12040022 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 11012 NORTHSEAL SQ CONTRACTOR:FOUR SEASONS ROOFING PERMIT NO: 12040022
OWNER'S NAME: POON KIN-MAN TRUSTEE PO BOX 1668 DATE ISSUED:04/032012
OWNER'S PHONE: 4088679896 SAN JOSE,CA 95109 PHONE NO:(408(278-0330
."i— LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
License Class C-39 Lic.N LOA cog r r r
y�
(a L-A-.3-12—
,,—\ q n MECH RESIDENTIAL COMMERCIAL
Contraclor Favrse.,ko,4 & ale -.3—I G..
hereby affirm that I am licensed under theovisions of Chapter 9 JOB DESCRIPTION: RHROOF,12 SQ,RHMOVH SIIAKf:,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.
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(his 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.FI Floor Area: Valualion:56500
APPLICANT CERTIFICATION
1 certify(hat I have read this application and state that the above information is APN Number:31640040.00 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(he City of Cupertino against I abilities,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 Date '_J L Issued by: __:5;FS9 Date: L�- 3•�a-
❑ OWNEA0 IILDER DECLARATION
I 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(Sce.7044, inspection.
Business&Professions Code) 7� Irl
1,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applignt Datc > L
construe(the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three ALI,ROOF COV- GS TO BE 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. 1 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. I will maintain
Section 3700 of Labor Code,for We performance of the work for which this compliance with the Cupertino Municipal Code,Chapter 9.12 and the Ilealth&
Safely 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 Ihm in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area,Air Quality Alanagemenl District 1 will
not employ any person in any manner so as to become subject to the Workers maintain compliance with the Cupertino Municipal Code.Chapter 9.12 and the
Compensation lases 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 peri(shall be deemed revoked. Own r agent: /�
Dale:
APPLICANT CERTIFICATION CONSTRII(TION LENDING AGE:N(N'
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 tr 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 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 Dale
Licensed Professional
CITY OF CUPERTINO
3 ITEMS OF 20 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . .. . . . . : 31640040.00
DATE ISSUED. . . . . . . : 04/03/2012
RECEIPT #. . . . . . . . . : BS000016446
REFERENCE ID # . . . : 12040022
SITE ADDRESS . . . . . : 11012 NORTHSEAL SQ
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . := CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : POON KIN-MAN TRUSTEE
ADDRESS . . . . . . . . . . : 20134 GLASGOW DR
CITY/STATE/ZIP . . . : SARATOGA, CA 95070
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 \�
FEE ESTIMATOR— BUILDING DIVISION
ADDRESS<44IMMorthseal Sq. DATE: 04/03/2012 REVIEWED BY: jsg
07APN: (p 1 BP#: 'VALUATION: $6,500
*PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARYMulti-Family Dwelling Buildina is PENTAMATION 1>4 OF
USE: 3 Stories O Yes ONO PERMIT TYPE:
WORK Remove shake replace with asphalt same color
SCOPE
FEE ID ROOF AREA
s.f.
1REROOFMRES " 1,200
P;,J,. 14:,n('h�,k Plwnh. Plan Chc<'d Hire_ f.
,1!rd,. A"wi( Fe". l7nmh. Prruii(F.'e: F:kr. !'eruair I r.
UrArr Alr,r:. IrnT Olinv'f7umh lnaq. ET
,Ilrri+. ln•.p, hlr- PLonh. b;,.p. l4•.r liter. /nr/,. hl r:
NOTE: This estimate does not include fees due to other Departments(Ge. Planning,Public Works, Fire,Sanitary Sewer District,School
District,etc). Thesefees are based on the prelhimina information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 E/T 711111) FEE QTY/FEE MISC ITEMS
!'!((rr Chad; /4cc
l'l�mb.l:ble'ch.ilflcc
Permit Fee: $168.00
;u(q,l. hr.';plee
P/umh.:':1-k,uh.iIile c
1'hrrnh.: hlrcb. rc Pcrnlil / cc.
T'n
,idinini.q wio, /''d(':
Work Without Permit? O Yes No $0.00
-I,Jvrm�0/P!almin,' 14 cs
/nrvul 0o(Itme(looms 1-CC's:
Strong Motion Fee: IBSEISMICR $0.65 Select an Administrative Item
Bldg.Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $169.65 $0.001 TOTAL FEE: $169.65
Revised: 1/19/2012
/ 1/22 04: 1 4089960226 i' i NOP.THPOINTI; 02/02
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o Dint Homeourn66 odatlon
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lease note that the rth Int Homeowners Assoc tiahon has 1
Ag
onVacted and approy.ed r Season's Roofing to perform re
n ,�t , oofisig of our homesz Th will replace the current CAL-Shake
� it "�` ii - stem with rand CanyorAsphalt Compositions
•:. I C: , I�f i i �•�� r I t �.:i ( ,iii � a4� '�
a.r huigles . We have . Alec : the Stonewto�'color forur roofs
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REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT.-BUILDING DIVISION �J�J
10300 TORRE AVENUE•CUPERTINO.CA 95014-3255
CUPERTINO (408)777-3228.• FAX(408)777-3333•buildincl cuoertino.oro \X
PROJL(TADURESS APN tl 2 1 ((/ �O 0"0
OWNER NAME PHONE 90-967-9`9941
-0 6 -31 (40
1 `0 E-MAIL
STREET ADDR V Cf7Y,y-rpTF,aP �
CONTACT NAME PHONE EMAIL
1; as 2ateS .p
SIREE'F ADDRILSS CrrY,STATE,ZIP o FAX
Sose Ca. 5
I ;
❑OWNER ❑ OWNER-BUILDER ❑ o"ERAGENf w CONTRACTOR ❑CONTRACDRAGENr ❑ ARCHREI.T ❑ENGNUR ❑ DEVELOPER ❑ M,1&17
CONIRACTOR.NAME - LICENSE NUMBER LICENSETYPE -� BUS.LIC.I 3 3
COMPANYN'AML EMAIL FAX
S I RI:ET ADDRLSS CrrY,STATE.ZIP PHONE
Z 5
ARCI IITECZENGINTER NAME I LICENSE NUMBER BUS.LIC M
COMPANY NAME E.MALL
FAx
STREET ADDRESS cnY,STATE,ZIP PHONE
USE OF ❑ SFD or.Duplex XMulli-Family ROOF AREA; ;�7vALUATON.
1
SIRUCIURE. ❑ Commercial $ S
EXISTING ROOF TYPE'. ❑BUILT-UPROOF ❑ASPRLL.TSNuNru FS ❑WOODSHARFS ❑WOODSRINGLES �OTHER(SPECIFY) AL SILJI
REMO%E(REPLACE(YES IF NO. PLYWOOD - _Q%- ❑ PLYWD ❑OSO PffCli. tl RWF SRA
❑ tl s U DV.
:12 ASS A
PROK)SED ROOF TYPE: ❑BUILT-UPROOF ArASPHALTS I INGLES ❑WOODStW(ES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORTtl
DESCRIPr1ON OF WORK:
n �
ins4,ii 3o# �eIk( 121%ft ..(AGwt # ins -ail GAF GTA, A co-A
Co 1
By my Signature below,I certily to each of the following: 1 am the property owner or authorized agent to act on the property owner's behalf. I have read this
appiwadon and the infomution 1 have provided Is correct. I have read the Description of Work and verify it is aecumw. 1 agree to comply with all applicable local
ordinances and stale laws relating to building co 'on. orimscistafives of Cupertino to enter the above-identifRd property for inspection purposes.
Signature of Applicant/Agent: per;
SUPPLEMENTAL INFORMATION REQ0KED OFFICE USE ONLY
If building is associated with a Ilome Owner's Association,provide letter PLAN CHUN TYPE ROUTING SLIP
of approval from HOA. "E
❑1 OVER-nT TuouNren ❑ Buamxc PLAN R%vlEw
_ Provide Planning approval to verify if there any restrictions. b - ' '- ❑ nwNNlnc PUN REVIEW
Provide copy of Manufacturers Installation Specifications. yT ', , ❑ nl>E DEN.
Provide signed copy of Cuperdno's Tear-OTT Policy. - ❑ OTHM.
Reroo6App_201 Ldoc revised 03/16.11