12030089 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10985 NORT14SEAL SQ CONTRACTOR:FOUR SEASONS ROOFING PERMIT NO: 12030089
OWNER'S NAhIF: CHU WEN K AND THECLA M PO BOX 1669 DATE ISSUED:03/192012
OWNER'S PHONE: 4088676766 SAN.IOSE.CA 95109 PHONE NO:(406)27841330
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG C ELECT 1- PLUMB r
License CIasC�-/—Jj �T Lie.p ;21 a
01ECH r RESIDENTIAL r' COMMERCIAL rl
Contractor =ldl�le�. Dale
1 herebyaffinn that 1 nm licensed under the provisions of Chapter 9 .108 DESCRIPTION: RE-ROOF TEAR OFF EXISTING CAL SHAKE AND INSTALL
(commencing with Section 7000)of Division 3 of the Business&Professions 30
Cade and that my license is in full force and effect. LOB PELT.COLOR AY6fENT AND GAFGRANDCANTON
SHINGLES.COLOR STONEWOOD-14 SQUARES
1 hereby affirm under penalty of perjury one of the following two declarations:
I have and will.maintain a cenilicate of consent m self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of(lie work for which this pemai(is issued.
I have and will nnimain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the perfo mance of the work for which this
Pei mit is issued Sq.Ft Floor Area: Valuation:56500
APPLICANT CERTIFICATION
I certify that I have read(tis application and state that the ahove information is APN Number:31640010.00 Occupancy Type:
correct.[.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(tie above mentioned propeny for inspection purposes. (We)agree(o 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(his permit. Additionally,the applicant undeistandsand will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR
with all non-point source regulations per the Cupertino Municipal Code.Section 1.80 D YS FRO!.WEAST CALLED INSPECTION.
9.18.
Signature / Date r
g �// � � / (y �. Issued by � � � Date:
❑ OWNER-BUILDER DECLARATION
hereby affirm(lint 1 am exempt from the Contractor's License Law for one of RE-ROOFS:
the following rvo reasons: All nwfs shall be inspected prior to any roofing material being installed.Ira roof is
I,as owner of the property,or my employees with wages as their sole compensation, installed wi(houl 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, inspection.
Business&Professions Code) . 41/_/<
h as owner of the properly,am exclusively contracting with licensed contractors to Signature of Applicant. ` Date:
construct the 111(ject(Sec.7044,Business&Professions Code).
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 die Labor Code,for the
performance of the work for which this pemnit is issued I have read the hazardous materials requirements under Chapter 6.95 of the
1 have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code.Sections 25505,254J3,and 25534. 1 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&
Safety Code,Section 25532(x)should I store or handle hazardous material.
pencil is issued Additionully,should 1 use equipment or devices which emit hazardous air
I certify(lint in the perfommace of die work for which this permit is issued,I shall contannuants as defined by the Bay Area Air Quality Management Dishict 1 wipe
not employ any person in any manner sons 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 cenificate of exemption,I Health&Safety Code.Sections 25505,25533,and 25534.
become subject to(he Worker's Compensation provisions of the Labor Code,I mus(
forthwith comply with such provisions is this permit shall be deenned revoked. Owner n• nuriz ent:
Dale:
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
I certify that I have read this application aid state that the above intonnation is
correct.I agree to comply with all city and county ordinances and state laws relating I hereby affirm(lint there is a construction lending agency for the perfonnance of work's
to building consruction,and hereby a diorize representatives of this city to enter for which(his permit is issued(Sec.3097,Civ C.)
upon the above mentioned property for inspection purposes,(We)agree to save Lender's Name
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs.and expenses which may accrue against said City in consequence of(he Lender's Address
granting of this pemtit.Additionally,the applicant understands and will comply
with all non-point source regulmians per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION
9.18.
1 understand my plats 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 . . . . . . . . : 31640010 .00
DATE ISSUED. . . . . . . : 03/19/2012
RECEIPT #. . . . . . ... . : BS000016306
REFERENCE ID # . . . : 12030089
SITE ADDRESS . . . . . : 10985 NORTHSEAL SQ
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER CHU WEN K AND THECLA M
ADDRESS . . . . . . . . . . : 1163 STAFFORD DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-4968
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 14 .00 196. 00 0.00 196 .00 0.00
---------- ---------- ---------- ----------
TOTAL PERMIT 197.65 0. 00 197 .65 0 .00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------
309 EXTERIOR LATH 311 SCRATCH COAT
601 ROOF TEAR OFF 6,02 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
N
I Northpoint Homeowners Association
10880 Northpoint Way
Cupertino, CA 95014
f City of Cupertino
T
HMarch 7, 2012
n
PF Re: Northpoint Roofing Project
01
To City of Cupertino
Please note that the Northpoint Homeowners Association has
N
and approved Four Season's Roofing to perform re-
roofing of our homes. They will replace the current CAL-Shake
roof system with new GAF Grand Canyon Asphalt Composition
1 r Shingles. We have selected the Stonewood color for our roofs.
Sincerely,
HF1
0( I I Linda Starnes
On Site Manager
A408-996-3734
10880 Northpoint Way
Cupertino,CA 95014
PH:408-996-3734
FX:408-996-0226
UNC Community
Management
6840 Via Del Oro
Suite 265
San Jose,CA 95119
PH:408-229-6000
FX:408-229-6001
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 10985 northseal sq DATE: 03/1912012 REVIEWED BY: larrys
APN: 0& 7d Q BP#: *VALUATION: $6,500
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition
PRIMARY SFD or Duplex PENTAMATION 1SFDWLR00F
USE: PERMIT TYPE:
WORK reroof. remove cal shake install 30 Ib felt of grand canyon composition roofing. 13. squares.
SCOPE /
We&Poul Chock Plauhb. Plan CbffA Live.Plan C'hack
4 enh. Pemhh hist Plush.Permit Fee: Ehv. Pernde Fee:
other Atech.Gap. Other Phonh hrtp. Other Elea.h)%p.
W"A Int). Fee.- Plmub.Insp.hit•: Firs.Imp, Fee.
NOTE: This estinutte does not include fees due to other Departments(i.e. Planning,Public Warks. Fire,Sanitary Sewer District,School
District,etc.). These ees are based on the prefininart in ornntion available and are only an estinmte. Contact tie De h or addn7 info,
FEE ITERIS (Fee Resolution 11-053 ER 7111/1) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 1,350 s.f. Re-roof
Suppl. PC Fee: Q Reg. O OT 0.0 hrs $0.00 $196.00 IREROOFRES
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Few@ Reg. Q OT 0.0 1 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Construction Tax.
ldntintvirative Fee: O
Work Without Permit? Q Yes Q No $0.00 G
Advanced Planning_Fee: $0.00 Select a Non-Residential t'
%raral Documentation Fens: Building or Structure
Strong Motion Fee: I8SEISA11CR $0.65 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $1.65 $196.00 TOTAL FEE: $197.65
Revised: 1/19/2012
REROOF PERMIT APPLICATION '
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINO (408)777-3228,• FAX(408)777-3333•building(dcuoertino.org
PROIECI'ADDRLSS t4 • p(O/O O j
O'WN'ER NAME 71CL ^ v
PI{UNE' b• 6 _6 (_(/ P.MAIL
�" � 1. 4
STREET ADDRESS //(T.C/ (S Q. Crry SI'A'IE'LIP FAX
a
CUNGLT NAMEYIIONE GMAIL
A \ 'redo C^'Z� res o _2318 0
Cl+STitEEr ADDRPSS CITY,STA'M:L:P FAX
• LC1�� Sri �Q. S
p
❑0WNE0. ❑ OwVEP-OUILUIfP ❑ 01CNIiR AC,WTCUYIRACfOR ❑CONIRACrO0.AGENT ❑ ARCIInE(T ❑{440I!:Ilak ❑ OEVELnI'Ii0. ❑ TENANT '
CONTRACTOR NAME gj r LICENSE IJUMHEI^ 1^� LI:ENSF.TYPE �^ HUS.LIC.a
COMPANY NAME C-MAII. a ,v y FAX
TtEEr ADDRESS C11Y,NTATL LII' PHONE
502- O ^. r' q'.TIIPoZ
AROUTECUENGINEER NAME LICENSE NUMBER BUS.LIC.i
COMPANY NAMil E-MAIL FAX
STREET ADDRESS Cr,Y,STATE•7.1P PIR)NE
USF.OF ❑ SFU or Duplex xmultl-Family RWI'ARP.\: �✓ VALUA'110N:
SIRUCTURE: ❑ Commercial ///»\ . .5Q• �6 SOC7
r-WnNORWFTYP�E❑: 0'0 1JUILYLUPROOF ❑ASPHALTSHINUI.CS ❑WOOUSIIAKFS 0W00r>SmsGLrs OTI ^` SF 4
A
PYD - PLYWD (3 0S8 PRRL\PONEAEYLACE 't (�IF"NO,
"'ERS KN SS Id•'
A
PROPOSED ROOF'IYPE: ❑BUILT-UPROOP ArASPHALrsiUNGLES -b WOOD SI L\KIS ❑WOODSHINGLES ❑OTHER . ICC-ISREPURTY
DESCRIPOON OF WORK: _
_ n _
i.n�.�.Ll 3�•��I_•4--un_d'_v1q�.n•�gn�' 3 S�kq.11 GAF Qr�1 Co.,�,�sn
n6j%IAj1e,N Color �vnewoocl _ /� S�S)
I F
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application andthe information I have provided is correct. I have read the Description 6 Wort arid verify it is accurate:.l"agree to comply With all applicable local
ordinances and state laws relating to building cons ion. thorize r scmatives of Cupertino to cn er the above-identified pro ny for inspection purposes.
Signature of ApplicanVAgcm:• �� '-' 'Date-: ' -� 3
• • SU4LEI,1tNTALINFORMA'60N RE EU • •- � ':,._, _-"""'
r ";'-:`•' �OFPICE USE ONLY -
_II•bu_Iding,ii associated vvith a home 0wners•Aulnia!ion,provide!crier• t�iPtsNCUECKiVPE- • ` ROUTING SLIP
nfapproval from flOA. ❑ 0VER-TH0ebUVhR ❑ HUILDINCPI.ANREYIEw'
• •Provide Planning approval to verify.il'theremty restrictions.' - 0'( `""ret tie:� t+ir " •` '
$XPRFSS' _ �❑'PI.A\'YINC PLAh'REVIEN"
Provide copy of\Ian UfactUrclS Installation Specifications. - •• *❑'STANDARD ❑ FIRE DEPT
Provide's'igned copy of Cupenino's Tetr-OPT policy. ❑ onwst:
. . LT'
Xeroof•1pp_2011.doc revisedO3116111