10080159CITY OF CUPERTINO BUILDING PERMIT
CONTRACTOR: FOUR SEASONS ROOFING
BUILDING ADDRESS: 20073 NORTHCREST SQ
PO BO`:1668
OWNER'S NAME:
LICENSED CONTRACTOR'S DECLARATION
�T�z°9
r1hereby
nse Class Lc.,t
Date
tractor
affirm that I am licensed under the provisions of Chapter 9
mmencing with Section 7000) of Division 3 of the Business & Professions
e 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
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
correct. 1 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. /' O Z3
CL f Date
Signature
BUILI►ING PERMIT INFO: BLDG r
PERMIT NO: 10080159
DATE ISSUED: 08/23/2010
PHONE NO: (408)278-0330
ELECT r— PLUMB r
MECH r RESIDENTIAL
I— COMMERCIAL r
JOB DESCRIPTION: RE -ROOF REMOVE EXISTING CEMWWOOD ROOF &
INSTALL A
NEW CLASS A COMPOSITION SHINGLE. GAF GRAND CANYON
(COLO t) STONEWOOD 12 SQ
Sq. Ft f
Area: Valuation: 54400
Occupancy Type:
APN qumber: 31638072.00
jJ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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
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.
1 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.
PERMIT EXPIRES OF PERMIT
IIFS DANCE OR
T STARTED
WITHIN 180 DAY
1.80 DAYS FROM LAST CALLED INSPECTION.
Issu !d by:
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
mify and keep harmless the City of Cupertino against liabilities, judgments,
, 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. /' /7-J)P
Com/ Date
Signature
Date:
RE -ROOFS:
All u oofs shall be inspected prior to any roofing material being installed. If a roof is
inst-, lled without first obtaining an inspection, I agree to remove all new materials for
insp potion. �Date:
23�d
Sigi ature of Applicant:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I h ive 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 &
Sa'ety Code, Section 25532(a) should I store or handle hazardous material.
At ditionally, should I use equipment or devices which emit hazardous air
co itaminants 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.
O Hner or authorized agent:/2; l6
Date:
CONSTRUCTION LENDING AGENCY
I uereby affirm that there is a construction lending agency for the performance of work's
fir which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
I ender's
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: -,ot:
APN ........: 31638)72.00
DATE ISSUED.......: 08/23/2010
RECEIPT #......... BS000)11254
REFERENCE ID # 10080159
SITE ADDRESS 20073 NORTHCREST SQ
SUBDIVISION ......
CITY CUPERTINO
IMPACT AREA ......
OWNER ............: BERT FRESCURA
ADDRESS 20073 NORTHCREST SQ
CITY/STATE/ZIP CUPERTINO, CA 95014
OPERATOR: patg
COPY # : 1
RECEIVED FROM ....: FOUR SEASONS ROOFIN
CONTRACTOR .......: DIAZ, ALFRED LIC # 21323
COMPANY ..........: FOUR SEASONS ROOFING
ADDRESS ..........: PO BCX 1668
CITY/STATE/ZIP ...: SAN DOSE, 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
0.00
1BSEISMICR VALUATION
4,400.00
0.50
0.00
0.50
156.00
1REROOFRES SQ FEET
12.00
156.00
0.00
----------
----------
------0_00
TOTAL PERMIT
-----------
157.50
0.00
157.50
0.00
VOICE ID DESCRIPTION
-------- ----------------------------
601 ROOF TEAR OFF
VOICE ID DESCRIPTION
-------- ----------------------------
602 ROOF PLYWOOD NAIL
604 ROOF IN -PROGRESS 605 FINAL REROOF
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISIOONIEWED BY:
DATE:
7APN:
ESS: *VALUATION: $4,400
BP#:
PLAN CHECK TYPE: Re -roof
kPERMIT TYPE: Minor Building Permit PENTAMATION 1 MFDWLROOF
Buildina is Yes C) No PERMIT TYPE:
PRIMARY Multi -Family Dwelling >3 Stories
USE:
WORK
NOTE: These fees are based on the retimina to u—
FEE ITEMS (Fee Resolution 09-051 Eft' 7/1/.10)
/'kin C 'Irc 'k Vcc>:
S�rl71�1. I't." f"Gt.
Permit Fee:
Soppl_ 1 lth 1""c
1 ail,
/�IGftltit,.; IL's tx'i l:./cc 1'F'i't7Nl F"c
Work Without Permit? Yes
No
Tt'rrt��'II .
Stront; Motion Fee_ 1BSEISMICR
Bld T Stds Conunission Fee: 1BCBsc
SUBTOTALS:
!ion avail o u
FEE I QTY/FEE
$156.00
$0.0
MISC ITEMS
Select an Administrative Item
$0.',0
$1.00
TOTAL FEE: $157.50
$157.50 $0.00
Revised: 8/17/2010