12030088 CITY OF CUPERTINO BUILDING PERMIT
BUILDING AI1f MS: 10977 NORTI ISFAL SQ CONTRACTOR:FOUR SEASONS ROOFING PERMIT NO: 12030088
OWNER'S NAIVE: CHIA-LING LEE PO BOX 1668 HATE I.S3UED:03/192012
OWNER'S PHONE: 4089961005 SAN.IOSE.CA 95109 PHONE NO:(408127841330
t�Er LICENSED CONTRACTOR'SDDECLARATION BUILDING PERMIT INFO: BLDG r— ELECT r PLUMB r
License Class C_ 3 Lic.4 !X ' �/ O� r r
C MECH RESIDENTIAL COMMERCIAL
Contractor -e •s AL DaleI �(
1 hereby affirm that 1 am licensed under the prorrsions of Clapter 9 •10B DESCRIPTION:RE-ROOF 13.5 SQ-TEAR OFF EXISTING CAI.-SHAKE
(commencing wish Section 7(100)of Division 3 of the Business& Professions ROOFING SYS'I'Ebl,INS'T'ALL 30H LB FELT UNDERLAYMENT,
Code and that my license is in full force and effect. GAF GRAND CANYON CLASS A
1 hereby affirm undo'penalty of perjury ane of the following Ivo declarations:
(have and will maintain a certificatc of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
perf imiance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,its provided for by
Section 3700 of the Labor Code,for the performance of die work for which this Sq.Ft Floor Area: Valuation:$6500
permit is issued.
APPLICANT CERTIFICA'T'ION APN Number:31640011.00 Occupancy Type:
I certify that I have read this application and stale than the above information is
correct.I agree to compty with all city and county ordinances and state Imus relating
to building construction,and hereby authorize representniv'es of this city to enter
upon(tie above mentioned property for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED
indemnity and keep harmless tome City of Cupertino against liabilities,judgments:
costs,and expenses which may accrue against said City in consequence of die WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting ofthispermit. regulations
the applicant in Municipal
and will comply l80 D YS FROMAST TALL INSPECTION.
withal) of
ftpoint sourceddkimmlly per tae Cupertino Municipal Code,comply S
4.1 y. //��/JJJ{/ 4 _ 9
Signature _ Date /�_ Issued by: Date:
❑ OWNER-BITILDER DECLARATION
RE-ROOFS:
hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is
the following two reasons: installed withou first obtaining an inspection.I agree 10 remote all new materials for
I,as owner of the property,or my employees with wages as their sole congeasatinn, inspection.
will do the work and the structure is not intended or offered for sale(See7044,
Business&Professions Code) Signature of Appl iaam: Date:
1,as owner of the property,am exclusively contracting with licensed conanetors to -
construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLAS$"A"OR BETTER
1 hereby affnrnn under penalty of perjuq.one of the following three
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 the Labor Code,for the I have read the hazardous materials requiremens under Chapter 6.95 of(lie
performance of the work for which this pemail 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 Health&
Section 3700 of the Labor Code,for the performance of the work fix which this Safety Code,Section 25532(a)should I store or handle hazardous material.
Additionally,should I use equipment or devices which emit hazardous air
r
peait is issued. contaminants as defined by the Bay Area Air Quality Management District I will
I certify tint in the perfor niece of die 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 Workers Health&Safety Code.Sections 25505,25533,and 25534•
Compensation laws of California. If,after making this certificate of exemption,1
Owner ar nn o '.cd: u:
become Subject t0 the Worker's Compensation provisions of the Labor Code,I mus
forthwith comply with such provisions or(his permit Shall be deemed revoked. Date:
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
I certify that I have read this application mid state that the above imiirnation is I herebv aHirn that there is a construction lending agency for tire performance of work's
correct.I agree to comply with all city and county ontinaaces♦tad slate 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
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
graining otthis permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
with all non-point source regulatiass per the Cupertino Municipal Code,Section
9.18. 1 understand my plans shall be used as public records.
Signature Date Licensed Professional
k'pv 3 00"
CiTY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 10977 northseal sq DATE: 03/19/2012 REVIEWED BY: larrys
APN: BP#: "VALUATION: $6,500
*PERMITTYPE: Building Permit PLAN CHECK TYPE: Addition
PRIMARY SFD or Duplex PENTANIATION 1SFDWLROOF
USE: I PERMIT TYPE:
WORK reroof. remove cal shake install 30 Ib felt of grand canyon composition roofing. 13.5 squares.
SCOPE
Veoll Plan Gne'k Plumb, Pion Check Elee.Plan Check
.M1luch. Pernor 4er Plumb. Pamir Fee: Flee Parma Fee:
IXhe"kfedu.laip. Onmr Phanh hrsp. Other Elva lmp.
Li I
V uh.Irnp Pee.' Plumb.hwp.Fee.. Fier.Int) Fee.-
NOTE: This astinuue does not include fees due to other Depanntents(i.e. Planning,Public Works,Fire,Sunita{v Sewer District,School
District,etc.). Thesefees are baser/on the trelininarrin ornmtion available and are onh an winmte. Contact he De t or addit7 info.
FEE ITEMS (Fee Resolution 11-053 EfX 7/1/11) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 1,350 s.f. Re-roof
Suppl. PC Fee: (j) Reg. 0 OT 0.0 Itrs $0.00 $196.001 IREROOFREs
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee:Q Reg. Q OT 0,0 [its $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Construction Tax:
.1 Jndnt,cirative Fee: 0
Work Without Pennit? O Yes Q No $0.00 0
Advanced Plinnine Fee: $0.00 Select a Non-Residential
fI mel Documentation Fees:
Building or Structure 0
Strong Motion Fee: IBSEISMICR $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
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COMMUNITY DEVELOPMENT-DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
II .,.I, IL . r.', , .14
(408)777-3228:• FAX(408)777-3333•buildind(dcuoertino.or0
CUPERTINO
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PROJEADDRESS AlorAsC S APN Y . I w -40 (-) 1
OWNER NAME PHO ( E-MAIL
( " NE' OS- - oof
TM-ETADDRESS Cr1Y,STATE,ZIP I FAX
D o rN5 s oCA S
CONTACT NAME' 1 C f� {• . PHONE I -O EMAD.
STREET ADDRESS CFTY,S`FATE,'ZIPI I - FAX
O .�oSe Ca. qS-Ilj
❑OWNER ❑ OWNER-BUILDER ❑ OWNER An 'p CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME LICENSE NUMBER' JO LICENSE TYPE -2 BUS.LIC. 3 3
OIn
COMPANY NAME T 1)- E-MAIC ! FAX
STREET ADDRFSS CITY;STATE,ZIPIII PHONE
02— 0 S468) A
ARCFITIECI'/ENGWEER NAME' 1 1 LICENSE NUMBER" a r • BUS.LIC.X
I '
COMPANY NAME E-MAIL FAx
STREET ADDRESS - CIT',STATE,ZIP PHONE
USE OF ❑ SFD Or DuplexYMuld-Family' POOP AREA: VALUATION: -
STRUCTURE: ❑ Commercial
EXISTING ROOF TYPE: ❑BUILT-UPROOF 13 ASPHALT SI IINGLM ❑WOODSIVKFS 0WOODSHINGLES /�OTHER(SPECIFY) AL SRA
it U-
REMOVE/REPLACE WYFS ffNO. PI.VWOOD ,Q•'A' ❑ - PLYwD ❑Tnu PITCH: . u ROOF
CLASS. A
• '-- i 'i•, i 11 I I i '' 1 \ ICC-FS REPORT
PROPOSEDROOFTYPE: ❑BUILT-UPROOF �ASPHALTSHINGI PC El WOOD SHARES ❑WOODSHING.ES ,❑OTHER
DESCRIMON OF WORK:
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By my signature below,I certify to each of the following: I atn the property owner or authorized agent to act on the property owner's behalf. 1 have rwd this
application and the information I have provided incorrect. I have read the Description of Work and verify it is accurate. 1 agree 10 comply With all applicable local
ordinances and state laws relating to building cons 'on.' thorize resentatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of ApplicanVAgenC' r Dater 3412
SUPPLEMENTAL INFORMATION RE D - * ;�.` ..%�'= ' -: +� - '
OFFICE USE ONLY
T Ll..,. i TI nn ry,;I,itll• - -KR.- PStl4 '.�,I d•. --c.•
_If building is associated With a Home Owmer's Association,provide letter PF•AN CHECK TYPE ROUTHG SLIP
ofaPProval from HOA' OVER-THE-COUNTER C` l•. Bl1LDINC PLAN
LAN RE
VIEW'
Provide Planning approval to verify if there my restrictions. f I..�+;n.:Fy� "„ny:; =-h• .• •' -
11 EXPRESS ❑ PLANNING PLAN REVIEW
_Provide copy of Manufatttuer's Installation Specifications. ❑ STANDARD ❑ FIRE DEPT
ProvidesiSned copy of CuPertino's Tear-OT Policy. ra . k.' t0, 'Ek.
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ReroojApp_201 Ldoc revised 03/16/11