12030090 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10967 NORTHSEAL SQ CONTRACTOR:FOUR SEASONS ROOFING PERMIT NO: 12030090
OWNER'S NAME: ELAM JEANNE G ET AL PO BOX 1668 DATE ISSUED:03/192012
OWNERS PHONE: 4089963734 SANJOSE,CA 95109 PHONE NO:(408)278.0330
r
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT f— PLUMB1-,
License ClasS� Lic.# oz �
C'3 Y / MECH I- RESIDENTIAL I✓ COMMERCIAL I-1
Contractor 1-S/4? - Date
1 hereby affunu that I am licensed udder the provisions of Chapter 9 JOB DESCRIPTION:RE-ROOF REMOVE CAL SHAKE,INSTALL 30LB FELT,GAF
(commencing with Section 7000)of Division 3 of the Business J Professions GRAND CANYON COMPOSITION ROOFING:13,5 SQUARES
Code and that my license is fa full force:old effect.
hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a cenificate 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 fiver which this pen nit is issued.
I have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Fluor Area: Valuation:$6500
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
APN Number:31640013.00 Occupancy Type:
APPLICANT CERTIFICA'T'ION
I certity that I have read this application and state that the above imbrication is
correct. I agree to comply with all city and county ordinances and slate haws relating
to building construction.mid hereby authorize representatives of this city to enter PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We)agree to save
indemnify and keel,harmless(lie City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may accrue against said City in consequence of the 180 D YS FROA' AST CALLED INSPECTION.
grunting of this pemtit. Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section - �,/ f
9.18. //( Issued by: rr �r�� / � Dote:
$IgllailfC `^tel DaICZ
❑ OWNER-B111LDFR DECLARATION RE-ROOFS:
All awls shall be inspected prior to any roofing material being installed.(fa roof is
1 hereby affirm that I am exempt from(lie Contractor's License Law for nae of installed without forst obtaining an inspection,I agree to remove all new materials lir
(lie following two reasons: inspection.
1,as owner of the property,or my employees with wages as their sole compensation, ////�
will do the wort:,and the structure is not intended or offered for sale(Sce.7044, Signature of Applicant: lYlDate:
Business S Professions Code)
I,is owner of the property.and exclusively contracting with licensed contractors to
construct(he prgiect(Sec.7(A4,Business 8e Professions Code). AL1.ROOF COVERINGS TO BE CLASS"A"OR BETTER
hereby affirm under,penalty of perjury one of the follow ing flute
declarations: IIAZARDOUS MATERIALS DISCLOSURE
1 have and will maintain a Certificate of Consent 10 self-insure for Worker's 1 have read the hazardous materials requirements under Chapter 6.95 of the
Compensation,as provided for by Section 3700 of the Labor Code,for the California Health d Safety Code,Sections 25505,25533,and 25534. 1 will maintain
perfimmance of the work for which(Itis permit is issued. compliance with the Cupertino Municipal Code.Chapter 9.12 and the Health S
I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code.Section 25532(x)should 1 store or handle hazardous material.
Section 3700 of the Labor Code,for the perbmtance 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
maintain compliance with the CupertinoMunicipal Code.Chapter 9.12 and the
I certify that in the performance of Ilse work for which this permit is issued,I shall Ileakil d Safety Code.Sections 2.5505,25533,and 25534.
not employ any person in any manner so as to become subject to die Worker's -
Compensation laws of Cal itbmia. If;aOer makin This certificate of exem pion,l Ownf}o tat zeA a enC 9
become subject to the Worker's Cmnpensaion provisions of the Labor Code.I must Date: 3
forthwith comply with such provisions or this permit shall be deemed revoked.
CON.SfRLICFION LENDING AGENCY
APPLICANT CERTIFICATION 1 hereby affirm(hat there is a construction lending agency for the performance of work's
f certify that I have read this application mid state that the above infunnadonl is for which this permit is issued(Sec.3097,Civ C.)
correct.I agree to comply with all city and county ordinances mitt state laws relating Lender's Name
to building construction,and hereby authorize representatives of this city to enter
upon(he above mentioned property for inspection purposes.(We)agree to save Lender's Address
indemnify and keep harmless the City ol•Cupertino against liabilities,judgments.
costs,and expenses which may accrue against said City in consequence of the
granting of this penuit.Additionally,the applicant understands and will comply ARCHITE(T'S DECLARATION
with aU non-point source regulations per the Cupertino Municipal Code.Section I understand my phos shall be used is public records.
9.18.
Licensed Professional
Signature Date
CITY OF CUPERTINO
3 ITEMS OF 15 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: B1k: Lot:
APN . . . . . . . . : 31640013 .00
DATE ISSUED. . . . . . . : 03/19/2012
RECEIPT #. . . . . . . . . : BS000016306
REFERENCE ID #, . . . : 12030090
SITE ADDRESS . . . . . : 10967 NORTHSEAL SQ
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : ELAM JEANNE G ET AL
ADDRESS . . . . . . . . . . : 1911 MILANO WAY
CITY/STATE/ZIP . . . : MOUNTAIN VIEW, CA 94040-4063
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 14 . 00 196. 00 0. 00 196 .00 0.00
---------- ---------- ---------- ----------
TOTAL PERMIT 197 . 65 0 . 00 197 .65 0 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
309
--------------------------
309 EXTERIOR LATH 311 SCRATCH COAT
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
CITY OF CUPERTINO
FEE ESTIMATOR— BUILDING DIVISION
97.14 ADDRESS: 10967 northseal sq DATE: 0 3/1 912 01 2 REVIEWED BY: larrys
APN: BP#: `VALUATION: 1$6,500
*PERMITTYPE: Building Permit PLAN CHECK TYPE: Addition
PRIMARY SFDorDuplex PEiSFDWLROOF
USE: PERM1IIT MITTTION Tl'PE:
WORK reroof. remove cal shake install 30 Ib felt of grand canyon composition roofing. 13.5 squares.
SCOPE
Reeh Plan Check Phunh. Ilion Check Elec.Plan Check
Mach.Pernih Fee: Plund'.Permit Fee: Ele,. Permit Fee.,
Clrinn•U.' h.Insp. Otho,Pluorb 1, 0/1wElve. lup.
V&h Imtp. Fee: Plumb. h p.Fee: Fier.Imp.Fee:
NOTE: This evimate does not include fees due to other Departments(Le. Planning,Public Warks. Fire,Sanhary Sem•er District.School
District,etc.). These fees are based on the prefininan in orntation available and are only an evintate. Contact the Dept for adda'I info.
FEE ITEMS (Fee Resolution 11-053 EfT 71111 1) FEE QTV/FEE MISC ITEMS
Platt Check Fee: $0.00 1,350 s.f. Re-roof
Suppl. PC Fee: tD Reg. Q OT 0.0 hrs $0.00 $196.00 1REROOFREs
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Feet@ Reg. O OT O.Q hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Cr uvttchun To.r.
Administrative Fee: O
Work Without Permit? 0 Yes G No $0.00
Advanced Planning Fee-. $0.00 Select a Non-Residential
Tnrnel Dociananwrion Fees: Building or Structure 0
Strong Motion Fee: IBSEISMICR $0.65 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $1.65 $196.001 TOTAL FEE: I $197.65
Revised: 1/19/2012
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE 'CUPERTINO,CA 95014-3255 .
CUPERTINO (400)777-322a- FAX(408)777-3333•building(a)cupertino.oro
PROJECTADDRESS SQ
ID I Nor sea
OWNER NAME GTO1 - o E- IL
5'63-3ea a 7 ,
STREET ADDRESS CITY.ST ZIP I FAX
o a "e A
CONTACT NAME C �(� 1, PIIONF. .O EMAIL
STREET ADDRESS CTIY';STATE:ZIP If } 7' i• FAX
O S SoSC Ca. S
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT W CONTRACTOR ❑'co I cTOR AOFNT, ❑ ARCBRECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAMELICENSE NUMBER . LICENSE TYPE BUS.UC. 3 R3
COMPANY NAME ' a' 1 E"10 FAX
STREET ADDRESS CTTY,SFATE ZIP PHONE
02 o 5
ARci TECTENGINEER NAME R LICENSE NUMBER''}. �}. • I BUS.LIC.tl .
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,SrATE,ZIP PDONE
USE OF Cl SFD or Duplex Multi-Family ROOF AREA: VALUATION:
STRUCTURE: ❑ (,OmIDefC1al II. / �• :� r .5. (� Too
t pt 1l
EXISTING ROOF TYPE:
----////❑BULLY-UP ROOF' ❑ASPITALTSIIINGI.ES ❑WOOD SLUKFS ❑WOOD SHINQ.ES rOl}IE0.(SPEIF
CY) A` SRA
REMOVEmEPLACH,WYFS IF NO, PLYWOOD J3%- ❑ PLYWD ❑DSD 1471`j
71` 1 t4 I ROOF �P
LAYERS
_ :
PROPOSED ROOF TYPE: ❑BUILT-UPROOF XMYHALT SIIINrR rS ❑W'OOD SHAKES ❑WOOD SHICC-ES REPORT YINGLE$ ❑OnfER
DFSCRPIION OF WORK:
_ r n _
ins - .11 # I r I t 1; T ; (;i:
30 5 I / Gj 1j
�n Coor
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By my signature below,l certify m each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I hove read this
application and the information 1 have provided is correct. 1 have read the Description of•Work and verify it is accurate. I agree to comply with all applicable local
ord'wnces and stale laws relating to building co on. thor'vs rcsenuuives of Cupar iip m enter.the above-identified p perry for inspection purposes.
, .1
Signanue of Applicarlt/Agent: L ' Date: 01
SUPPLEMENTAL INFORMATION RE ED a.OY'FICE USE ONLY
I, I ' Ii it
If building is associated with a Home Owner's Association,provide letter `"-: cllecx TMPer ROUTING SLIP'
of approval from HOA. - ' � '❑�ovER-nle.cotmTER . �. ❑ BUILDING PIAN REVIEW
Provide Planning approval to verify if them uny restrictions. '}"" 'i] `;at:; }Y?- ''" r t*.
❑
.'EXPRESS PLANNING PLAN REVIEW
• f.L�"C'yF}f • . .. t'' a
Provide copy ofManufacturer's Installation Specifications. ❑ STANDARD- S ❑ FIRE DEPT
Providesigned copy of Cupenino's Tear-Oft Policy. - .,! ,"r';T'� �ConleR:
}
Rermifapp_2011.doc revised 03/16/11