12040017 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10994 NORTHSEAL SQ CONTRACTOR:FOUR SEASONS ROOFING PERMIT NO: 12040017
OWNER'SNAME: LAUWILIAAMWANDLEECHARMAINECM PO BOX 1668 DATE ISSUED:04103/2012
OWNER'S PHONE: SAN JOSE,CA 95109 PHONE NO:(408)278-0330
ia;�* LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
License Class C- 3 1 Lic.9 (41S td Q• MEC, r RESIDENTIAL r COMMERCIAL r
Contractor 1 O eoJ, C Date
1 hereby affirm that 1 am licensed under Ih rovisions of Chapter 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
I 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 the work for which this
permit is issued. Sq.F1 Floor Area: Valualion:$6500
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is APN Number:31640037.00 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.
918-
11—S � �Signature y
❑ OWNER-BUILDER DECLARATION
1 hereby affirm that 1 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 being 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 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)
I,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applic m Date 7
construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three ALL ROOF COVER STO BE CLASS"A"OR BETTER
declarations:
I have and will maintain a Ccrtificale 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 Health&Safely 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 Ilealth&
Safety Code,Section 25532(a)should I store or handle hazardous material.
permit is issued- Additionally,should I use equipment or devices which emit hazardous air
1 certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Qualitv 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 Cade,Chapter 9.12 and the
Compensation laws of Cali forma. IL tiller 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 s ri 41:
Date:
APPLICANT CERTIFICATIONCONSTRUCTION LENDING AGENCY
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 laws relating I hereby affi at 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 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 . . . . . . . . : 31640037. 00
DATE ISSUED. . . . . . . : 04/03/2012
RECEIPT #.. . . . . . . . . : BS000016446
REFERENCE ID # . . . : 12040017
SITE ADDRESS . . . . . : 10994 NORTHSEAL SQ
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT- AREA . . . . .
OWNER LAU WILLIAM W AND LEE CHARMAIN
ADDRESS . . . . . . . . . . : 709 SOMERSET LN
CITY/STATE/ZIP . . : FOSTER CITY, CA 94404
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
CITY OF CUPERTINO ` U
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 109 Northseal Sq. DATE: 04/03/2012 REVIEWED BY: jsg
APN: tC?j BP#: VALUATION: $6,500
=PERMIT TYPE: Minor Building Permit I PLAN CHECK TYPE: Re-roof
PRIMARY Multi-Family Dwelling Buildina is • PENTAMATION 1 OOF
USE: 0 3 Stories Yes No PERMIT TYPE:
WORK Remove shake replace with asphalt same color
SCOPE
FEE ID ROOFAREA
s.f.
1REROOFMRES " 1,200
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,Ilrrii. G:•u. l':'e: l8undr. Ga•,;. Frc /`hr. !n sp. l5'r:
NOTE: This estimate does not include fees due to other Departments(ie Planning,Public Works, Fire,Sanitary Sewer District,School
District, etc). These fees are based on the prelimina information available and are only an estimate Contact the Det for addn'l info.
FEE ITEMS (Fee Resolution 11-053 ER' 7/1.11) FEE QTY/FEE MISC ITEMS
l'hrn, C7rrrk Frc:
S7.r;opL VC hve
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Permit Fee: $168.00
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Work Without Permit? 0 Yes Q No $0.00
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7S-,meal l)ocnrnrrdcrliarr lu<•.;:
I
Strong Motion Fee: 1BSE1SX9CR $0.65 Select an Administrative Item
Bldg Stds Commission Fee: 18CBSC $1.00
SUBTOTALS: $169.651 $0.001 TOTAL FEE: $169.65
Revised: 1/19/2012
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REROOF PERMIT APPLICATION m
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION V V
10300 TORRE AVENUE•COPE RTI NO,CA 95014-3255
(408)777-3228.• FAX(408)777-3333•buildinO(a)cuoertino.oTO
CUPERTINO
PROJECT ADDRESS 1,02161 Ale rea I APN0 3 1�
OWNER NAME P
l••C, . /. E-MAILEf ADDR
STRLESS � CnY A �/ 1
La. 111,
"I FAx
CONTACT NAME 1 maa ZA�e.S PHONE E-MAIL
T .pZ:gnl
SIAECF ADDRISS CITY,STATE,ZIP FAX
o SOS s Cw. S
❑ UN'NEN ❑ Ow'N04 BUU.DER ❑ O%WERAGENT- V CONTRACTOR ❑CONTBACIMR AOFNr ❑ ARCHU ECT ❑ENGINEER ❑ DEVELOPER ❑ ILIA\T
CONTRACTOR N.A.ME LICENSE NUMBER LICENSETYPE 'BUS.LIC. ^
COMPANY NAME E-MAB. FAx13 R s
SIRELTADDRESS CITY,STA ZIP PHONE
O
ARCFITTECT,ENGRIEFIt NAME LICENSENUMBER BUS LIC.6
CO.MPANV SAME E-MAIL FAx
STREET ADDRESS Cf1Y,STATE,ZIP PI IoNE
USE OF ❑ SFD or Duplex Multi-Family ROOF AREA: VALUATION'. J@��
STRU'CTURE'. El Commercial 5 '1 4 cl
FX1S'UNGR(x)FTYPE 11 BUILT-UP ROOF ❑ASPHALT SHINGLES'❑WOODSIWCFS ❑WOOD SHINGLES /10nILR(SPF.CIh'Y) AL S).}p
REMOVEIREPLACE IDYFS IF NO. PLYWOOD �K" ❑ PLYWD Lipsu PITCH: I RWF
❑" a CI - tiJ-4—:12 A
PROPOSEDROOFTYPE: ❑DUILT-UPROOF �ASPHALTsinNGLEs ❑w00D SHAKES ❑wooD smai-Es ❑OnffR ICC-ESREPORTP
DESCRIPTION OF WORK:
_ n w _
#k S G
1 I I
HNmy signature below,I certify to each of the following: 1 earl the property owner or authorized agent to act on the propeny owner's behalf. I have read this
application and the information 1 have provided is correct. 1 have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building cons 'on. thoria res(N tatives of Cupertino to enter the abovo-identified pr rty for inspection purposes.
Signature of Applicant/Agent:' Dom:
SUPPLEMENTAL INFORMATION REQAfiD OPFICEUSE ONLY
If building is associated with a Home OWTters Association,provide letter p-v+CHFXKTYP ROUTING SUP
of approval from HOA.
❑ OVER-THECOUNTER ❑ BUILDING PLAN REVIEW
Provide Plmning approval to verify if there any restrictions. I "i �" :0 1
EXPRESS, O PIANNING PIAN REVIEW
Provide copy of Manufacturer's Installation Specificalions. �•
isTANp .. ;, _ EltT�DEPT
.
Provide signed copy of Cupertino's Tear-Off Policy. _ ❑ OTvse
Rerog6App_20ll.doc revised 03/16111