10060126 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10954 NORTHSEAL SQ CON'rRACTOR:FOUR SEASONS ROOFING PERMIT NO: 10060126
OWNER'S NAME: RAYMOND&JANE CARHART PO BOX 1668 DATE ISSUED:06/22/2010
NER'S PHONE: 4082296000 SAN JOSE,CA 95109 PHONE NO:(408)278-0330
L9- LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT r— PLUMB r
License Class — /Lic.# 1
'/0 MECH RESIDENTIAL COMMERCIAL
Contractor Date V
I her affirm that I am r the provisions of Chap er 9 JOB DESCRIPTION: RE-ROOF RMV EXISTING CEMWOOD ROOF.INSTALL
(commencing with Section 7000)of Division 3 of the Business&Professions NEW GAF
GRAND CANYON ASPHALT COMP 50 YR ROOF SYSTEM
Code and that my license is in full force and effect. "STONEWOOD"IN COLOR CLASS A 1400SQFT
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.I t Floor Area: Valuation:$3188
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is APN Number:31640029.00 Occupancy Type:
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, 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 [80 DAYS FROM LAST CALLED INSPECTION.
9.18.
Date Issued b Date:
Signatur y:
L� OWNER-BUILDER DECLARATION
I hereby affirm that aui exempt from the Contractor's License Law for one of RE-ROOFS:
the following two reasons: All i Hofs 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, into lled without first obtaining an inspection,I agree to remove all new materials for
will do the work,and the structure is not intended or offered for sale(Sec.7044, insp&tion.
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: _ Date: (U
3 -
construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE
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. I 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 Health&
Safi ty Code,Section 25532(a)should I store or handle hazardous material.
permit is issued. Adc itionally,should I use equipment or devices which emit hazardous air
I certify that in the performance of the work for which this permit is issued,I shall con aminants as defined by the Bay Area Air Quality Management District I will
not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Compensation laws of California. If,after making this certificate of exemption,I Hea Ith&Safety Code,Sections 25505,2553IING
become subject to the Worker's Compensation provisions of the Labor Code,I must —'�
Ow authorized agent:forthwith comply with such provisions or this permit shall be deemed revoked. Date•APPLICANT CERTIFICATION CONSTRUCTION LNCY
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 I he-eby affirm that there is a construction lending agency for the performance of work's
to building construction,and hereby authorize representatives of this city to enter uhirh -is-issued(Sec.3097,Civ C.)
upon the above mentioned property for inspection purposes.(We)agree to save Ler thi��P„der's Name
-mify and keep harmless the City of Cupertino against liabilities,judgments,
,and expenses which may accrue against said City in consequence of the Ler der'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.
I ur derstand my plans shall be used as public records.
Signature Date
Lic:nsed Professional
CITY OF CU:?ERTINO
3 ITEMS OF 18 PERMIT R]3CEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: :,ot:
APN . . . . . . . . : 31640029 . 00
DATE ISSUED. . . . . . . : 06/22,12010
RECEIPT #. . . . . . . . . : BS000010685
REFERENCE ID # . . . :- 10060126
SITE ADDRESS . . . . . : 10954 NORTHSEAL SQ
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : RAYMOND & JANE CARHART
ADDRESS . . . . . . . . . . : 10954 NORTHSEAL SQ
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : FOUR ;SEASONS ROOFIN
CONTRACTOR . . . . . . . : DIAZ, ALFRED LIC # 21323
COMPANY . . . . . . . . . . : FOUR ;SEASONS ROOFING
ADDRESS . . . . . . . . . . : PO BO:{ 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 3, 188 . 00 1. 00 0 . 00 1 . 00 0 . 00
1BSEISMICR VALUATION 3, 188 . 00 0 . 50 0 . 00 0 .50 0 . 00
1REROOFRES SQ FEET 14 . 00 182 . 00 0 . 00 182 . 00 0 . 00
---- ------ ---------- ---------- ----------
TOTAL PERMIT L83 .50 0 . 00 183 .50 0 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
CITY OF
CITY OF CUPERTINO
REROCIF
ELI I
C U P E RT I N O PERMIT APPL[CATION
11 AP-N
Date
I Building Address: 55'
o�ll
L2
�o
Owners Name. + Phone #:
J
' Name: � �c�t 1nc:�r �- J�Y1 e � YY_r �4-
HOA: Yes No ❑ If yes, provide letter from HOA
Contractor: �o•-� ��s��J � '�'"y Phone #: C
Fax 7g
Cupertino Business License #: Contractor License #:
Type of Roof Covering:
Existing: Proposed:
Built-Up Roof o Built-Up roof
Asphalt Shingles �( Asphalt Shingles
:i Wood Shakes o Wood Shakes
Wood Shingles / ❑ Wood Shingles
Other (Specify) Li
(Specify)
`umber of existing coverings o Provide LC.C.E.S. Report#
To be Removed ❑ Provide Mfgr. Installation Specs.
rJob Description:
j Residential Commercial
Green Building: Please complete relevant portion of the Confirmed with_Planning Dept. if
Green Building Checklist & attach it to the applic..tion or if there are any restrictions: ❑
applicable, include in plan set & the sheet index.
Valuation: --
I Have Read, Understand and Will Comply with Cupl;rtino's Tear-Off Policy:
Signature
Revised 02/05/09