12040087 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10811 NOR"fHOAK SQ CONTRACTOR:FOUR SEASONS ROOFING PERMIT NO: 12040087
OWNER'S NAh1E: WISECARVER JEFFRY C PO BOX 1668 DATE ISSUED:04/17/2012
OWNER'S PHONE: 4088731017 SAN JOSE,CA 95109 PHONE NO:(+08)278-0330
LICENSED C'ONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
License Class C-3 Lic.8
y/ QI /7 1 .� MECH r RESIDENTIAL r COMMERCIAL r
Contractor / s�1!mli:Ldl
Date
hereby affirm that censeunder the provisions f Chapter9 JOB DESCRIPTION: RE-ROOF TEAR-OFF EXISTING CAI.-SHAKE ROOFING
SYSTEM,INSTALL COMP
(commencing with Section 7000)of Division 3 of the Business&Professions S 13SQ COLOR AND TYPE TO
LS
MATCH EXISTING CLASS A 135Q
Code and that my license is in full force and effect.
1 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,m provided for by
Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area: Valualion:$6500
permit is issued.
APPLICANT CERTIFICATION APN Number:31641024.00 Occupancy Type:
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 stale 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 PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. G �(
1 7 /'Z Issued by: Date: Y-/7'`,—
Signature Date
❑ OWNER-BUILDER DECLARATION
RE-ROOFS:
1 hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is
the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
1,as owner of the property,or my employees with wages as their sole compensation, inspection.
will do the work,and the structure is not intended or offered for sale(Sec.7044, `-
Business&Professions Code) Signature of Applicant: Date:
1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). ALI,ROOF COVERINGS TO BE CLASS"A"OR BETTER
I hereby affirm under penally of perjury one of the following three
declarations: HAZARDOUS MATERIALS DISCLOSURE
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 1 have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California Health&Safety Code.Sections 25505,25533,and 25534. 1 will maintain
as provided for by
I have and will maintain Worker's Compensation Insurance, compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Safety Code,Section 25532(a)should I store or handle hazardous material.
Section 3700 ol'the Labor Code,for the performance 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 1 will
I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534.
Compensation laws of California. If,after making this certificate of exemption,I
become subject to the Worker's Compensation provisions ofthe Labor Code,I must Owner/oy<�uthorized agent: e/ ,
forthwith comply with such provisions or this permit shall be deemed revoked. E�� 41 Date:
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION
"I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's
correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec 3097.Civ C.)
to building construction,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupertino against I iabilities,judgments, Lender's Address
costs,and expenses which may acerae against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
with all non-point source regulations per the Cupertino Municipal Code,Scclion
9.18. 1 understand my plans shall be used as public records.
Signature Date Licensed Professional
CITY OF CUPERTINO
3 ITEMS OF 15 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 31641024 . 00
DATE ISSUED. . . . . . . : 04/17/2012
RECEIPT #. . . . . . . . . : BS000016556
REFERENCE ID # . . . : 12040087
SITE ADDRESS . . . . . : 10811 NORTHOAK SQ
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : WISECARVER JEFFRY C
ADDRESS . . . . . . . . . . : 10811 NORTHOAK 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 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 13 .00 182.00 0.00 182 .00 0. 00
TOTAL PERMIT 183 .65 0.00 183 .65 0.00
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
FEE ESTIMATOR— BUILDING DIVISION
ADDRESS: 10811 northoak square DATE: 04/16/2012 REVIEWED BY: bobs.
APN: BP#: `VALUATION: $6,500
"PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition
PRIMARY SFD or Duplex PENTAMATION 1SFDWLR00F
USE: PERMIT TYPE:
WORK tear-off existing cal-shake roofing sysYtem. install comp shingles Color and type to match exisitin .
SCOPE
,Urclr. flan CherA Plumb. Plrur ChccA Elec. Phu,Ch,rck
,tlech. Vernal Foe: Plumh. Permit Pee: Elet. Pwunl rte:
0111"'.A rrh. Imp. 011ier Plumb Imp. Ocher Elco. trop.
.4h:rh. amp. rec: Plumb brap. red: E/ce./rr.vp. Fec:
NOTE: This estimate does not include fees due to other Departments(le Planning, Public Works, Fire,Sanitary Sewer District,School
District,etc). Thesefees are based on the prelimina information available and are only an estimate. Contact the De l or addn 7 info.
FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/11) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 F-13 01 s.f. Re-roof /
Suppl. PC Fee: (j) Reg. Q OT FO.0 I hrs $0.00 $14.00 IREROOFRES�
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. FeelD Reg. Q OT 0,0 1 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Consnvr•tion Tarr:
Admini.cuvnire Fee: O
Work Without Permit? O Yes Q No $0.00 0
Advanced Planning Fee: $0.00 Select Non-Residential 17 Building or Structure 0Tnivel Documentation Fees:
Strong Motion Fee: IBSEISMICR $0.65 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: 1 $1.65 $14.00 TOTAL FEE: $15.65
Revised: 04/01/2012
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