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12030116 CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRESS: 10955 NORTI ISEAL SQ CONTRACTOR:POUR SEASONS ROOTING PERDI I'1'NO: 12030116 OWNER'S NAME: LYDIA BALANO TRUSTEE PO BOX 1668 DATE ISSUED:0322/2012• OWNER'S PRONE: SAN JOSE.CA 95109 PHONE NO:(408)278-0330 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r' PLUMB rf License Class C-11 Lie.0 (A Z10p r r r MECH RESIDENTIAL COMMERCIALContractor FAMr SCISs,.t i..e Date 1 hereby affirm that I am licensedunder the provisions of Chapter .JOB DESCRIPTION:SFDWL REROOF,.13 SO,TEAR OF17 EXISTING CAL-SI'IARE (commencing with Section 7000)of Division 3 of the Business&Professions ROOFING SYSTEM,INSTALL 30N FELT UNDERLAYMENTS AND Code and that me license is in full force and effect. INSTALL GAP GRAND CANYON SHINGLES, 1 hereby affirm under penally of perjury one Of the followingtwo 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. (have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of Ole work Ion which Ihis Sq.Fl Fluor Area: Vnluationi:$7000 permit is issued. APPLICANT'CERT'IFICATTON G71L• APN Number:.31640021.00 Occupancy Type I certify that have read this application and stale that the above information is correct. Iagree to comply with all city:and county ordinances and state Imes relating to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save PERMIT EXPIRES 1F WORK IS NOT STARTED indemnify and keep harmless.tire City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply• 1$O DAYS M LAST CALLED INSPECTION. withal)non-point source regulations per the Cupertino Municipal Code,Section 9.18. Is ed 7/7 LL Date: Signature Date Z ❑ 'NF:R-BUILDER DECLARATION RF-ROOFS: 1 hereby affirm that I am exempt from the Contractor's License Law far 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 I,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the stricture is not intended or offered for sale(Sec.7044, Business&Professions Code) Signature of Applicant: I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVER 1, .S TO IDC CLASS"A"OR BEEPER hereby affirmu oder penalty of perj try one of the rolluwi ng three declarations:, I have and will maintain a Certificate of Consent to set Gins-ure for Worker's IIA'LARDOUS htAT'ERIAI.S DISCLOSURE Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Ilea th&Safety Code.See tions 25505,25533,and 25534. 1 will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code.Chapter 9.12 and the Ilealth& Safely Code,Section 25532(x)should I store or handle harrrdous material. Section 3700 of the labor Code,for the performance of the work for which This Addiliomdly,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Ray Area Air Quality Management District I will I certify that in the performance of Ore 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 iz• nr•' a become subject to the Workers Compensation provisions of the Labor Code,I mOwner ora ust 1u lonhwith comply with such provisions or this permit shall be deemed revoked. Date: APPLICANT CER'fl FIG\'PION .ONSIRUC`I'ION LENDING AGENCY I certify that I have read this application and state that the above information is I hereby affim (here is a construction lending agency for the performance of work's correct. I agree to comply with all city and county ordinances and stale 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 indenmify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address costs,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply ARCIII'I'I:CI'75 DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. I understand my plans shall be used,is public records. Signature Dale Licensed Professional CITY OF CUPERTINO 3 ITEMS OF 15 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 31640021 . 00 DATE ISSUED. . . . . . . : 03/22/2012 RECEIPT 4. . . . . . . . . : BS000016333 REFERENCE ID # . . . : 12030116 SITE ADDRESS . . . . . : 10.955 NORTHSEAL SQ SUBDIVISION . . . . ... . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : LYDIA BALANO TRUSTEE ADDRESS . . . . . . . . . . : PO BOX 1244 CITY/STATE/ZIP . . . : CUPERTINO, CA 95015 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 7, 000 . 00 1. 00 0 . 00 1. 00 0 . 00 1BSEISMICR VALUATION 7, 000 . 00 0 . 70 0. 00 0. 70 0. 00 1REROOFRES SQ FEET 13 . 00 182 . 00 0 . 00 182 . 00 0 .00 TOTAL PERMIT 183 . 70 0. 00 183 .70 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 04: 18, 4089960226 NORTHPOINT M02 Aktlr1 br if s 816,N OFUI OA yvaiA, m .1 fiv 4v 4 11 i;f CUOPIM11) Bx flortfTpoint Homeovinen A Association PLXN 'ap )0,-.0AW W q . 11 4E V-51 1 14 Ul 1, 7, 4, 'in L F qui of Cupen. Ah! NG 1) P I WA,l Ir v* P ' arch 7, 2012 ;441111 if ...... .... I J* 0, t MOUT bjec 1 eff NiciMpoin of Cupertino s. 0 City note that the N� brthq intHomeown`b Asso6iOonhas le;i�e r 5 .4 Ail Itontract6d and'apprdied bur Season's Roofing to p&form re h6mes�)Thgy, will replace t6e current CAL-Shake 7, %Too ng.ol our. NP R -Grand Canyo n ew.)GA Ff- oof stem wltiIi n' t Composition ,,A hal ."Z 991eddd the Sto �rl cor 'f"- rigles.,We he colo thi live new r fqrFur roofs. -CZI Iii 4 ly, "REM J �t� on Site Manager .. unda.Star%nes 408-996-3734 II 4 It -FX:4MzM—;j1J-me ti 01 q IAL 4P: x- It I . 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DA'Z'E: 03/22/2012 REVIEWED BY: Sean APN: BP#: "VALUATION: $7,000 •PERMITTYPE: Minor Building Permit PLAN CIIECK TYPE; Re-roof PRIMA RI SFD or Duplex PF,NTAMATION 1SFDWLR00F USE: PERMIT TYPE: WORK Tear-off existing cal-shake roofing system, install 30#felt underla ments and install GAF Grand SCOPE Canyon Shingles (1300 so, Color: Stonewood. FEEID ROOFAREA (s.f. iREROOFFRES 1,300 ifech. Plan Check Plumb. flan Check Elec.Plan Check bliu;ir. Permit Fee: Plumb. Permit Fee: Flee. Permit Fee: t.'Ither'Itech.hap. Other Phnnh Insp. Other Elec.11151). Li He<:h,Imp. Fee: Plumb. Insp.Pee: Fier./m1). Fa:a: NOTE: This esvitrut(e tloes not inchetle fees due to other Departments(i.e. Planning, Public Works, fire,Sanitup'Sem'er District.Sch(lol District,etc.). These feev are baser/on the prefinjinan information available and are oudw,un esdnatte. Contact the De ( or addn'I in o. FEE ITEMS (Fee Resolution 11-053 F_iI7/1111) FEE QTY/FEE MISC ITEMS Plan Cheek Fee: Suppl. PCFee Phnnh.lHech,:'F.lec Permit Fee: $182.00 Suppl. hasp Fee Pl t ran l.;Ar/e(.h.:Llec Pltmth_!:bieclt.:h'ler.Permit Fere: Construction Tax: Aelministralive Fee: Work Without Permit? O Yes C) No $0.00 A(haneed Planning Fees: Trove(Documentation Fees: Saone Motion Fee: iBSFISAIICR $0.70 Select an Administrative Item UI(le Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: 1 $183.70 $0.00 TOTAL FEE: $183.70 Revised: 1/19/2012 REROOF PERMIT APPLICATION 11 COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION �3 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255' CUPERTINO (408)777-3228'• FAX(408)777-3333•buildinG(lilcuoertino.om I PROJECT ADDRESS. APN a 0;3� � OWNER NAME Pito I EMAIL 0ADDRESS CIN,SFA ZIP I FAX aCUNTACT NAME PHONE EMAIL 1•� do z.a�e-s .o SIAELT ADDRESS CIN,STATE,�ZIP t' FAX o Sose Cw. S ❑OWNER ❑-OWNER-BUTLOER ❑ OWNER AGENT CONTRACTOR ❑CON RAC Int AGENT ❑ ARCHITECT ❑[ GINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME LICENSE NUMBER LICENSETYPE I a BUS.UC.M 3 3 COMPANY NAME E-MAIL t a FAX STREET ADDRESS CRY,STATE ZIP PHONE �Z � A. 5 ARCHRECTIENGLNEERNAME - LICENSEN•UMBER t BUS.LIC.M COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE y� USE OF ❑ SFD or Duplex U[ Multi-Family ROOF AREA:- 'VALUATION: SIRULTURE: ❑ Commercial /\ S EXLSTING ROOF TYPE: ❑BUILT-UPRWF ❑ASPHALT SHINGLES 11 WOOD SHAI:P-S ❑WOODSHINOT-ES OTHER(SPECIFY) A�L S^ A SRA REMOVE/REPLACE jp /❑_ N0 qW NO0,OS : ROOF. W ❑ D Q }' A PROPOSED ROOF TYPE: ❑BUILT-UPROOF XASPHALT SHINGLES C1 WOOD SHARES 11 WOOD SHINES ❑ GLOTHER ICC-FS REPORTY DESCR1PIION OF WORK: - _ _ i n s4,e,I i 3 * s G �n Co or t1' By my signature below,I certify to each of the following: I am the property owner or authorized agent m 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 relating Io building cons 'on.[ thou resentatives of Cupertino to enter the above-identified property for inspection purposes. Signanue of Applicant/Agent: t• .I•' Date: SUPPLEMENTALINFORMATIONRE ED OFFlCE USF.ONLY _If building is associated With a Home Owners Association,provide letter `'F"'+PLANCHECK'rYPE •t'}`` ' ' ROUTING SLIP c".iii Bt7 ./.LLTµ . of approval from HOA. :. . .❑'-OVER•TBF.COUNTER- ❑ BUILDING PL.VI REVIEW Provide Planning approval to verify if them any restrictions. t'' )•;n$`v rt7!}; f;:, ` t ' ❑ ©LPRLSS: ❑ PLANNING PLAN REVIEW _Provide copy of Manufacturer's Installation Specifications. t I t ❑,STANDARD ❑ FIRE DEPT' }'I ••SFO - Provide signed copy of Cupertino's Tear-Off Policy. ❑. OTHER: - i RerogJ App_2011.doc revised 03116/11