12040089 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10801 NORTHOAK SQ CONTRACTOR:FOUR SEASONS ROOFING PERMIT NO: 12040089
OWNER'S NAIVE: BIANCHI CRAIG H TRUSTEE PO BOX 1669 DATE ISSUED:04/17/2012
OWNER'S PHONE: 6509641899 SAN JOSE,CA 95109 PHONE NO:(408)278-0330
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
License ClassC_3S Lich I /,)-lQ� r r r
MECH RESIDENTIAL COMMERCIAL
Contractor�S/L— Date 0
1 hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION:RE-ROOF TEAR OFF EXISTING CAL SHAKE ROOFING
(commencing with Section 7000)of Division 3 of the Business&Professions SYSTEM,INSTALL COMP SHINGLES COLOR AND TYPE TO
Code and that my license is in full force and effect. MATCH EXISTING CLASS A 13SQF'T
I 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 Sq.Ft Floor Area: Valuation:$6500
permit is Issued.
APPLICANT CERTIFICATION APN Number:31641026.00 Occupancy Type:
I certify that I have read this application and slate that the above information is
cored.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 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
granting of this permit Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulations per the Cupertino Municipal Cod ,Section
9.18.
SignatureG�� Date Issued by: Date:
l � L�/�1�1/
❑ OWNER-BUILDER DECLARATION
RF.-ROOFS:
1 hereby affirm That I 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,mat rials for
1,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(See7044,
Business&Professions Code) Signature of ApplicutL
1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044.Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1 hereby affirm under penalty of perjury one of the following three
declarations: HAZARDOUS MATERIALS DISCLOSURE
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 I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California Ilealth&Safely Code.Sections 25505,25533,and 25533. 1 will maintain
I have and will maintain Worker's 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 I store or handle hazardous material.
permit is issued. Additionally,should I use equipment or devices which emit hazardous air
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 Health&Safely Code,Sections 25505,25533,and 25534.
Compensation laws of Cal ifamia. If,after making this certificate of exemption,I
become subject to the Worker's Compensation provisions of the Labor Code,1 must Owner or aulhorize�aaaf.:,
forthwith comply with such provisions or this permit shall be deemed revoked. Gf/ "� l_ Date:
APPLICANT CERTIFICATION CONSTRUCTION LF.NDINC AGENCY
I certify that 1 have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's
correct.I agree to comply with all city and county ordinances and slate 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 liabilities,judgments, Lender's Address
costs,and expenses which may acerae 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 Dale Licensed Professional
CITY OF CUPERTINO
3 ITEMS OF 15 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 31641026. 00
DATE ISSUED. . . . . . . : 04/17/2012
RECEIPT #. . . . . . . . . : BS000016556
REFERENCE ID #. . . . : 12040089
SITE ADDRESS . . . . . : 10801 NORTHOAK SQ
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : BIANCHI CRAIG H TRUSTEE
ADDRESS . . . . . . . . . . : 5953 ARTHUR DR
CITY/STATE/ZIP . . . : PLEASANTON, CA 94588
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 13 .00 182. 00 0.00 182 . 00 0. 00
TOTAL PERMIT 183 .65 0 .00 183 .65 0 .00
VOICE IDDESCRIPTION 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: 10801 northoak square DATE: 04/16/2012 REVIEWED BY: bobs.
APN: BPk: 'VALUATION: $6,500
`PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition
PRIMARY SFD or Duplex PENTAMATION 1SFDWLR00F
USE: PERM IT TY PE:
WORK tear-off existing cal-shake roofing sysytem, install comp shingles Color and type to match exisitin .
SCOPE
,lh�:lr. !'!nn Cherk Plrmrh.Plow C'hcok Elec. Plan Chelk
Slerh. A n h Far: Plumh.Permit Fre: Elec I'ervnir Fr.-:
Ohhcr 11rch. In y. Other Plumb Ingr. Li I Oita)/lee.My,
,Ih:rh. Imp- Fcr: Plmuh. htrp.Fee: liter. bup.
NOTE: This estimate floes not include fees due to other Departments(i.e. Planning, Public IVorks, Fire,Sanitary Sewer District,School
District,eta). Thesefees are based on file prefimina information available and are onl'an estimate Contact the Dept for addn 7 info.
FEE ITEMS (hee Resolution I1-053 Efl. 711/11) FEE QTV/FEE MISC ITEMS
Plan Check Fee: $0.00 13 s.f. Re-roof
hSuPPI. PC Fee: Reg. OT0.0rs $0.00 $14.00 RER/OO
FRES
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee:Q Reg. 0 OT F0,0Thrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Canso uetion Tax.
Aelminisu'(Ilire Fee:
Work Without Permit? 0 Yes (E) No $0.00 E)
Advanced Plannine Fee: $0.00 Select a Non-Residential 0
Building or Structure
%'rrnad Uncuux•elarinn Fuel: Building �
Shone Motion Fee: IBSEISMICR $0.65 Select an Administrative Item
Bide Std Commission Fee: IBCBSC $1.00
SUBTOTALS: 1 $1.65 $14.00 TOTAL FEE: $15.65
Revised: 04/01/2012
240899602261 Q.'
NUMTHPC I NT,1 02
kk i �r
Ef
o olnt Homeown A ociation g
No 01
1�y of Cupertino t i ; � ..
; e y1 i 1I
T.
1 a'; JF 'll •' Mph I:�1N 1! ,�"1 ;, tvx •Ca7Fl�3�'
i n.vd ` jrl Vl&Qh !1 2012
,• AAA j .f •FF + .. i_
y, .e: lilorrhpoint ii+ g' J�Ct
,`,1
p; o City cf Cupertino 2,
a
1 I I k `�•
lease note that the rth int Homeonriers Associaa;iorl has vl
Iii
g ' ontracted and aPer ed ur-Season s Roofing to perform re-
)�. - � a^I 'I I I I I 11 '� '!, I ±-1 • , n :t !n', I r :
yp I`' oofing of our.homes Th will replace the current CAL- Shaky -
+ it I
oof5ystern month nevi
A rand Canyo Asphalt Compqsiiior
Li
hingles UVe haVe le the 1Stonew ��color for4our roofs t
11 pp i.Cl
S,noerely. TFeee[S
" 7 Linda Starnes
�a
On S to Manager r ' i II, L r
408-9Gn-3734'
14
i
52
Iia l.5• C ry [
h ISf
- a. '-
L3iREROOF PERMIT APPLICATION Z U L-1 U
�
COIJMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO, CA 950143255
C UPERTINCL (408)777-3228• FAX(408)777-3333•buildinn(alcuoerlino.oro
H MAIL
Ali 4ia�c(^r UNIT 9bY-/�8/f)9
- --- � -
CnT. s I S,IL,ZIi• SII I.\:; -----------
L MAIL
--------R.1_I'�rCdo \�.2=alCS �40�7 �.1 n-v3�ll _
I ___ - __._-1 G1_—a'I_:_Lt�l:]���—� Jr1 �0S�'��111• --_
.� V'8 fdn L:-ICUI:k ❑ UN%Lk AGINp
I ly CO\IXACIUN ❑('UrfIRACNM A(ilN'r ❑ ARCIIr:L("I ❑ LNGmik ❑ ❑Imi., iK ❑
Cu': nt't Ga:�A).:° n� o R LICF_NSE NUhtDER LI('FN]Gll•YI[ ... Lu-n 13
- - Fosr_r_s�:�n -3
P:.NAIL! 3
Clly
`v 2o S S u' 9 -L ,n
.:.Ftlillla i1daVF.F.R VANE LI[hYsl!NG\IRII( !11;5 1.I(' _
CrIY,s:,\'IL.LII'
�. ❑ 51'D
or DuplC.\ yam ;\lull)-Fwn II)' RIX)F ARIA'
13 so.
❑ %sru.\LTsuucfus ❑v:uuuslhAEls ❑N•Lwu SIIIR(iLlis uuu:k ur��,� =l•FA -�"
._.... .. :...:..te�;'raTl fru. rcru'aro ❑ v- ❑ FLANv ❑usu plrcu t1 Ralf
❑ f .I.\f rl<c _1tnrRnrvc Li sex.. 1)IT Q (1 \ss A _
11 19.. ❑uuu.l.IIP RWIArnsm', Tsm.Nuhs ❑N'O(A)SILAU, 01VDUD51111GLE5 ❑OIIIERA Fs RrJVAI=
r)!-HORS.
-- — ear-o
n _� 11__ O# cu'nt�<c,b�t�sc��_3�e�s11_ aAJ��r_w
Ln y�QS -..4-I o f J'T'O APL
PA
--_
�:_l uture lcluw,I Ca(n�w each ui ILc lullu'sing! I nIu the propuly owner or Ruuwlin'd'ngnu to uct un the pl ulh�nc o.u:erb l<hall. I lan c teac lil:\ —
i ,,I ion I F n C p uutk-•ri CO? ccl. I h1n a read We Ihsuipuun of\1'mA aIIJ\erily i1 a accw 1;; I��ee w..•nlph 'r a al pl i;::Dl
w nail:.ing\ Lot l thorwx ppr,sCnWti% of Cup Nino to cnWr the abuvcllcey fico pu j.L11 I"r 'I1vau yw lx';.
SUPPLEMENTAL INFORMATION RE ED OFFICE use u.vLI
\\itlt;: i!orltc ON,n:r's Aiso:i:vior.,pruN hle Idler PLA.9 CIIELX'n•PE RUO I1m;suP
'e OVER-THE{'OIINI'ER m;u.urvG 11LAN MEvu:\c
;)pfuv;l Iu r._ri )'71-1hurC an)'
❑ EXPRFSS ❑ I•I_\9.\I\C YL.\V R!:\'IGH
:uucr's Insu111ation SpC:iliew [is, SFARDARD ❑ FIke.DF:Pr
f•:�r.I.:c,:!da:J coo':of Cl:;'cninu's fear-Dli l'ulicr, ❑ 01111k: