12040023 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 11014 NORTHSEAL SQ CONTRACTOR:FOUR SEASONS ROOFING PERMIT NO: 12040023
OWNER'S NAME: BARRETT JOY L TRUSTEE PO BOX 1668 DATE ISSI IED:04/03/2012
OWNER'S PHONE: 4089963712 SAN JOSE,CA 95109 PHONE NO:(708)278-0330
❑ LICENSED CONTRACTOR'S DECLARATION r r r
/� �1 BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class C- 97 Lic.q R 12104? r r r
CC 14,
/� f� MECH RESIDENTIAL COMMERCIAL
Contractor &vr Sda.d Fes[',aide JOB DESCRIPTION:REROOF, 12 SQ,REMOVE SI IARF:,RI>PLACE WITH
���'� �C
1 hereby affirm that I am licensed under Ihd/provisions of Chapter 9
(commencing with Section 7000)of Division 3 of the Business&Professions ASPHALT,
Code and that my license is in full force and effect. SAME COLOR
1 hereby affirm under penally 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. Sq.F1 Floor Area: valuation:$6500
APPLICANT CERTIFICATION
1 certify that I have read this application and state that the above information is APN Number:31640041.00 Occupancy Type:
cored. 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(he City ofCupertino against liabilities,judgments, PERMIT EXPIRES IF WORK IS NOT STARTED
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR
with all non-point source regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION.
9.18. —� !
Signature Date �2 Issued by: �E�N �Ar6r/ Date: y-3•/g
❑ OWNER- , FR DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for one of RF.-ROOFS:
the following Ivo reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
1,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for
will do the work,and the s(mclurc is not intended or offered for sale(Sec.7044, inspection.
Business&Professions Code) rj
I,us owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: Dale: —/L
construct the project(Sec.7044,Business&Professions Code).
1 hereby affirm under penalty of perjury one of the following three ALL ROOF COVER ' S TO BF.CLASS"A"OR BETTF,R
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSI IRF:
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 read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533.and 25534. 1 will maintain
Section 3700 of the Labor Code,for the performance of the work for which this compliance with the Cupertino Municipal Code,Chapter 9.12 and the Ileallh&
Safety Code.Section 25532(x)should I store or handle hazardous material.
permit is issued. Additionally,should 1 use equipment or devices which emit hazardous air
I certify that in the performance of the work for which this permit is issued,l shall contaminants as defined by the Bay Area Air Quality Management District 1 will
not employ any person in any manner so as to become subject to the Workers maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Compensation laws of California, If,after making this certificate of exemption,I Ileallh&Safely Code,Sections 25505,25533,and 25534.
become subject to the Worker's Compensation provisions of the Labor Code,1 must
forthwith comply with such provisions or this permit shall be deemed revoked. Owner o nl: 0
Dale: 40
APPLICANT CERTIFICATION ONSTRUZ1,ON LENDING AG F.NCy
I certify that 1 have read this application and state that the above information is
cored. I agree to comply with all city and county ordinances and stale laws relating I hereby affi that there is a ceast
mclion lending agency for the performance of work's
to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.)
upon the above mentioned property for inspection purposes-(We)agree to save Lender's Name
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which mayaccrue against said City in consequence of the Lender's Address
granting 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.
1 understand my plans shall be used as public records.
Signature Date
Licensed Professional
CITY OF CUPERTINO
3 ITEMS OF 20 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 31640041. 00
DATE ISSUED. . . . . . . : 04/03/2012
RECEIPT #'. . . . . . . . . : BS000016446
REFERENCErID # . . . : 12040023
SITE ADDRESS 11014 NORTHSEAL SQ
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : BARRETT JOY L TRUSTEE
ADDRESS . . . . . . . . . . : 10969 NORTHSHORE SQ
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-0533
RECEIVED FROM FOUR SEASONS ROOFIN
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 6, 500.00 1.00 0 .00 1 .00 0. 00
1BSEISMICR VALUATION 6, 500 .00 0.65 0 .00 0 .65 0.00
1REROOFRES SQ FEET 12.00 168.00 0 .00 168 .00 0.00
---------- ---------- ---------- ----------
TOTAL PERMIT 169.65 0.00 169..65 0.00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 1, 255.90 #011810
---------------
TOTAL RECEIPT 1, 255. 90
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- --------------------
309 EXTERIOR LATH 311 SCRATCH COAT
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
CITY OF CUPERTINO —
I FEE ESTEVIATOR—BUILDING DIVISION
ADDRESS:JrTNorthseal Sq. DATE: 04/03/2012 REVIEWED BY: jsg
APN: � .0 BP#: -VALUATION: $6,500
*PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY Multi-Family Dwelling Building is • PENTAMATION 1R2ROOF
USE: 3 Stories O Yes O No PERMIT TYPE:
wORK Remove shake replace with asphalt same color
SCOPE
FEE H) ROOF AREA
s-
1REROOFMRES " 1,200
�N �
s
-
.11a:G. !'Gm Oiierk phanh. Plnu CharA fie% Plan(.ir;'CA
mech. A-1 wil l-'ee: 1'11rmh. Permit F.i•: !{ler. Pennh Fre:
0111er llcrh. /n.vP Other PlumL Imp. Lj Ulher/ilrr•. Glp.
"ef/e hu/). Fee: Plumh. hup. Fee: lila•.Grrp. I",r:
NOTE: This estimate does not includejees due to other Departments f6e Planning,Public Works,Fire,Sanitary Sewer District,School
District,ete . These ees arebased on the relimin information available and are only an estimate Contact the Dept for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 Efl 7/1/11) FEE QTY/FEE MISC ITEMS
Plan Che(,Ic Fee:
,suppl. PC/'rte
1'/:nnh-:5l"!c•rh.i li lec
Permit Fee: $168.00
Sup/ l. Ins'p 1'ee
Pltmrh.:',blech.:7i lCc
l'lnnrh.'Adreh.iF.7ac I'erulil Fee:
I on.m i«•cion Trac:
Admini.tnrnive Pee:
Work Without Permit? O Yes Q No $0.00
Advanced Painting, 1 ves:
Tnwet Ooeuniei talion leers:
Strone Motion Fee: IBSEISMICR $0.65 Select an Administrative Item
Blde Stds Commission Fee: IBCBSC $1.00
s[rsTOTAI $169.65 $0.00 1a, aTOTAL FEE`= $169.65
Revised: 1/19/2012
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rand Canyor�}Asphait Composition ,
hi n'It s. We have . le the Stonew color fqr our roofs.
,a• J,
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Oh Site Manager
{ 408-996-3734
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REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISIONOil
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINO (408)777-3228'•FAX(408)777-3333•buildingt@cuoertino.oro \
PROIECTADDRESS AMY Site LfO OctI
UN'NEH N'A\IE O
S'rRELTADORESS _ ,^r! CT',STAAZIP FAX
Al
(�,. Y O
COWACr NAME1l aC �f^ c PHONE EMAIL
W .O
SI REIT AOURESS CITY.STATE,ZIP' FAX
o SOse Co.. q6-jJj
❑ UW:�ER ❑ UW'NER-BUILDFA ❑ OWNERAGENT -W CONIRACIOR ❑CONIRACrORAGENT ❑ ARCHULCT ❑1]:GINUR ❑ DE\'ELOPER ❑ TEIA.N-r
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC.Y 3 3
COMPANY NAME EMAIL
FAX
S I REFr ADDRESS CITY.SPATE ZIP 1'110.,N'E
O2 o S
ARCHFTECTiENGINFFRNAME LICENSE NUSIBER - BUS.LIC.Y
COMPANY NAME
EMAIL FAx
SIREF.T nODR1:S5 ��,,// CITY,STATE,ZIP - PHONE
USI:OF ❑ SFD or Duplex g Multi-Family HOOF AREA: VALUATION:
SmUCTURE'. ❑ Commercial 5 6 -qr—.
rkqa
EXIS IING ROOF TYPE: ❑BUILTUP ROOF ❑ I'R
ASPHALT SHB. Ff ❑WOOD St1ACFC ❑WOOD SInNO1P5 rOTHER(SPECIFY)
REMOVE(REPLACE WYFS IF NO. PLYWOOD QK- ❑ PLYWD ClwOSB PRCH'. Y ROOF
❑ NO Y LA H NF ❑ aW PE V D% —J—:12 CLAA. A
PRUiuSEURWFTYPE, ❑BUILT-UPROOF AfASPINLT SIBNGLFS ❑WOOD SI URNS 13 WOOD SHINGLES ❑OTHER ICC-13 REPORI'R
DESCRIPTION OF WORK-
_ w n _
i+ 3 ' sI G
I
Hy my signature below,l certify to each of the following: 1 am the property owner or authorized agent in act on the property owner's behalf. 1 have read this
application and the information 1 have provided is correct. I have read the Description of Work and verify it is accurate. 1 agree W comply with all applicable local
ordinances and slate laws relating to building con on. thO=,VWreS1NHalJM of Cupertino to enter the above-iden feed ropeny for inspection purposes.
Signature of Applicam/Agent: Due: Z
SUPPLEMENTAL INFORMATION REQ9fED - "`' OFFICEUSEONLY
If building is associated with a Rome Owner's Associatiorq provide letter ^-PLAN CRUX TYPE- ' ROOnHc SUP
of approval from HOA. ' ' WT
❑ OYER-iHP.(.•oUnTER ❑ .BUII.DINC PLAN REVIEW
Provide Planning approval to verify if there any restrictions. ` '
❑ EXPRESS ❑ PLANNI.NGPLANREVIEW
Provide copy Of Manufacturer's Installation Specifications. I 1 ''
❑'STANDARD ❑ FIRE DEPT
Provide signed copy of Cupertino's Tear-Off Policy. ❑ OTHER,
Rerwifdpp_201 Ldoc revised 03/16111
l'