12040020 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 11004 NORTHSEAL SQ CONTRACTOR:FOUR SEASONS ROOFING PF-RNI IT NO: 12040020
OWNER'S NAME: PETER WILT TRUSTEE PO BOX 1668 DATE ISSUED:04/03/2012
OWNER'S PHONE: 4082536595 SAN JOSE,CA 95109 PHONE.NO:(408)278-0330
T LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
License Class G�3 / Lic.# "/ �''��0 r r r
MECH RESIDENTIAL COMMERCIAL
Contractor FwrSei.ca e 4-3 - 1
hereby affirm that 1 am licensed under the pialvisions of Chapter 9 JOB DESCRIPTION: REROOF. 12 SQ.REMOVE SHAKE.REPLACE WITH
(commencing with Section 7000)or Division 3 of the Business&Professions ASPHALT,
Code and that my license is in full force and effect. SAMI:COLOR
1 hereby affirm under penally of perjury one of the following two declarations:
I 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 work for which this permit is issued.
I 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
pemtil is issued. Sq.Ft Floor Area: Valuation:$6500
APPLICANT CERTIFICATION
I certify that I have read this application and stale that the above information is APN Number:31640039.00 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,and 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 Issued by: ���/✓ �/�/� Date: y•3•/a
❑ OWNE -B ,DER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS:
the following two reasons: All roofs shall be inspected prior to any roofing material berg installed.If a roof is
I,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agar 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 ollhe properly,am exclusively contracting with licensed contractors to Signature of Applicant: Date:
construct the project(Sec.7044,Business&Professions Code). I
I hereby affirm under penalty of perjury one of the following three ALL ROOF COV ERI GS TO BF.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
I 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 ofthe Labor Code,lox the performance of the work for which this compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Safety Code,Section 25532(1)should I store or handle hazardous material.
permit is issued, Additionally,should t use equipment or devices which emit hazardous air
I certify that in the performance of the work for which this permit is issued,1 shall contaminants as defined by the Bay Area Air Ouality Management District 1 will
not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Cade,Chapter 9.12 and the
Compensation laws of Cali fomia. If,after making this certificate of exemption,I Ilealth&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 oro a ' nC /Z
—Date;�
APPLICANTCERTIFICATION CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is
coffee(. I agree to comply with all city and county ordinances and stale laws relating I hereby affirm that 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 properly 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 ARCHITECT'S DECLARATION
9.18.
1 understand my plans shall be used as 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 31640039. 00
DATE ISSUED. .... . . . : 04/03/2012
RECEIPT #. . . . . . . . : : SS000016446
REFERENCE ID # . . . : 12040020
SITE ADDRESS 11004 NORTHSEAL SQ
SUBDIVISION : . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER. ... . . . . . . . . . . : PETER WILT TRUSTEE
ADDRESS 25818 GOLDEN BELL WY
CITY/STATE/ZIP . . . : SPRING, TX 77389
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
o�
CITY OF CUPERTINO
(SD` ' FEE ESTIMATOR— BUILDING DIVISION
ADDRESS: 199rZNorthseal Sq. DATE: 04/03/2012 REVIEWED BY: jsg
APN: t{p039 1 BPN: 'VALUATION: 1$6,500
*PERMITTYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY Multi-Family Dwelling Buildina is PENTAMATION 1 OF
USE: 3 Stories 0 Yes 0 No PERMIT TYPE:
WORK Remove shake replace with asphalt same color
SCOPE
FEE ID ROOF AREA
s.f.
1REROOFMRES " 1,200
_� s1 �•;r��.f�t'�y�rMui��l ./ .. _. ._ ._.fir - � SS54 .. ,mak �:�' �.-��4, �'f r$tL?�1i_�.
.11relr, I7m-r('far:k !'lamb. P(un Chard Dec. 1'1,17 l.'la:ck
,lh•elr. Permit Fc,' Phunh. Permit h:r: Flt( Pemiir Vee:
Otho-1/erh. Msp Other Plumh ln.rp. Other/iicr.My. Li
.1 A!,h. Drip. h;..e. Plurnh. hc.p. Frr: Orr. Lrrp. l-de:
NOTE: This estimate does not includejees due to other Departments(Le.Planning,Public Works, Fire,Sanitary Sewer District,School
District,etc.). These eesare based on the prelimina information available and are only an estimate Contact the De 1 or addn'l info.
FEE ITEMS(Fee Resolution 11-053 EA.' 7!l/11) FEE QTY/FEE MISC ITEMS
/Tarr Check Fre:
,Supp/. PC:1-ve
Pl uwh.:'t1 dech.:'F.lec
Permit Fee: $166.00
Supp/. hrsp Fee
Plulnh.lA-Ie ch.:'lilec
Pfitrn/r..14re/1.!li/rc Perak/Fee.
C'unsnvcrion Tax.
rldminal ruive Ver:
Work Without Permit? () Yes No $0.00
JdvalIcr(l Planning, bees:
Travel I)Ocnmrnlalion Fees.
Strone Motion Fee: 111SE1SMICR $0.65 Select an Administrative Item
Blde Stds Commission Fee: 1BCBSC $1.00
c
SUBTOTALS;; $169.65 $0.00r Faa, 'rITOTAL`FEE $169.65
Revised: 1/19/2012
2 04: 18 4089960225 u NOPTH�OINTJ 02202
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lease note that theorth int Homeow filers Assoc'rn has ¢
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ontracted and'approved Fur Seasons Roofing to perform re- f
oofiag of our homes Th will replace the current,CAL
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REROOF PERMIT APPLICATION �U
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION ,
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
C UPERTIN0 (408)777-3228.•FAX(408)777-3333•buildina(Mcuoertino.om
PROJECTADDRESS APNa +I ' ^ 0
611
NE
OWNER NAME v v
Al
.' EMAIL Zs�I C6 C (�-✓(=N u-
S'I REEf ADU7S CITY.STATE ZIPend ap. Eq 1 v 77
CONTACT NAME U aC f re c J - PIIONE -O E-MAIL I
SINEF7TADDRISS vCOY.STATE,ZIP FAX
O .Eos 2 Ca. q6,11
❑ UM.M:R ❑ OWNER BUILDER ❑ OWNERAGENT 'yl CONTRAMR ❑CONIRACTORAGFNT ❑ ARCHtMCI ❑ITGINEER ❑ OCVELOPFR ❑ TFSAIT
COSIAACTOR NAMELICENSE NUMBER LICENSETYPE BUS LIC 3 3
Q-72 ioA -43q
COMPANY SASIE E-MAIL FAX
SIRLLT ADDRESS CIIY,STA ZIP PHONE
02
ARCI IFT7FCT/ENGINEER NAMI: LICENSE NUMBER BUS.LIC.R
COMPANI'NAME E-MAIL
FAX
STiU_Fr ADDRESS Crry STAT$ZIP PHONE
USE OF ❑ SFD or Duplex Multi-Family ROOF AREA? VALUATIONS.
STRLCIURE: ❑ Commercial S •
EXISTING ROOF TYPE: 11 BUILT-LIP ROOF 11ASPHALT SHINGLES ❑WOODSHAKES ❑ 11111A
FS WOODSHINGI /i OTHER(SPECIFY)
REMOVE ntEPt.YCE OYFS M NO, PLYWOOD La.1 'A- ❑ PLYWD La OSB PIIT;FT. )Z ROOF A
TYPE fl � LA,
PAOU SEDRWf TYPE: ❑BUILT-UPROOF A(ASPHALTSHINOLES ❑WOOD SHAKES ❑WOODSHINGLES ❑OTHER ICGFSREPORTe
DESCRIPTION OF WORK:
_ r n
* I - II _ /1op As4,ti
•+ t ; $ G
1 '
CO 1
' 1
By my signature below,I certify m each of the following: 1 errs the property owner or autlmrizod agent tow on theo
applicaBon and the information I have provided s correct. 1 have read the on of Wort and r a Penowner's behalf 1 have read this
Description verify it is accurate. 1 eg rce m wmply with oll applicable local
ordinances and slate laws relating to building M. rhe tatim of CuperUm to enter the abovo-identifi property for inspection purposes.
Signature of ApplicanUAgem: Dare: 't
SUPPLEMENTAL INFORMATION REQAfED - OPITCE USE ONLY
It building is associated with a Home Owrwes Association,provide letter PIAN CHFAXTYPE. RoonnG SUP
Of approval from HOA. ❑.OVER-THECOUNTER ❑ BUILDING PLAN"EW
Provide Planning approval to veri fy if there any restrictions. I I ,'iiiry
❑ EXPRESS ❑ PLANNING PLAN REVIEW
Provide copy of Manufacturers Installation Specifications.-
. .. ❑ STANDARD ❑ FIREDEPT
I I .
Provide signed copy of Cupertino's Tea-Off Policy. ❑ OTHER
Reroof f pp_1011.doc revised 03/16111