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13060187 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10791 NORTHFORDE DR CONTRACTOR:,FOUR SEASONS PERMIT NO: 13060187 ROOFING OWNER'S NAME: ANN JEFFERSON PO BOX 1668 DATE ISSUED:06/24/2013 OWNER'S PHONE: 4082579517 SAN JOSE,CA 95109 PHONE NO:(408)278-0330 ❑ LICENSED CONTRACTOR'S DECL�A}RATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL E) License Class Lic.# (� (1125 S.F.)TEAR OFF(E)COMP,INSTALL(1)40 YR /.� COMP Contracto Date I hereby affirm that I am licensed u er 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. Sq.Ft Floor Area: Valuation:$2500 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:31637057.00 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 180 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 DAYS FRO LED 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 Date: Z granting of this rmit. Additionally,the applicant understands and will comply with all -poin source regulat' e e Cupertino Municipal Code,Section ar 9.18. 5�: //�� RE-ROOFS: Sign DateO� r All roofs shall be inspected prior to any roofing material being installed.If a roof is installed without first o mg inspection,I a4yee to remove all new materials for inspection. ❑ OWNER-BUILDER DECLARATION Signature of AppI can Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL OOF 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) I,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. 1 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 maintain compliance wit Cupertino M ipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Cpile,' Sec. ns 25 255 a 2 4 Section 3700 of the Labor Code,for the performance of the work for which thisOwner or authorized age Dater 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 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 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 � 10300 TO,RRE AVENUE-CUPERTINO,CA 85014-3255 0 CUPIGRTINC! (408)777-3228-FAX(408)777-3333-building0cupertino.grg `M PROJECT ADDRESS010f APN# `3 T C) OWNER NAW E-MAIL STREET ADDRESS CITY,STATE,ZIP OIL FAX CONTACT NAME PHONE E-MAIL TRS y6 is S g jpDREE�WJi /_ S 6 n /a► �� FA dcZ>3SJ ❑OWNER ❑ OWNER-BUILDER ❑OWNERAGENT YCOITI.CTOR ❑CONTRACTOR AGENT ❑ APcHrrECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACT RNAME ILI;wU/M." LTepjr std 4 3 COMPANY NAME E-MAIL; 7 VAX(VU a' rv333 s AnAREss , Q� c STAT P �5- .2 g�v 3 3 v ARCHITECUENCINEER NAME LICENSE NUMBER BUS.LIC.# COMPANY NAME F-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑ SFD or Duplex Multi-Family ROOF AREA: VALUATION: STRUCTURE: ElCommercial Z —5 -Z's-00. EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES IIIOTHER(SPECIFY) ,44 REMOVE/REPLACE91N0 ES IFNO, PLYWOOD ❑ PLYWD 13OSB PITCH: ROOF LA �41iCK1QE9S: 518" TYPE: CDX '12 CLA : A PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES (3 OTHER ICC-ES REPORT# DESCRIPTION OF WORK: do eaf.�'� Cl�l�-+�� I'av� ,S s�.Cs+'-- �vl �r�.�s+✓� �� 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 property for inspection purposes. Signature of Applicant/Agent: c -r� Date: t c g" ✓ r2 � ?y SUPPLEMENTAL WORMATION REQUIRED If building is associated with a Home Owner's Association,provide letter � � "- a�� _. ¢ r� .y'✓ _�r�*� �ti:Fir bar z ia.a{�^�1� a�d: of approval from HOA. r s � Provide Planning approval to verify if there any restrictions. _Provide copy of Manufacturer's Installation Specifications. Fsz � e _Provide signed copy of Cupertino's Tear-Off Policy. s '1' a x 3� z -g k .. ��" �'�r�✓i'3t �n ,s ReroofApp_2011.doc revised 03116111 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 CUPER7`040 (408),777-3228•FAX(408)777-3333•building okupertino.org PRQIEGT 0791 79/ b J 1 APAPN NO p E-MAII. Mud STREET ADDRESS -- ITY, STATE, /�/` FAX CO CTO N LICENSC,JU�� / ,v a LI `S BUScL�. C N `R-MAIL L! FAX G.r -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 In'spectioit 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 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 ori-site to review at the time of the inspection. ` c. Pfoper 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 monoxi7o�Orectors are re d o be installed in accordance with Sections R314 and R3.5 of the 2010 California Residential Signature of Applicant/Agent: Date: Z, L;____ - ReroofPolic3_2012.doc revised 1017112 .f'. NORTHPOINT HOMEOWNERS ASSOCIATION Northpoint Homeowners Association Aril 23, 2013 10880 Northpoint Way p Cupertino, CA 95014 PH:408-996-3734 FX:408-996-0226 City of Cupertino UNC Community Management 6840 Via Del Oro Suite 265 San Jose,CA 95119 Re: Roofs PH:408-229-6000 FX:408-229-6001 To whom it may concern; Northpoint 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