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12040019 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 11002 NORTHSEAL SQ CONTRACTOR:FOUR SEASONS ROOFING PERMIT NO: 12040019 OWNER'S NAME: BOHRINGER WILLIAM F AND PAULINE TRU PO BOX 1668 DATE. ISSUED:04/032012 OWNER'S PHONE: 4082445922 SAN JOSE,CA 95109 PHONE NO:(408)278-0330 .gam LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r License Class G"3g Lic 9 if'n/Q • r r r ff /L. MECH RESIDENTIAL COMMERCIAL Contractor f—O&W Lwf a4C Axziiie / hereby affirm that I nm licensed under the provisions of Che ler 9 JOB DESCRIPTION: REROOF,12 SQ,REMOVE SHAKE,REPLACE WITH (commencing with Section 7000)of Division 3 of the Business&Professions ASPHALT, Code and that my license is in full force and effect. SAME COLOR 1 hereby affirm under penally of perjury one of the following two declarations: I have and will maintain a ceniticate of consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the performance orthe work for which this permit is issued. 1 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. Sq.Ft Floor Area: Valuation:$6500 APPLICANT CERTIFICATION 1 certify that I have read this application and state that the above information is APN Number:31640038.00 Occupancy Type: 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 of Cupertino against liabilities,judgments, PERMIT EXPIRES IF WORK IS NOT STARTED costs,mid expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non-point source regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION. 9,18- Signature Dale /t Issued by: fir/G Date: ❑ O%V4 .R-BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for one of RF:ROOFS: the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is 1,as owner of the property,or my employees with wages as their sole compensation, installed without 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) 1,as owner of the properly,am exclusively contracting with licensed contractors to Signature of Applicait: Date: construct the project(Sec.7044,Business&Professions Code). 1 hereby affirm under penalty of perjury one of the following three ALL ROOF COVF.WOBE 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 the Labor Code.for the performance of the work for which this permit 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 Ileallh&Safety Code,Sections 25505,25533,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(a)should 1 store or handle hazardous material. permit is issued. Additionally,should I use equipment or devices which emit hazardous air I certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I will not employ any person in any manner so as 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 certificate of exemption,I Health&Safety Code,Sections 25505,25533,and 25534. 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. Owner or a 1 1: �,Z e: APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is cored I agree to comply with all city and county ordinances and state laws relating I hereby affithat there is a construction lending agency for the performance of work's to building construction,and hereby authorize representatives of this city to enter for which this 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 the Lender's Address granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section ARCIIITF.CT'S DECLARATION 9.18. 1 understand my plans shall be used&s public records. Signature Date Licensed Professional CITY OF CUPERTINO 3 ITEMS OF 20 PERMIT RECEIPT, OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : ,31640038 . 00 DATE ISSUED. . . . . . . : 04/03/2012 RECEIPT #. . . . . . . . . : BS000016446 REFERENCE ID # . . . : 12040019 - SITE ADDRESS. ... . . . : 11002 NORTHSEAL SQ SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO. IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . BOHRINGER WILLIAM F AND PAULIN ADDRESS . . . . . . . . . . : 1041 FERNLEAF DR CITY/STATE/ZIP . . . : SUNNYVALE, CA 94086 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 12 .00 168 .00 0 .00 168 .00. 0 .00 ---------- ---------- ---------- ---- ------ TOTAL PERMIT 169.65 0 . 00 169.65 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 (yo �cl CITY OF CUPERTINO 1102, FEE ESTV4ATOR- BUILDING DIVISION 1 ADDRESS: tt&Northseal Sq. DATE: 04/03/2012 REVIEWED BY: jsg APN: Sj(.p . 3 BPIF: 'VALUATION: $6,500 £PERMITTYPE: Minor Building'Permit 7PLAN CHECK TYPE: Re-roof PRIMARY Multi-Family Dwelling Buildina is PENTAMATION 1 ROOF USE: 3 Stories O Yes (F) No PERMIT TYPE: WORK Remove shake replace with asphalt same color SCOPE ' FEE H) ROOF AREA Vol s.f. 1REROOFMRES " 1,200 Los+I h� ��f l 4 y�W 4� 1' .',, � v � 1'1un(.'h,:rk Plonrh. P1nn ChrrA Plrur(.'1a'cA ,Llach. P.,,mil Fe": 1'hmih, Pcnni/Fac: 1:7rr. Pormil F,a: Udro, Iferh. /r6T Odw, Numb/n.v,. (ldrer Flee invi, ale,h. ln.P. 1'?e Plrtmh- ln:p. Fre: /.Irv.JnV). 1%c' NOTE: This estimate does nottinclude fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). Thesefees are based on the prelitmnina in ormadon available and are only an estimate. Contact the De t or addn't info. FEE ITEMS (Fee Resolulion 11-053 EB' 7///1/) FEE QTY/FEE MISC ITEMS l'!an Chee6c Fee: ,Supp/. PC:I've l'l:unh.:';1•lerh.:'ISIc'c Permit Fee: $168.00 Suppl. 11;sp Fee e Phnnh.,'aderh.-'Ii lec 1'lunrhJ14rcd.il:7cc' I'crolil l•iza: C'un.vrurrion T n. ildlninisuarice Fee. Work Without Permit? Yes (j) No $0.00 Adrrnurd Phnwinv /Fees: Truvel I)nemnenlalion Fees: Strong Motion Fee: IBSEISMCR $0.65 Select an Administrative Item Bldg_Stds Commission Fee: IBCBSC $1.00 $169.65 $0.00 'G'L` bTOTAL FEE ' $169.65 SUBTOTALS: Revised: 1/19/2012 1/2 2 24: 18 4089960226 n NOPTHPOINTI;I S P,2L82 I � i. 4 Int Homeown odation §� g4 110 ( ' A f;. p, tty of Cupertino i u } N i It i tardi 7, 2012 ? n fi. rr�...eee Li ' Q -: + � - I i i- I.'.6rvn�r` J- 6t�`�y 1h`b}.�S.�7IF,,IP 1. 2 , 1 i Li' .l,-rr t ,L fAJ , t 9I e �ldithpoinf•�1. g` sect I i ' x' . . It p o City of Cupertino J: xr1EI ? lease note that the f?torth int Homeowners Asso6ia4ton has �! < ontracted and ed Ur'Season's Roofing to perform re- ofirig of our , esu Th will replace the current CRL-Shake 1 r` s 0of5ystem with A rand CanyotsFAsphalt Co�rnposltion { 7�: , I :, 'j ,III �� A h! les. We Have lec the Stonewt�o�,'color fd" roofs fl J JtiRl F Sincerely, It Linda Stamen ' On Srte Manager f f 408-996-3734 way � 8 g l+" n e�b��9.E000 i } r ."&72".'`, 001 1 � f •r i. r I � ,r Nr , . I , r , n n m Ir •ar• rl :, _ - f • c• ,0 R0 . j,� , •,f t**�•*i 4 © .`'�C *D� �i ca •� i '=1'} i�'7' i l i}yl aThr •��� .e r 4C^i �IJ �i -T f t s• 1 +r '� �-Yr hal .S a�'ra. �� � _`k`T'� 3'E'F.' '{ I— •-?, S+ i sr�A f 1 �'�3 z radl u�'�n 4..' ,�L n(�y`,,5"h f(`-0aLrF ) aF il• r tis b' S '[ f w �3a I i 1�{maa'",�Y f;�11�}Y�Y�1'r.�R ,• (. '.�__ �" ?i`a3i eaN'T\��' ! (t r� . 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S i REROOF PERMIT APPLICATION rJ COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION J 10300 TORRE AVENUE•ICUPERTINO,CA 95014-3255 C UP ERTI NO (408)777-3228.• FAX(408)777-3333•building0cuoertino.oro \1 PROJECT ADDRESS L A APN Y 2 O OWNT:R NAAfE PHO J E-MAIL v a S TRk!-T ADDRESS CITY,STATE,Z X CONTACr NAME /1 1 PHO .O EMAIL STRECADDRESS - CITY,STATE,ZIP FAX o SoSQ. C'a. S ❑ON?ER ❑ OWNER-BUILDER ❑ OWNER AGENT 'Ip CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCIBrECF ❑L\OINEER ❑ DEVELOPER ❑ itis&.\T CONTRACTOR NAMELICENSE NUMBER LICENSE TYPE BUS.LIC.0 CONIVANYNAME ` E-MAILS FA% SnEI-1 ADDRESS �Z CITY,STA ZIP P"ONB A RCIIITECl/T.NGINTER NAME I LICENSE NUMBER BUS LIC.0 &MALL COMPANY N..MF. FAX Sl REE T ADDRESS CIT,STATE,ZIP PHONE USE OF ❑ SFD or Duplex XMUlti-Family ROOF AREA: 2/ VALUATION: STRLCURE: ❑ Commercial 5 560 EXISTING ROOF T'PE::/❑BUILT-UPROOF 13 ASPHALT SMGLES ❑WOOD BETAKES ❑WOOD SHINGIFS rOl}TER(SPECIFY) a�L SF}p RE_MOVE,APL EACE IDYE$ IF NO. PLYWOOD .f]SS" ❑ PLYWD ❑OSB PITCH I ROOF V % 14 [!` LAS,. A PNOPUSEDROOFTYPE: ❑BUILT.UPROOF ASPHALT SHINGLES 'd WOOD SHARES ❑WOOD SHINGLES ❑OTHER ICC-ES RFPORI'< DESCRIPTION OF WORK' _ n n _ 1AS--all 3b# a CO'AuoA ` i 1 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 and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinmces end stale laws relating to building can an.. fin unim of Cupertino to enter the Rho ve-identifiedpro for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQAIKD _ omauseoNl,Y I f building is associated with a Home Owner's Association,provide letter PLANCHEACTYPE' ROUTING SLIP of approval from IIOA. • " ❑ OV01-THK-COUIYFER ❑ BUILDING PLAN MVIEw Provide Planning approval to verify if there any restrictions. pEXPRIEM. I', ❑ tNdryNLYG PLAN IlEV1EN' Provide copy of Manufacturer's Installation Specifications. ❑ STANDMM _ ❑ FIREDEPf Provide signed copy of Cupertino's Tear-OR Policy. ❑ OTHER Neroofdpp_NU l.doc revised 03/16111