12030115 CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS: 10947 NORTIiSEAL SQ CONTRACTOR:POUR SEASONS ROOTING PERMIT NO: 12030111
OIVNHR'S NAAIE: RAJU&.SI'IARMEELA SIIAIi 1'0 BO.0 1668 DATE ISSUED:03222012
OWNER'S PIIONIS: 4088610924 SAN.IOSE.CA 95109 PHONE NO:(408)278-0330
�1 LICIiNSED CONI'KACI'O[ik'S UICCLOA KA"1'ION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB
License Class Lic.
r
( �' fl ti-M0%
MEC11 r RESIDENTIAL 11 COMMERCIAL r
Contractor Ir.0/5eafoS ate Z�Zz-/Z
1 herehy;afirm that 1 am licensed under lite revisions of Chapter 9 30B DESCRIPTION:SFDWL REROOF, 13 SQ,TEAR OFF EXISTING CAL-SHAKE
(commencing with Section 7000)of Division 3 of the Business& Professions ROOFING SYSTEM,INSTALL 309 FELT UNDERLAYMENTS AND
Code and that my license is in full force and effect. INSTALL GAP GRAND CANYON SHINGLES,
1 hereby!alftnu 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 die Labor Code,lir 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 oldie work for which this Sq.Ft Floor Area: Valuation:$7000
permit is tissued.
API'LIC,\N"I'CIiK'fI RIC,\'PION �� APNNumber:31640022.00 (Occupancy Type:
I certify that I have read this application mid state that the above information is
correct.I agree to comply with all city and county ordinances mad state laws relating
to building constriction,and hereby authorize representatives of this city to enter
upon the above mentioned property fior 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 accmeagainstsaid City inconsequence ofthe WITHIN 180 DAYS OF PERMIT ISSUANCE OR
grading of this permit. Additionally,the applicant unLrstands and will comply 180 DAYS ROM LAST CALLED INSPECTION.
with all non-point source regulatims per the Cupertino Municipal Code,Section -
9.18.
Issu dd by:I L Date:
Signature Date
❑ ON' : -FUILDER DE.CLAHATION
REI-ROOFS:
hereby affirm that I am exempt from the Contractor's License Law fur one of All roofs shall be inspected prior to any roofing material being installed.If a roof is
the following ton 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,mid the structure is not intended or offered for sale(Sec.7044,
Business&Professions.Code) ,Signatureof Applicant:_�/�
1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,13usiness& Professions Code). ALL ROOF CO\'FKINCS'1'O 13E CLASS'4\"OR BE'19'IiK
hereby affirm under penalty of perjury one of the following three
declarations:
I have and will maintain it Certificate of Consent to self-insure for Worker's IIA%ARDOUS MATERIAI 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 Health&Safety Code,Sections 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&
Section 3700 of the Lahor Code,for the performance of the work for which this Safety Code,Section 25532(x)should 1 store or handle hazardous material.
Additionally,should I use equipment or devices which emit hazardous air
permit is issued. contaminants as defined by the Bay Area Air Quality planagement District I will
I certify that in the performance of dm 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 many manner so as to become subject to the Worker's I lealth&Safety Code,Sections 255115,25533,and 25534.
Compensation laws of California. If eller making this certilicate ofexmnption,I
become subject to the Worker's Compensation provisions of the Labor Code,I must Owner or i igen .3�24r•
forthwith comply with such provisions or this permit shall be deemed revoked 1a tea
,\I'PI,ICAN'I'CER'I'IFIC,\'TION �'S'VRUCHON LENDING AGIiNCY
I certify that I have read this application tad state that the above information is I hereby affirm thin there is a construction lending agency for the performance of murk's
correct.I agree to comply with all city arra county ordinances mid state laws relating for which this permit is issued(Sec.3097,Civ c.)
to building construction,mid 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 liabilities,judgments, Lender's Address
costs,and expenses which may accrue against said City in consequence of the
granting of permit.Additionally,theapplicant understands and will comply ,U2CI II'I'FCI"S DECLARATIONwith all non-point source regulations per the Cupertino Municipal Code,Sectio
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 . . . . . . . . : 31640022 . 00
DATE ISSUED. . . . . . . : 03/22/2012
RECEIPT # . . . . . . . . . : BS000016333
REFERENCE ID # . . . : 12030115
SITE ADDRESS . . . . . : 10947 NORTHSEAL SQ
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : RAJU & SHARMEELA SHAH
ADDRESS . . . . . . . . . . : 10123 PARISH PLACE
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 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
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 918 . 50 #011764
--------------- _
TOTAL RECEIPT 918.50
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
FEE ESTIMATOR CB ILD N DIVISION 120
Ims ADDRESS: 10947 Northseal Sq. DATE: 0312212012 REVIEWED BY: Sean
APN: BP#: 'VALUATION: $7,000
*PERMITTYPE: Minor Building Permit PLAN CEIECK TYPE: Re-roof
PRIMARY SFD or Duplex PENTAMATION 1SFDWLR00F
USE: PERMITTYPE:
WORK Tear-off existing cal-shake roofing system, install 30#felt underla ments and install GAF Grand
SCOPE. Canyon Shingles (1300 sf), Color: Stonewood.
FEEID ROOF AREA
1REROOFFRES 1,300
aifryh. Plan Check Plumb. Plan Check Elec.Plmt Cbcck
Mech. Permit Fee: Plumb,Permit Fee.: Flee. Permit Fee:
01her Hoch.hup. Other Plumh hrssp. Ohio-Elec. Inrp. Li
dfrch./m/t. Fee: Plumb. Insp.Fee: Eder:Imp.Fee:
NOTE: This estiuuue does not include fees due to other Departments(i.e. Planning, Public Works, Fire,Sanitary Sewer District,School
District.etc.). Thesefees are based on the prefininan information available and are ono'an e.vIbrude. Contact the De I or aaddn'l info.
FEE ITEMS flee Resolution 11-0531J.711111 FEE QTY/FEE MISC ITEMS
Plan Cheek Fee:
Supp/. PCFee
Plutnh%A:Iech.;Elec
Permit Fee: $182.00
Supp). !lisp Fee
Pttanh., ,)r!ch.1rlec
Plumb.%,Llrch.rFlec
Permit Fee:
Construction Tax:
Administrative Fee:
Work Without Permit? 1) Yes e No $0.00
Advuneed Planning Fees:
Truvel Documentation Hees:
Strone Motion Fee: IBSEISHICR $0.70 Select an Administrative Item
Bide Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $183.701 $0.001 TOTAL FEE: 1 $183.70
Revised: 1/19/2012
pp 03/2l/20fl2 04: 18! 4089980226 d NOPTHPOINT .62/02
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REROOF PERMIT'APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION �O\
10300 TORRE AVENUE CUPERTINO,CA 95014-3255
CUPERTINO (408)777-3228'• FAX(408)'777-3333•buildinGokuoertino.orG \�
PROJECTADDRESS APNY 31( _ 0 /^
o eo. �(/ v
OUTER NANIE , d.- Pt N I E-MAS.
SIREE: ADDMSS CITY,SI'A ZIP FAX
/0 Q 41 gL
CONTACT NAME 1 ^ 1 ( I, PHONE -O SMALL
\T QO
STREET ADDRESS • CrIY,STATE ZIP n r t FAX
o So'e Cw. 6
❑OWNER ❑ OWNT -BUILDER ❑ OUTERAGENT -W CONTRACTOR, ❑CONIRAMORAOQ ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TET'A.1T
CONTRACTOR NAME. LICENSENUMBER LICENSETYPE BUS.LIC.00119g^
CUMPANY NAME' I C-MAIL FAX S
STREET ADDRESS Cr1Y,STATE ZIP PHONE
�� O S
ARCrHT MENGINEER NAME • LICENSE NUMBER I BUS.Lica
COMPANY NAME E-MAIL FAX
STREET ADDRESS cnY,STATE,ZIP PHONE
USE OF ❑ SFD or Duplex Multi-Family ROOF AREA: VALUATION:
STRUCTURE: ❑ Commercial I s • OO O
I I T
EXISTING ROOF TYPE//❑BUILT-UPROOF ❑ASPHALT SHINGLES ❑W'OODSHAKF-S ❑WOODSHUNGLES OTHER(SPECIFY) QL SI}p
REMOVE/RER.ACE�YFS ffNO. PLYWOOD ,p w" ❑ PLYWD QOSB PITCH' 1 0.00E
❑ N M , RS' KNF_S I] " Q —�_.12CLASS
A
- IICC-PS REPORT a
PROPOSEDROOFTYPF.: ❑BUILT-UPROOF ASPHALT SI UNCLES 11 WOOD SHARES ❑WOOD SHINGLES ❑OTHER
DESCRIPTION OF WORE:
n _
1 'I f 1
IAS•-.11 3Q# �'el 0AA4 lwvMU� ; ins �w�l GAF Grq A C -Ayon
�n Co o T
I 1 I ,.
By my signature below,l cattily,to each of the following: I an,the property owner or authorized agent to act on the property owner's behalf. 1 have read this
application and the information I have'provided is ocnvct. I have read the Description of Work and verify it is accumte.•1 agree to comply with all applicable local
ordinances and store lows mlating to building cons ion.' thorize• resenmtives orCupenino to enter the above-idendfied property for inspection purposes.
Signature of Applicam/Agent• Date:
SUPPLEMENTAL INFORMATION RE ED ' OFFICE.USE ONLY
_Ifbuilding is associated with a Home Owns s Association,provide letter -`�N CHECK - -- •RotmnesuP
of approval from HOA. '❑ o4ei THE-Coulir i ❑ BIBLDINC PLAN REVIEW
Provide Planningapproval to verify If there an restrictions. rl''EX�RESS G'};!�'�1�;r,' - r ' - •7 r'
aFP Y Y ❑ �EXPRPSS ❑ PLANNING PLAN REVIEW
Provide copy of Manufacturcr's Installation Specifications. ❑ bY'ANDARD- ❑ FTREDEPT
Provide signed copy of Cupertino's Tear-Off Policy. ^ '• ❑ OTHER:
o
-- RerwfApp_201I.doc revised 03//6/1