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12040016 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10992 NORTHSEAL SQ CONTRACTOR:FOUR SEASONS ROOFING PERMIT NO: 12030016 OWNER'SNAME: REIN ECKE ROBERT C TRUSTEE PO BOX 1668 DATE ISSUED:04/03/2012 OWNER'S PHONE: SAN JOSE,CA 95109 PHONE NO:(468)278-0330 [� LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r License Class C-3 Lic.H 41 V(0? r r r C' MECH RESIDENTIAL COMMERCIAL Contractor Fou/l@rsf%A ale 4'3' 12 1 hereby affirm that l am licensed under the visions of Chapter JOB DESCRIPTION: REROOF,12 SQ,REMOVE SHAKE AND REPLACE WITH (commencing with Section 7000)of Division 3 of the Business&Professions ASPHALT.SAME COLOR Code and that my license is in full force and effect. 1 hereby affirm under penalty 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(he work for which this Sq.FI Floor Area: Valuation:56500 permit is issued. APPLICANT CERTIFICATION APN Number:31640036.00 Occupancy Type: I certify that I have read this application and stale that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to budding 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 indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs.and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR gramingofllhispermil. Additionally,the applicant underslandsand will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code.Section 9,18. ` _J,/2 Issued by: JEAiI/ f 7?r41 Date: 41--3 -1,;2Signature Date ❑ OWNkZBIJILDER DECLARATION RF:ROOFS: hereby affirm Ih 1 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 without first obtaining an inspection,I agree to remove all new 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 Applicant: Date 7' I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERT O BE CLASS"A"OR BETTER I hereby affirm under penalty or perjury one of the following three declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSIIRF: Compensation,as provided for by Section 3700 of the Labor Code,for the 1 have read the 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 maintain Workers 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 for which this Safety Code,Section 25532(a)should 1 stare or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District 1 will I certify that in the performance of the 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 Worker's Ilealth&Safety Code,Sections 25505,25533,and 25534. Compensation laws of Califamia. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Cade,I must Owner a or' agent: forthwith comply with such provisions or this permit shall be deemed revoked. Dale' 3 APPLICANT CERTIFICATION 413>CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I hereby affirm that[here is a construction lending agency for the performance of work's correct. I agree to comply with all city and county ordinances and stale 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 l iabil ities,judgments. Lender's Address costs,and expenses which may accrue against said City in consequence of the granting of this permit Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION with all non-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 4 ITEMS OF 20 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec:' Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 31640036. 00 DATE, ISSUED. . . . . . .: 04/03/2012 RECEIPT #. . . . . . . . . : BS000016446 REFERENCE ID # . . . : 12040016 SITE ADDRESS . . . . . : 10992 NORTHSEAL SQ SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : REINECKE ROBERT C TRUSTEE ADDRESS . . . . . . . . . . : 10992 NORTHSEAL SQ CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-0532 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 1BUSLIC FLAT .RATE 1 .00 119.00 0.00 119. 00 0.00 1REROOFRES SQ FEET 12 .00 168 . 00 0. 00 168 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 288.65 0. 00 288.65 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 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 10992 Northseal Sq. DATE: 04/03/2012 REVIEWED BY: jsg APN: 3 1 (D L40 0,'2)' BP#: `VALUATION: $6,500 *PERMIT TYPE: Minor BuiWing Permit PLAN CHECK TYPE: Re-roof PRIMARY Multi-Fa welling Building is PENTAMATION 1 OOF USE: 3 Stories O Yes O No PERMITTVPE: WORKRemove shake replace wit 'as halt same color SCOPE FEE ID ROOFAREA s.f. 1REROOFMRES 1,200 Alech. flan Ch,wk I'luorh. Phm Check Elee. Plan Chrrk dlech. Pe nril Fein Plamh, Permit Fee: lilec. Permit Fra: Other 31ech, Insp. Ocher Plumb ln.cp, other Eley.Lisp. 'I kch.logy. Fee: Plomh. /usp. Fre: Elev. Lisp. Feer NOTE. This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District, etc). Thesefees are based on the prelimbur in ormadon available and are only an estimate Contact the Dept for addn 7 info. FEE ITEMS FEee Re.solation 11-053 EN: 711/1/1 FEE QTY/FEE MISC ITEMS Plun Check Fee: Supp/. PC Fee /'lun+h,hl•tech./Flee Permit Fee: $168.00 Supp/ lhl,cp Fee Pluulb.;klecb./Elei: Plunlh./Adech./Llec Permit Fee: Conclrnclion Tax: Adminisnrnive Fee: Work Without Permit? O Yes O No $0.00 it dennced Miming Fees: Travel Documentaliorr Fees: Strong Motion Fee: IBSEISMICR $0.65 Select an Admi istr iv Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: 1 $169.65 $0.001 TOTAL FEE: $169.65 Revised: 1/19/2012 04: 18 4089960226 �l - 1 NORTHPOINT�, 4�c _02L02 f yTj I`omtHomeovm�is A ociation �a 4 ti:• Northpol Wa j 6 r:' r� ;;;. n , �,+•�,�'�1 ` ' aF 1 i j no 6 ^11 al tty'ofCupertino '4 tarch 7, 2012 W t`c I�! I eortt►pofnt tl g: eCt F, o City of Cupertino Rill T F7 � � I; i iE -'ii ii4� � •i lease note that the North ` tnt Homeowners Assocrdon has n ?. 1 — ' � ontracted and approved Four Season's Roofing to perform re z oofih of our homes'1Th will replace the current CAL-Shake Sa s oof6ystem Wath _` rand CanyugA�s�Qhalt Cplpositron IV �` , -' h. s., We have � e Uie Stonew�od:'color forpur roofs � £ Yah. a Stncerely,.. _, ,a IL Linda.Starnes M On S 'Manager . ., , § r I 408-996-3734 SS 4" F � Way r,' �.�i' , FX i. -. • 'R � GV}iF�•�CJ :� ri tt REROOF PERMIT APPLICATION CP 10300 COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION t yC 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 JT` C (408)777-3228:•FAX(408)777-3333•buildingAcuoertino.orG \ PROJEC-r.ADDRESS APN7 1 I IO O `� OWNER NAME ONE I �� I--�E-MALL o lt ere Yr rADDRESS CITY',STATE IP FAX 92 Al., edCA 4 3-014 CONTACT NAME ,�r�ac �(c^ n PHONE JF E-MAIL N -0 I REIT I AUURI5S CnY,STATE,ZIPFAS SoS e co'. 6 1 I ❑ UWNER ❑ OWNMUIJILDER ❑ OWNERAGFNr yy co. i Mlk ❑CONTRAMR AGENT ❑ ARCHRFlr ❑ENGINEER ❑ DEVEWPER ❑ TENA\T CON•ITKA TOR NAME WCEN$E NUMBER LICENSE TYPE BUS I.IC.q �OUr Le CO%1PANY NA.%T E-MAR. FAX SI'RFE] ADDRESSOZ CfrY,SrA PHONE ZIP ARCFRTECMENGINEER NAME • LICENSE NUMBER HUS.LIC.tl COMPANY NAME E-MAIL FAX S rRL17 ADURF.SS ,,,��/// CITY,SEAT$LP PIIONI: USE OF E] SFD or Duplex 1� MUIU-Farnily. ROOFAREA: VALUATION: $}�� SIRLCILRL. El Commercial ' ` � _ - 5 •1 li.\'IST"L\G RIX]r TYPE: ❑BUILT UP ROOF ❑ASPILLLTSIIINGLFS ❑WOODSINKES ❑WOODSHINGLES OTHER[SPECIFY) AL S�a REMOVE,RIYLACE XYFS IF NO, MYWOOD aw 11 OSB ROOF ❑ Y WRCm_ 2 ICIASS Lj 518" A PRO[ SEDROOFTYPE: ❑BUILT-UPROOF ArASPHALTSIDNOLES 13 WOOD SHAKES 13 WOOD SHINGLES ❑OTHER ICC-IS KF RT. DESCRIPITON OF WORK' _alpp nQedw _ Al 1r , ! ! . I 1 /1 i*F I •rat ` V1 1 . A By my signature below,I unify 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 1 have pmvided is correct. 1 have read the Description of Work and verify it is accurate. 1 agree to comply With all applicable local ordinances and slam laws relating to building cons 'on. Itroria move of Clrpenirw m enter the Rbove-iden'tied p rry for inspection purposes, Signature of Applieanl/Agenl' Date: SUPPLEMENTAL INFORMATION RE D OFFICE USE ONLY _ If building is associated with a Home Owner's Association,provide letter ' • PIANCHP.CRTYPEROUTING SIJP of approval!mm HOA. ❑-ov®-THE-COU iTeR ❑ BUILDING PLAN REVIEW there Provide Planning approval to verify if my restrictions. 1 `""":''i" '''';'rt> • ❑ EKPRLSS: ❑ PLANNING PLV[REVIEW Provide copy of Manufacturer's Installation Specifications. 0-grANagp ElFTREDEFT Provide signed copy ol'Cupenino's Tear-Off Policy. ❑ OTHER: RerwfApp_2011.doc revised 03/16111