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11050005CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20235 NORTHGLEN SQ I CONTRACTOR: FOUR SEASONS ROOFING I PERMIT NO: 11050005 I OWNER'S NAME: DEBORAH CHEN I PO BOX 1668 1 DATE ISSUED: 05/03/2011 OW'SER'S PHONE: 4083686025 G LICENSED CONTRACTOR'S DECLARATION [� License Class �� q Li,. # l 7,31 { E)E Contractor Date " l I hereby a rm that I am licensed under the provisions of Chapter 9 (commence ion-MO0 of Division 3 of the Business & Professions Code and that my license is in full force and effect. SAN JOSE, CA 95109 PHONE NO: (408)278-0330 BUILDING PERMIT INFO: BLDG f— ELECT r— PLUMB r MECH r— RESIDENTIAL f— COMMERCIAL r JOB DESCRIPTION: RE -ROOF REMOVE EXISTING CEMWOOD ROOFING, REPLACE WITH COMP SHINGLES CLASS A 14SQ 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: 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 �� f C OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1, 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) 1, 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 upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, cc •nd expenses which may accrue against said City in consequence of the g: g 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 APN Number: 31639007.00 Valuation: $4400 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by:,--' Date: RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Appli t: Date: 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 25505, 25533, and 25534. Owner or authorized _ 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 Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional 3 ITEMS OF 18 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 31639007.00 DATE ISSUED.......: 05/03/2011 RECEIPT #.........: BS000013366 REFERENCE ID # ...: 11050005 OPERATOR: TraciC COPY # : 1 SITE ADDRESS .....: 20235 NORTHGLEN SQ SUBDIVISION ...... CITY .............. CUPERTINO IMPACT AREA ...... OWNER ............. DEBORAH CHEN ADDRESS ..........: 20235 NORTHGLEN SQ CITY/STATE/ZIP ...: CUPERTINO, CA 95014 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 ---------- 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 604 ROOF IN -PROGRESS VOICE ID DESCRIPTION -------- ---------------------------- 311 SCRATCH COAT 602 ROOF PLYWOOD NAIL 605 FINAL REROOF CUPERTINO REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building cncupertino.org PROJECT ADDRESS� O ^ AP N O` �� o, �0 OWNER NAME PHONE E-MAIL r ^ STREET ADDRESS CITY, STATE, ZIP FAX i APPLICANT NAME \ c eca� R zaf� PHONEE-MA t)!5_22 —3IL G3 7 STREET ADDRESS Z 1 U I -T, CITY, STAT, v� ec4r•�<l FA p.' �U -0333 C3 OWNER 1-1 OWNER -BUILDER El OWNER AGENT34 ONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER 11DEVELOPER 1:1TENANT CONTRACTOR NAMEr� nn LICENSE NUMBER LICENSE TYPE BUS LIC At - 2r C;,Cr, 1 -re c &10 COMPANY NAMEE-MAIL FA K 78 033 v" r Se.,_. STREET ADDRESS /� Sb� ST. CIT , STATE ZIP PHONE 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 ❑ COmmerClal / Gd EXISTING ROOF TYPEBUILT-UP ROOF ❑ ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES tl, F R (SPECIFY) L'j��w C ••❑ REMOVE;REPLACE ,b rES IF NO. PLYWOOD ❑ %" ❑ PLYWD ❑ OSB PITCH: ROOF ❑ NO k LAYERS: THICKNESS: ❑ 5/8" TYPE: ❑ CDX 12 CLASS A PROPOSED ROOF TYPE: ❑ BUILT-UP ROOF Ar 5PHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES ❑ OTHER ICC -ES REPORT 4 DESCRIPTION OF WORK 1eS , (or.��- 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 relatinZtb ding nstruction. I authorize representatives of Cupertino to enter the above -identified pro rty for inspection purposes. Signature of Applicant/Agent: Date: Z SUPPLEMENTAL INFORMATION REQUIRED -f'ol+ic�uSoNL ':; (hA a q P " N CIiECI� TYy?E 't"' 1tOU.TIPIG SLIP = "= If building is associated with a Home Owner's Association, provide letter of approval from HOA. OVER THE-COUN]'FR BUILDING PLAN REVIEW Provide Planning approval CO verify If there any restrictions. O EXPRESS` PLANNING Provide copy of Manufacturer's Installation Specifications. STANDARD ❑ FIRE DEPT ,L't'rovide signed copy of Cupertino's Tear -Off Policy. O. OTHER: ReroofApp_2011,doe revised 03/02111 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION FEE ID ROOF AREA s.f. 1REROOFFRES 1,400 NOTE. These fees are based on the nreliminary information available and are only an estimate. Contact the Dept_tor addn't in/o. FEE ITEMS (Fee Resolution 09-05/ f.?ff ' 1.10 FEE QTY/FEE MISC ITEMS Permit Fee: $182.00 Work Without Permit? Q Yes No $0.00 Strom Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: 1 $183.50 $0.00 TOTAL FEE: $183.50 Revised: 04/29/2011 ADDRESS: 20235 northglen square DATE: 05/02/2011 REVIEWED BY: bobs. 1191 APN: BP#: "VALUATION: 1$4,400 'PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re -roof PRIMARY SFD or Duplex USE: PENTAMATION 1 SFDWLROOF PERMIT TYPE: WORK remove existing cemwood roofingreplace with comp shingles. SCOPE FEE ID ROOF AREA s.f. 1REROOFFRES 1,400 NOTE. These fees are based on the nreliminary information available and are only an estimate. Contact the Dept_tor addn't in/o. FEE ITEMS (Fee Resolution 09-05/ f.?ff ' 1.10 FEE QTY/FEE MISC ITEMS Permit Fee: $182.00 Work Without Permit? Q Yes No $0.00 Strom Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: 1 $183.50 $0.00 TOTAL FEE: $183.50 Revised: 04/29/2011