12050165 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20082 NORTHCREST SQ CONTRACTOR:FOUR SEASONS ROOFING PERMIT NO: 12050165
OWNER'S NAME: TANNERT HANS K AND HILDE TRUSTEE PO BOX 1668 DATE ISSUED:05/22/2012
OWNER'S PIIONE: 4082552227 SAN JOSE,CA 95109 PRONE NO:(+08)278-0330
mr— LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
License Class C- 11 Lic.4 !419.108 r r r
�1 MECH RESIDENTIAL COMMERCIAL
Contractor ES Date S�22. 12
1 hereby affirm that I 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 30p FELT UNDERLAYMENT AND INSTALL
Code and that my license is in full force and effect. GAF GRAND CANYON Sl TINGLES,COLOR:STONEWOOD CLASS
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.FI Floor Area: Valuation:$6500
permit is issued.
APPLICANT CERTIFICATION APN Number:31637013.00 Occupancy Type:
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 stale 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,
casts,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 Code,Section
9.18. oe
.{_
Signature ate s• 't.2-12- Issued by: r�~A�✓ y�TGrI Date:
❑ O{VNF. - I.DER DECLARATION
RE-ROOFS:
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 materials 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(Sec.7044,
Business&Professions Code) Signature of Applicant: Date:. S'T? • 12,
1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). ALL ROOF COV' TO BE CLASS"A"OR BETTER
I hereby affirm under penally of perjury one of the following three
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 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 Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Ileallh&
Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(x)should I store or handle hazardous material.
permit is issued. Additionally,should 1 use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District 1 will
I cenify that in the performance of rhe 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&Safety Code,Sections 25505,25533,and 25534.
Compensation laws of Cali forma. If,after making this certificate of exemption,1
become subject to the Worker's Compensation provisions of the Labor Code,I must Owner � i glllfF S�Z Z 12
forthwith comply with such provisions or this permit shall be deemed revoked. Date:
APPLICANT CERTIFICATION -;:�Ca STRUMON LENDING AGF.N'CV
I certify that I have read this application and stale that the above information is I hereby affirm that there is a construction lending agency for the Performance of%wrk's
correct.I agree to comply with all city and county ordinances and state 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
with all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION
9.18. I understand my plans shall be used as public records.
Signature Dale Licensed Professional
CITY OF CUPERTINO
3 ITEMS OF 12 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 31637013 . 00
DATE ISSUED. . . . . . . : 05/22/2012
RECEIPT #. . . . . . . . . : BS000016876
REFERENCE ID # . . . : 12050165
SITE ADDRESS . . . . . : 20082 NORTHCREST SQ
SUBDIVISION . . . . . . . -
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . ... . . . .
OWNER TANNERT HANS K AND HILDE TRUST
ADDRESS . . . . . . . . . . :'20082 NORTHCREST SQ
CITY/STATE/ZIP . . . ! CUPERTINO, CA 95014
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 14 .00 196. 00 0. 00 196 .00 0.00
---------- ---------- ---------- ----------
TOTAL PERMIT 197. 65 0.00 197 .65 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 790.60 AMEX
---------------
TOTAL RECEIPT 790.60
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: 20082 Northcrest Sq DATE: 05/22/2012 REVIEWED BY: Sean
APN: BP#: 'VALUATION: $6,500
FPERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Duplex PENTAMATION 1SFDWLR00F
USE: PERMIT TYPE:
WORK Tear off existing cal-shake roofing system, install 30#felt underla ment and install GAF Grand Canyon
SCOPE shingles, color: Stonewood.
FEEID ROOFAREA
s.f.
1REROOFFRES 1,400
,Ur,:Ir. l7nn('hrr k
Plumb. Plan Check Flee. Plan Check
blech. /:anlil Foe: Plumb. Penni/Fee: !alar,; Pennir l4•a:
Otho .1lerh. Imp. Other Plumb Insp. Li I Other Llet% Insp.
,11,7(h.Imp. Fac: Plumb. hvp. Fee: lift(-.Insp. Arc:
NOTE: This estimate does not include fees due to other Departments(i.e. Planning,Public Works, Fire,Sanitary Sewer District,School
District,eta). These fees are based on the prelimina information available and are onlp an estimate Contact the De r or addn 7 info.
FEE ITEMS (Fee Resohllion 11-053 E2' 7/1/111 FEE QTY/FEE MISC ITEMS
Plan Check Fee:
.Stipp/. PC Fire
Plurnh./rf-lech./li let
Permit Fee: $196.00
Suppl. htsp Fee
P11nnh.41,1ech./Elcc
I'htmh./rldcch./li7eu Parmit Fee:
Con.s'triw ion Tax.
ilcbnmist arive Fee:
Work Without Permit? 0 Yes (E) No $0.00
.Idcrnrced phuming Fees:
Trcn'rl Doclrmertlalion Fees:
Shone Motion Fee: IBSEISMICR $0.65 Select an Administrative Item
131da Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $197.65 $0.00 TOTAL FEE: $197:65
Revised: 04/01/2012
i REROOF PERMIT APPLICATION
COtml M J I;I I y DEVELOPMENT DEPARTMENT - BU I WING D[ViSio I.,
1C500TORRE AVENUE -CUPERTINO. CA 9-3014.3255
C UPERTIN C, 1 (408)777-3228 - FAX (408)777-3335-buildirIg @DrLlr)er6 io ow
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