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12030113CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRESS: 10937 NOR fHSEAL SQ OWNER'S NAME: JAKOB MARY ET AL OWN E R'S PI ION Ii: 4083783887 a-- LICENSED CO\ FRACTOR'S DECLARATION License Class (r-39 Lie. 9/�11tQY Contractor FFonr mat o,o C Iieynt fM Date 1 Z Z hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Di%ision 3 of the Business & Professions Cade and that my license is in fall 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, as provided for by Section 3700 of the Labor Code, for,the performance of the work Tort which this permit is issued. _ APPI-ICAN'1' CF-I2'1'II>ICA'FION I certify that 1 have read this application mid state that the above infomration is correct. I agree to comply with all city and county ordinances and state Imus 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 indenmi ti• and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands mid will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Sianmure /—O Date ❑ OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for one of the following aro reasons: I, as owner of the property, or my employees with wages as their sole compensation, will do the work, mid the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) I, as owner of the. property, am exclusively contracting with licensed contractors to construct the project (Scc.7044, Business '& Professions Code). hereby affirm under penalty of perjury one of the following three 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 permit is issued. I certify that in the performance of die work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation Imes of California. If, ager making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICAN F CERTIFICATION I certify that I have read this application mid state that the above infomration is 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 o'Cupertino againsrliabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18, CONTRACTOR: FOUR SEASONS ROOFING PERMIT NO: 12030113 PO BOX 1668 DA'Z'E ISSUED: 03222012 SAN JOSE. CA 95109 PIION'E NO: (408)278-0330 BUILDING PERMIT INFO: BLDG (- ELECT (_ PLUMB NIECH r RESIDENTIAL r COMMERCIAL JOB DESCRIPTION: RE -ROOF TEAR -OFF EXISTING CAL-SIIAKE ROOFING SYSTEM, INSTALL 30N FELT UNDERLAYhIENTS AND INSTALL GAF GRAND CANYON SHINGLES 1300SQFT CLASS A, Ft Floor Area: ) Valuation: $7000 APN Number: 31640024.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS OM LAST CALLED INSPECTION. Iss a by: CSG G Dale: RF --ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. LL Signature of Applicant: Date: JAvf l ALL ROOF COVERINGKTO)BE CLASS "A" OR BETTER IIAZARDOUS MATERIALS DISCLOSURE have read the hazardous materials requirements under Chapter 6.95 of the California llealth & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain compliance with the Cupertino Municipal Code. Chapter 9.12 and the l lcalth & Safely Code, Section 25532(a) should 1 store or handle hazardous material. Additionally, should 1 use equipment or devices which emit hazardous air contaminants as defined by the Bac Arca Air Quality Management District I will maintain compliance with the Cupertino Municipal Code. Chapter 9.12 and the llealth S Safety Code. Sections 25505, 25533, and 25534. Owner ora Ihrizen1: / Date: :ONSI'RIICI'ION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Leader's Name Lender's ARCIIITEC`F'S DECLARATION I understand my plans shall be used as public records. Signature Date I Licensed CITY OF CUPERTINO 3 ITEMS OF 15 PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 31640024.00 DATE ISSUED.......: 03/22/2012 RECEIPT #.........: BS000016333 REFERENCE ID # ...: 12030113 SITE ADDRESS .....: 10937 NORTHSEAL SQ SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ....... OPERATOR: patg COPY # : 1 VOICE ID DESCRIPTION 309 EXTERIOR LATH 601 ROOF TEAR OFF VOICE ID DESCRIPTION 311 SCRATCH COAT 602 ROOF PLYWOOD NAIL 604 ROOF IN -PROGRESS 605 FINAL REROOF OWNER ............: JAKOB MARY K ET AL ADDRESS ..........: 170 ALTURA VISTA CITY/STATE/ZIP ...: LOS GATOS, CA 95032 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 FEET13.00 182.00 0.00 182.00 0.00 TOTAL PERMIT 183.70 0.00 183.70 0.00 VOICE ID DESCRIPTION 309 EXTERIOR LATH 601 ROOF TEAR OFF VOICE ID DESCRIPTION 311 SCRATCH COAT 602 ROOF PLYWOOD NAIL 604 ROOF IN -PROGRESS 605 FINAL REROOF CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION FEE ID ROOFAREA 5.r. 1REROOFFRES 1,300 ADDRESS: 10937 Northseal Sq. DATE: 0 312 212 01 2 REVIE\VED t31': Sean blush. Pernh Fee: APN: I3P#: "VALUA'T'ION: $7,000 *'PFRMITTYPE: Minor Building Permit PLAN CHECKTYPE: Re -roof PRIMARY SFD or Duplex USE: Flee. Imp. Fee: PFNTAMATION 1SFDWLR00F PERMIT TYPE: WORK Tear -off existin cal -shake roofing system, install 30# felt underla ments and install GAF Grand SCOPE Canyon Shingles (1300 sf), Color: Stonewood. FEE ID ROOFAREA 5.r. 1REROOFFRES 1,300 N07'1,': This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, .School District, etc.). These fees are based on the nrelininarr infort anion available (aid are onh, an estimate. Contact the Dem for addn'1 into. FEE ITEMS (Pee Resolution 11-053 Elf 71111// Afeeh. Plan Cheek Plumb. Plan Chm* Flee. Plan Check blush. Pernh Fee: Murch. Permir FCC: Flee, Permir Fee: Offier Afeeh ha7r. Other Phonh 1, other Flea hnp.Ej A7eeh. Imp. Fee.• Plumb. lisp. Fee: Flee. Imp. Fee: N07'1,': This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, .School District, etc.). These fees are based on the nrelininarr infort anion available (aid are onh, an estimate. Contact the Dem for addn'1 into. FEE ITEMS (Pee Resolution 11-053 Elf 71111// FEE QTY/FEE MISC ITEMS Plan Check Fee: Supp/. PC.Fee Phunh.6Nech.;Elec Permit Fee: $182.00 .Supp!. lisp Fee Pl a b-,Mech.iE'lec Pfumh_lMech.:Elec Permit Fee: Corut uctiun Tax: Administrative Fee: Work Without Permit? O Yes ( No $0.00 Advanced Planning Fees: Travel Docnunenitrtion Fees: Stron¢Motion Fee: IBSFISMICR $0.70 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $183.70 $0.00 TOTAL FEE: 1 $183.70 Revised: 1/19/2012 9 r,i :1" r �, rli it .•,i`x q' ! ,� ✓tagrlF�4.;1.; •� ' If .._ r ••llj �,1. Y I .;� .S• 03/21/20 2 04:18;. 4089960226 4 NORTHPOINT{ S i e.� P22/02 q p y 4 k h a iort;ipolnt Homeownd's Association PLAN, GHECYSD BY ti, ,L �� Flno; GA'9A4 i j' i16 1 zq I DATE" RINI it ' pI' ,= of Cupertino F li t t 1:• i . f. jt , r 9 ,��. ►n,rx:.� n.,� �x l�ilarcri 7, 2012 -:' `• '•� '� � , • �" �' ° r y Pit YI 1I �j�?� N rtn' .h a - ' t.��•�r! MSI^�. i@i} f16"i7 �?� , p3 hat e.Q;thpoinf:�—ong g, rfo City of Cupertino Fy �� •» Sty tl .. n. I . If. Please note that the ii�orthp� !nt Homeowners Associawn has on, t acted and `approved Four Season's Roofing to perform re aofirig. o` our. hem ss`The will replace the current, _+! 3.] . y j SP1 oof system with nevv-+-AF?•Grand Can on.A halt Composition nngles.. We have selected the Stonew � dcolor fqr,�our roofs" ' <; 'lo6rel�7. r I r ��•'� �',�; � ,fit.: •, 1 r f y Y �i t GS a Linda.Starries ts:• ,: On Site Manager x n08-996-3734 # A! ri1A:�9�iin 7fa tr ;I r�R 4C4�i ER I 92 34 -F. 4drr F26 yi ti ; tuiIla t N. i s r �0a2•`L%•! Ila F FX 40&22 PH a0d-es00 , „ J. iiM � .� t..rr rjt•' .. i � ' ��' � i4! s tll 10937 NorthseaE.Sq 1G✓ 11 �.4�vl,r",` � � ='. `..;.�r � R... � � n k �: r�.:,rs,a, ., i ( ...1 ... �IA _tip. '_`_yy �1 `i^r _v.Y j sTY��':',1�''o-_._.. . l: � ��-_M1 _ Y�c �� . ,• � . �.,�. .l 1 +?_may . .Cl�.� .. N ...' .. _ .l .''li '1 _ a 4�. l:' 1 ' • C G REROOF PERMIT APPLICATION • � r COMMUNITY DEVELOPMENT DEPARTMENT— BUILDING DIVISION y, Z � C 10300 TORRE AVENUE • CUPERTINO,'CA 95014-3255 `•" CUPERTINO (408) 7773228 • FAX (408)'777-3333 • buildinG(GdcuDertino.oro p .� PRO/EC ADDRESS tilnrflmeal SQ. A T q O E 1- OWNER NAME\� PHO I 8• STREET ADDRESS CITY, SPATE, ZIP' I FAX G CONTACr NAM[ 4 1 0 fir^ c PHONE 409) -O E-MAIL MEET.ADDRFSS d W CRY, STATE; ZIP �' FAX O ITas 9- Cw. S ( ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT 5r CON'KACTOR ❑ CONIRAmit AcoNr ❑ ARCHrriwT ❑ ENGINEER ❑ DEVELOPER ❑ IMN'AN'r CONTRACTOR NAME - -LICENSE NUMBER LICENSETYPE, 5 BUS 'LIC 0 QD� COMPANY NAME I E -MATT: ❑ WOOD SHINGLES A OTHER (SPECIFY) .N L SRA f� Ve- REMOVE iREPLACE$YFS /❑ FAX PLYWOOD SrREET ADDRESS 02 0 'PLYWD ❑OSB CITY,SI'ATE,•ZIP o ar '_. S(46 PHONE OE o ARCHrrEMENGINEM NAMEt i � 1 .0. UCENSE NUMRLR�•- "3• rl _ ❑ OTTR:R BUS: LIC.N DESCRIPTION OF WORK: COMPANYNAME E-h1AU. FAX STKEI?ADDRESS CITY, SfATE;ZIP PHONE C]SFD or Duplex Multi -Family ROOF AREA: • VALUATION:. USE OF application and the information I have provided is correct. I have read the Description of Sraucruae: ❑ Commercial ordinances and state laws relating to building cons ion, thoriu resentativw of Cupertino to enter the abovo-identified property for. inspection purposes. 5 Date:' 3 -al -la' QD� EXISTING ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES A OTHER (SPECIFY) .N L SRA f� Ve- REMOVE iREPLACE$YFS /❑ IF NO. PLYWOOD 13 -A" ❑ 'PLYWD ❑OSB PRCN: a ROOF. o ar '_. 1 G sre- OE o —I' —:.I2 CLAS A PROPOSED ROOF TYPE: ❑ DUILT-UP ROOF I . .• ACASPHALTSt1INGLFS 11 11WOODSHAKF•_S , ❑ WOOD SHINGLES _ ❑ OTTR:R ICC -ES REPORTa DESCRIPTION OF WORK: .I - 1,-tJ 1 I.I.. J i S4 -.,.t l 3�# •�• 4--nd r�Ut 3 Sns�w�l GAF Gro,d Co,Auon I ISMAA115S Lo By my signature below, I certil-y, to each of the following: 1 am the property owner or authorized agent to 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. -1 agree to comply with all applicable local ordinances and state laws relating to building cons ion, thoriu resentativw of Cupertino to enter the abovo-identified property for. inspection purposes. Signature of ApplicanVAgenC• � Date:' 3 -al -la' 'SUPPLEMENTAL INFORMATION .RE D 1111 *'�+�aK PY..=:i. �• '. OFFICE Use ONLY . , .r• 1 i' .;u••, _ If building is associated with a H,ome Owner s Association, provide letter ... .ye ~ -• PWNCHECKTYPF.ir.-' ROVrINC SLIP orappfrom HOA. I PP „ .3111131.11,. ;•,tv=: ❑'OVER -TRF. COUNTER, ' ❑ BUILDING PLAN REVIEW _Provide Planning approval l0 verify llthere my restrictions.❑,EXPRESS=.'If" ❑ PLANNING PLAN REVIEW _ Provide copy Of Manufacturer's Installation $peClflCallOnS. �❑�STANDARDARDNI,,, • - 0 FIRE DEPr � �'j. _ Provide signed copy ofCupertino's Tear -Off Policy:: "': ', h}'It ❑ OTHER: , Reroojdpp_?01 I.doc.revised 03/16111