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12030092 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10975 NORTHSEAL SQ CONTRACTOR:FOUR SEASONS ROOFING PERMIT NO: 12030092 OWNER'S NAME: RASE•SIiKUhiAR SIJAIi PO BOX 1668 DATE ISSUED:03/192012 OWNER'S PHONE: 4083943086 SAN JOSE,CA 95109 PHONE NO:(4081278-0330 ❑' LICENSED CONFRACTOR'S DECLARATION r r 1-' ( BUILDING PERMIT INFO: BLDG ELECT PLUMB License Claus C 3 1 I is b � MECH r RESIDENTIAL C COMMERCIAL r Contractor -,x Dale-3/1 1 hereby allirm that 1 am licensed under the procisimu of Chapter 9 .TOB DESCRIPTION: RE-ROOF 13.5 SQ-TEAR OFF EXISTING CAL-SHAKE (commencing wide Section 71100)of Division 3 of(lie Business&Professions ROOFING SYSTEM,INSTALL 303 LB FELT UNDERLAYMENT, Code and that my license is in full force and effect. GAF GRAND CANYON CLASS A 1 hereby affirm under penalh•of perjury one or the rollnwing two declarations: (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 wok for which this permit is issued. I have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 ofthe Labor Code,for the performance of One work for which this Sq.Ft Floor Area: Valuation:S(500 permit is issued. APPLICANT CERTIFICATION ,APN Number:31(400(2.00 Occupancy Type: 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 to building construction,and hereby aahorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED indemnity and keep harmless the City of Cupertino against liahilities.judgmems, costs,and expenses which may accrue against said City in consequence of the WITHIN.180 DAYS OF PERMIT ISSUANCE OR grntingof this permit. Addilionnlly,the tytplicnm understands and will comply 1.120 D YS FRO LAST CALLED INSPECTION. with all not-point source regulations(�ul+crtino Municipal Code,Section P�� 9.13. 3 t/. Signature � Date Issued by Date: ❑ OWNER-BUILDER DECLARATION RE-ROOFS: hereby affirm that I am exenmpr from the Conlracmr's License Law for one of All roofs slmll'.be inspected prior to any roofing material being installed.If a roof is (lie following two reasons: installed without first obtaining tan inspection,1 agree to remove all rim materials for 1.as owner of(lie property,or my employees with wages as their sole compensation, inspection. will do the work.and the structure is not intended or offered for sale(Sec.7044, > �// Business&Professions Code) Signature of Applicant: Date: L as owner of the property,am exclusively contracting with licensed contractors m construct die project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 1 hereby affirm under penalty of perjury one of the following Three declarations: HAZARDOUS MATERIALS DISCLOSURE 1 bare 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 I have read(he 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 mmnimain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter9.12 and the Health& Section 3700 of the Labor Code,for the performance of(lie work for which this Safety Code,Section 25532(x)should 1 store or handle hazardous material. Additionally,should 1 use equipment or devices which emit hazardous air Perini(is issued, contaminants as defined by the Bay Area Air Quality Management District I w'i11 I certify that in the performance of die work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the nu employ any person in any manner so as to become subject to(he Worker's He:dth&Safety Code.Sections 25505.25533.and 2553.1: Conmpensation lases of Cnlif:�rnia. If,after nuking this certificate of exemption,I become subject to the Worker's Compensation provision ofthe Labor Code,I must Ow;ncror nufb `te nl: -/ forthwith comply with such provisions or(his permit shall be deemed revoked. �[ Date: APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCI I certify that I have read this application mid sate that the above intonation is I hereby affirm that there is a construction lending agency for the performance of work's correct.I agree to comply with all city and county ordinances mid state laws relating for which this permit is issued(Sec.3097,Cir C.) to building construction,and hereby authorize represcr atives of this ci(v 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 whichmay accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulxtims per(he Cupertino Municipal Code,Sectiat ARCHITECT'S DECLARATION 9.18. 1 understand my plans shall he 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 . . . . . . . . : 31640012 . 00 DATE ISSUED. . . . . . . : 03/19/2012 ' RECEIPT #. . . . . . . . . : BS000016306 REFERENCE ID # . . . : 12030092 SITE ADDRESS . . . . . : 10975 NORTHSEAL SQ SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . : OWNER . . . . . . . . . . . . : RASESHKUMAR SHAH ADDRESS . . . . . . . . . . : 2078 LOUISE IN CITY/STATE/ZIP . . . : LOS ALTOS, CA .95112 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 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF 'a- CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION is ADDRESS: 10975 northseal sq DATE: 03119/2012 REVIEWED BY: larrys APN: BP#: "VALUATION: $6,500 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex PENTAMATION 1SFDWLROOF USE: PERMIT TYPE: WORK reroof. remove cal shake install 30 Ib felt of grand canyon composition roofing. 13.5 squares. SCOPE tfecb Pour Ch..k Plumb. Pion Chtrk Etc,.Pim Check Much. Penuir hrc' Plumb. Pameh Fee: Fie- Permit Fee.• Other If"eh.Imp. L-iOther Piuuih hap. Other Elea bap. dish.imp. Fav Pluub.bap.Yr.c Elee.Insp.Fee: NOTE: This cstinmte does not include fees due to other Departments(i.e. Planning,Public Works. Fire,Sanimn•Sewer District,School District,etc.). These ees are based on the trelinina in ornutdon available and are onlr an estimate. Contact the De 1 or adder?info. FEE ITEMS (Fee Resolution 11-053 EB' 7/1/11) FEE QTY/FEE I MISC ITEMS Plan Check Fee: $0.00 1,350 S.f. Re-roof Suppl. PC Fee: Q Reg. 0 OT0.0 Idrs $0.00 $196.00 IREROOFRES PME Plan Check: $0.00 Permit Fee: $0.00 SuppI. Insp. Fee-.0 Reg. Q OT O 0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tar: Adndnistrulive Fee: O Work Without Permit? O Yes t) No $0.00 G Advanced Planning Fee: $0.00 Select a Non-Residential G Tr rout Uocutnaniation Fees: Building or Structure Strong Motion Fee: IBSEISHICR $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 PERMITAP,PL-ICATION COMMUNITY DEVELOPMENT DEPARTMENT•_BUILDING_ DIVISION 10300 TORRE AVENUE I•CUPERTINO,CA 95014 3255' (408)777-3228;• FAX(408)777-3333•buildinG(D-cuoertino.orD CUPERTINO .r r r! •r : r - I,I. It _Q PROJECT ADDRESS Or a ,-�{]L APN0 . rz ' ' ^ +C) C) OWNER NAME PHONE. 1 ✓ lJ, E-MALL aces p 5 a 08-3 1- OR STREET ADDRESS 20.48 o V t S e n r c�y,��" '�of c 4 A .S CA FAX CONTACT NAME Pt10NE' &MALL T C1 -p STREET ADDRESS .CITY.STATE,'ZIP' _R 1' FAX Sose Ca. 6- jjj ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT •51 CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑FNGINIER ❑ DEVELOPER ❑TENANT CONTRACIOR N!! U r LICENSE NUMBER WCFNSETYPE —� Bus.LIC N 3 3 COMPANY NAME FAX STREET ADDRESS - CffY,STATELP PHONE SO2 S AROUTEC:ENGINEER NAME , LICENSE NUMBER ' 'I - BUS:I.IC a COMPANY NAME E-MAIL FAX ! STREET ADDRESS CrIY,STATE,'ZIP ' PHONE USE OF '❑ SFD Or.Duplex Multi-Family ROOF�T� VALUATION: STRUCTURE: [3 Commercial EXISTING ROOF TYPE: 13 BUILT-UP ROOF ❑ASPIW.T SfnNGLit I ESI. ❑WOODSIIAEES ❑WOODSIUNGLES p OTHER(SPECIFY) qt. SI-}p a If REMOVE lRFP1.ACE YES IF NO. PLYWOOD ,Q%-. ,0, " ❑ PLYwo ❑OSB PTCH: F ROOF ❑ N q K S CI Sla' I I YE, O• b �_c 12 CIASS. .� • I Ar( 11 1 ICC-ES REPORT /i PROPOSEDROOFTYPE: ❑BUILT-UPROOF ASPHALTSHINGLES ❑WOOD sIWCFS ❑WOOD SHINGI F¢ ❑OTHER DESCRIPTION OF WORE: ' _ r n _ r 1 . II It ;; '1 t. li ' :.1 i r ' 1 � 11 ' �n Color t. Hy my signmtue below,I certify w each of We following: Icon the property owner or authorized agent w act on the property owner's behalf. I have read this application and the information I have provided is correct. 1 have read the Description of Work and verify it is accurate.,t agree to comply with all applicable local ordinances and state Is"relating to building cons 'on.' thoriu resenmtives of Cupertino to inner the above-i entifi property,for inspection purposes. ( .r r. .,�'.. . '1 'ten, - .v Signature of AppliranVAgent:• � paro; � r3Zia SUPPLEMENTAL INFORMATION RE ED OFFICE USE ONLY .I trr.rr , rlrl,. tl 9 ! ! {i� : . . ii .. . If building IS ESSOCIaled with Home OWTIef 5 Association,provide Teller ••:PLAN CHECK TYPE ROUTING SLIP of approval from HOA. 1'4; -1�iL .t'.. IDovER-TR6COUNTER ❑ BUILDING PLAN REVIEW _Provide Planning approval to verify if them any restrictions. 1'' 1 1 i. „ , r ❑` FXPRFSS7 1 ', - '❑ PLANNING PIAN REVIEW Provide copy of Manufacturers Installation Specifications. . "❑ STANDARD'" / - ❑ FTREDEPTi1 } Provide signed copy of Cupertino's Tear-ORT Policy. { s+ ' ' - ❑ 0711ER:. . .- .. t? ReroofApp_201l.doc revised 03116/11