 1BSEISMICR VALUATION 21, 000 . 00 2 .10 1REROOFRES SQ FEET 46 .00 598 . 00 0 . 00 598 . 00 --- -0_00 TOTAL PERMIT 601 . 10 0 . 00 601 .10 0 . 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION-- ---------- _ __ 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF %JTY OF CITY OF CUPERTINO D2 , REROOF CUPERTINO PERMIT APPLICATION ' Date: 5 Building Address: o Phone : �� Z/ Owner's Name: 4110,01C, r HOA: Yesgl No ❑ If yes, provide letter from HOA Phone Contractor: ''"�r G > Fax#: Cupertino Business License #: Contractor License #: Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles VAsphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles Other(Specify) {/�.�••�—..r� �- � ❑ Other (Specify) Number of existing coverings ❑ Provide I.C.C.E.S. Report# ❑ To be Removed ❑ Provide Mfgr. Installation Specs. Job Description: Residential Commercial ❑ Building: Please complete relevant portion of the Confirmed with Planning Dept. if Green g ❑ Green Building Checklist & attach it to the application or if there are any restrictions: a licable, include in plan set & the sheet index. Valuation: I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy: Signature Revised 02/05/09 CITY OF CUPERTINO 10 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 1REROOFRES Re-roof Residential B 1SFDWLR00F 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICRE Seismic Residential B Ab 1RER00FMRES Re-roof Multi-Family B 1MFDWLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES 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., BUILDING OFFICIAL 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228- FAX(408)777-3333 • buildina(d)cupertino.oEg /d C� fU �� t �� APN# PROJECT ADDRESS t E-MAIL OWNER NAME rr ` �,/ PH STREET ADDRESS CI / C STA7TEG,ZIP FAX CONTRACTOR NAME �1 U LICENSE (RU� LICEE TYPE BUS.LIC.# COMPANY NAME E-MAIL FAI/o -g FTCITSTREEETT,ADDRESS Y,STATE,ZIP PHONE�7� nL 1t/ ff I UNDERSTAND AND AGREE 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 before the inspection date. Please call (408)777- 3228 between 7:30 - 3:30pm (Mon-Fri) to schedule the 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 is 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 from 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 available 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. By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on he property owner's behalf. I understand and a ee to comply with the re-roof policy stated a ove. Signature of Applicant/Agent:n - Date: ReroojPolicy_2010.doc revised 04/14/10 C?� R_c<f � v% ,s �NORTHPOINT HOMEOWNERS ASSOGI.►TiON _ 10880 Northpoint Way NPHOA.ORG Cupertino, CA 95014 (408) 996-3734 March 10, 2009 City of Cupertino Re: Northpoint Roofs To the City of Cupertino; Please note,the Northpoint Homeowners Association has contracted and approved Four Seasons Roofing to perform re-roofs of our horries replacing the current Cal-Shake roof system with new GAF Grand Canyon Asphalt(:omposition Shingles. We have selected the Stonewood color for our roofs. Sincerely, J��Ir�•✓ Linda Starnes On Site Manager PML MANAGAGeMENT,666 Mariners island Blvd. Sulto 301, San Mateo, CA 94404(550) 349-9113 Z0 3Jvd +dOH 1NIOdHl8ON 9ZZ096680V L5=ti0 GOOZ/0Z/Z0 Z0 39dd ONI300a SNOSd3S 2jnoj EEE08LZ80b L0:5Z 0Z0Z/EZ/170 -CERTIFICATE OF WORKERS'COMPENSATION COVERAGE DATE(MMIUDIVY) Master Aeeou+lt 3/3/2010 THIS CERTIFICATE OF COVERAGE IS ISSUED AS A MATTER OF INFORMATION ONLY AND Mainstay Business Solutions CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT P.O.BOX 1128 AMEND,EXTEND OR ALTER THE COVERAGE;AFFORDED BY THE COVERAGE BELOW. Blue Lak®,CA 95526 ENTITY AFFORDING COVERAGE Staffing Client INSURER A:Mainstay Business Solutions(a Self Insured Employer,Certificate#2318) Four Seasons Roofing 502 Horning St DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLESII=XCLUSIONS San Jose,CA 95112 ADDED BY ENDORESEMI=NT/SPECIAL PROVISIONS Fax:408-278.0333 This coverage is afforded only to the employees provided to Four Seasons Roofing by Mainstay Business Solutions.This coverage complies with the requirements of the Director of Industrial Relatlons under the provlSlons of Sections 3700 to 3705,Inclusive,of the Labor Code of the State of California for consent to self—Insure- COVERAGES THE COVERAGES LISTED BELOW HAVE BEEN ISSUED TO THE ENTITY NAMED ABOVE FOR THE PERIOD INDICATED,NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE COVERAGE AFFORDED BY THE CERTIFICATE OF COVERAGE DESCRIBED HEREIN 15 SUBJECT TO ALL THE TERMS.EXCLUSIONS AND CONDITIONS OF SUCH COVERAGE.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, letter TYPES OF COVERAGE CLIENT NUMBER CLIR'NT EFFECTIVE CLIENT EXPIRATION LIMITS DATE IMMI offy) DATE(MMUDDIYY) 69NERAL LIABILITY EACH OCCURRENCE4 $ eeYMCNOAL O9NSRA�L�L-1A-teILlry FIRE DAMAGE(Arty one firo) $ CWNe M-09 C] oeeuR MED EXP(Any one arson) $ PERSONAL&ADV INJURY $ 06N'L LJQR APA saPER: GENERAL AGGREGATE $ ►oucr SEC° Lac PRODUCTS—COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANYAUTA (Ea accident) $ ALL OWNED AUToo BODILY INJURY SCHEDULED AUT05 (Per person) $ NIRAb AUTOa NP"WNCDAUTOs BODILY INJURY $ ((Por accident) PROPERTY DAMAGE $ Per accident)GARAGE LIABILITY ANrAtlro AUTO ONLY—EA ACCIDENT $ 8 OTHER THAN EA ACC $ AUTO ONLY; AGG EXCESS LIABILITY EACH OCCURANCE OCCUR O CLAIMS MADE AGGREGATE $ n OEbUCYILLLS $ R06NT10N j A Workers Compensation MBS-SIP-00R11- 6/6/2007 2/28/2011 10 WC STATUTORY LIMITS EL DISEASE-EMPLOYEE $1 MIL EL DISEASE--LIMIT $1 MIL EL EACH ACCIDENT $1 MIL CERTIFICATE HOLDER X CANCELLATION Four Seasons Roofing SHOULD ANY OF THE ABOVE DESCRIBED COVERA139 BE CANCELLED BEFORE THE EXPIRATION DATE 502 HorningSt San Jos® CA 95112 THEROF.THE ISSUING ENTITY WILL ENDEAVOR TO MAILZLOAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OaLJOATION OR LIABILITY OF ANY KIND. AUTHORIZED REP 6 NTATIVE TO 39VJ ONIAOO�J SNOSV3S ano-i EEE08LZ80b OZ :ST OIOZ/EZ/VO Community Development m 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 CITY Of Fax(408)777-3333 "UPEkTINO Buildin De artment JOB ADDRESS: �� /��' ✓ PERMIT # 6 SYOff— /v&'1.3 -- �923 ® /�x33 OWNER'S NAME: PHO / NE # �� a 7 - 3'c GENERAL CONTRACTOR: FAX # r9laf 7S-- 0�3 I am not using any subcontractors: — --��` �---•�' / Signature Date Please check applicable subcontractors and complete the 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 Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile � �/<D owner/Contractor Signature Date