12030091 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10965 NORTHSEAL SQ CONTIU%CfOR:FOUR SEASONS ROOFING PERMIT NO: 12030091
OWNER'S NAME: SANIAY PAL PO BOX 1668 DATE ISSUED:0311912012
OWNER'S PHONE: 4082429676 SAN.IOSE.CA 95109 PRONE NO:(4081278-0330
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r_-
License
License Class 3 Lic.N y 7�/ D r_ r rl
DIECH RESIDENTIAL COMMERCIAL
Contractor �5�, Date f F /Z.
1 hereby affirm that I am licensed under(lie provisions of Chapter 9 JOB DESCRIPTION: RE-ROOF-REMOVE CAL SHARE,INSTALL 30LO FELT,
(commencing with Section 7000)of Division 3 of the Business& Professions GAF
Code and that my license is in full force and effect. GRAND CANYON COMPOSITION ROOFING 13.5SQ
hereby affirm,under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self-insure(or Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this pennit is issued.
1 have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performnce of the work for which this Sq,Ft Floor Area: Valuation:$6500
Pei mil is issued.
APPLICANT CERTIFICATION APN Number..31640014.00 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 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 PERMIT EXPIRES IF WORK IS NOT STARTED
indenaify and keep harmless(lie City of Cupertino against liabilities.judgmens.
toss,and expenses which may accrue against said City in consequence ofthe WITHIN 180 DAYS OF PERMIT ISSUANCE OR
grinning of this permit. Additionally,the applicant understands and will comply 180 D YS FROM AST CALLED INSPECTION.
with all non-pion(soh 'e regulations per the Cupertino Municipal Code,Section
9.1 S. Issued hy: f
Date:
3 2
Signature � Dat<
❑ OWNER-RUILDER DECLARATION
RE-ROOFS:
1 hereby affirm tont I am exempt from the Contractor's License Law for One of All roofs shall be inspected prior no any roofing material being installed.If a roof is
the following two reasons: installed without first Obtaining an I agree w remove all nevv materials for
I,as owner of the 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 Applicmt: Date:
[,as owner of the property,am exclusively contracting will licensed contractors to
construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
hereby affirm under penalty of perjury one of the following three
declarations: HAZARDOUS MATERIALS DISCLOSURE
I have and will maintain a Certificate of Conserv to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for die I have read the hazardous materials requirements under Chapter 6.95(if the
performance of the work for which this pemhit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
1 have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and t1¢Health&
Section 3700 of the Labor Code,for the performance of the work-for which this Safety Code,Section 25532(a)should I store or handle lmznrdous material.
Additionally,should 1 use equipment or devices which emhaz
it ardous air
permit is issued. contanhinans as deflued by the Bay Area Air Quality Management District 1 will
I certify that in the perfomance of due work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and(he
not employ any person in any ntamer so its m become subject to the Worker's Heal(it&Safet'Code.Sections 25505.25533.and 25534.
Compensation laws of California. If,after making this certificate of exemption,I
become subject to the Worker's Compensation provisions of to Labor Code,I must OwnoL'-1rJhntlrp'zed agent:
m
forthwith comply with such provisions or this permit shall be deemed revoked. /.�/ l^ Dale: / C
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
I certify that I have read this application acid state that the above inforation is I hereby affirm that there is a construction lending agency for the performance of work's
correct.I agree to comply with all cityand county ordinances and state laws relating tier which this permit is issued(.Sec.3097,Civ C.)
to building construction,and hereby authorize representatives of(his city to enter Lender's Name
upon the above memioned 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 this pennit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
with all tion-point source regulations per the Cupertino Municipal Code,Section
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 . . . . . . . . : 31640014 . 00
DATE ISSUED. . . . . . . : 03/19/2012
RECEIPT #. . . . . . . . . : BS000016306
REFERENCE ID # . . . : 12030091
SITE ADDRESS . . . . . : 10965 NORTHSEAL SQ
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : SANJAY PAL
ADDRESS . . . . . . . . . . : 10965 NORTHSEAL
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-0529
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
-------------------
309 EXTERIOR LATH 311 SCRATCH COAT
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
CITY OF CUPERTINO
FEE ESTIMATOR— BUILDING DIVISION
ADDRESS: 10965 northseal sq DATE: 03/19/2012 REVIEWED BY: larrys
7i] APN: BP#: "VALUATION: $6,500
*PERMITTYPE: 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
.1levh. Plan Chick Plaodt. Plan Check Elm.Plan C•beck
blech. Permit h Plaa1.POtmit 1700: Flec. Perneit Fee:
Uthrr Af vb.174y. t.)thw•Plumb brsp. Otbrr Elm.hap.
VCJI./Ay. Pee: Plumb./nap•Fee 810x.Inc). Fev.:
NOTE: This estimate does not include fees due to other Departnteues(i.e. Planning,Public Works. Fire,Sanitary Sewer District,School
District,etc.). These fees are based on the prelininai3 in ornwrion av 'able and are on/v an estimate. Contact Ute De 1 or addn'I info.
FEE ITEMS (Fee Resolution 11-053 Elf 711111) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 1,350 1 s.f. Re-roof
Suppl. PC Fee: Q Reg. O OT 0.0 Ins $0.00 $196.00 1RER00FRES
PNIE Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. FeeG Reg. 0OT0.0 hrs $0.00
PME Unit Fee: $0.00
PM Permit Fee: $0.00
Consinielion Tar:
Ada inishwln,e Fee. O
Work Without Pennit? O Yes (D No $0.00 E)
Advanced Planning Fee: $0.00 Select allon-Residential Q
Travel Documentation Fees: Building or Structure O
Strong Motion Fee: 1BSEIS,VICR $0.65 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $1.65 $196.001 TOTAL FEE: 1 $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(ftuoertino.org 1
PROJECT ADDRESS, APNNNI
1Qq65- Ala, kSea I SO , 1 l
OWNER NAME PHONE C-MAIL
Sam; A R w �-
STREET ADDRESS Cn,.STATE,ZIP
u O
CONTACT NAME 1 ^ 1 �feS PIIONE O -O E-MAIL
T QO
STREbTADDRESS CITY,STATE,ZIP CFAX
p Sos eC, S
❑OWNER ❑ OWNER-BUILDER ❑ OWNERAGENr yY CONTRACTOR ❑CONIRACTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME. LICENSE NUMBER O LICENSETYPE -� BUSAAC:N ^^
COMPANY NAME E-MAIL FAX O( s
STREET ADDRESS CrrY,11g;It PHONE
Sot O 5
ARCHITF.0(ENGINEER NAME LICENSE NUMBER BUS.LIC.#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑ SPD or Duplex MUhI-1'amlly ROOF AREA: ,y/ VALUATION: G G�
STRUCTURE: ❑ Commercial 3 T s Sg• tqO
EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHA10 SHINGLES ❑WOOD SHARES ❑WOODSHINGLFS /Z OTFIER(SPECIFY) OAL SRA
REMOVE/REPLACE_WYES IF NO. PLYWOOD �,QIM' ❑ PL
❑.OSB PTI'CH: 1 ROOF fT
❑-N gI,AICR 1ICKNESS 05/8" TYP^ OGDX —+—')2 LASS: A
PROPOSEDROOFTYPE: ❑BUILT-11P 0.00E XASPHALTSHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES -. ❑OTHER ICC-ES REPORT#
DESCRIPTION OI+WORK:
n n
arpA GA Il i2A
3 3 s G
^A CO(Or
By my signature below,I cenify to each of the following: I am the property owner or authorized agent to act on the property owneds behalf. 1 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. thorize rescrnatives ofCupenino to enter the above-idea Mad p operty for inspection purposes.
/12
Signature Of ApplicanUAgent: Date: 3
SUPPLEMEM'AL INFORMATION RE ED OFFICE USE ONLY
_If building is associated with a I lome Owner's Association,provide letter PWN CIIECK TYPE ROUTING SIAP -
ofapprovalfromHOA.. ❑ OVER-THE-coax TER ❑ BUILDING PIAN REVIEW
_Provide Planning approval to verify if there any restrictions. ❑ EXPRESS ❑ PLANNING PIAN REVIEW
_Provide copy of Manufacturer's Installation Specifications. ❑ STANDARD ❑ FIRE DEPT
Provide signed copy of Cupertino's 9'ear-OTT Policy. ❑ OTHER:
ReroofApp_201!aloe revised 03/16/11