12060025 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10959 NORTHSHORE SQ CONTRACTOR:FOUR SEASONS ROOFING PERMIT NO: 12060025
OWNER'S NAME: SI IF'F rY VASANTHA AND PREMLATA PO BOX 1668 DATE ISSUED:06/05/2012
OWNER'S PIIONE: 4082863599 SAN JOSE,CA 95109 PHONE lNO:(408)278-0330
gr LICENSED CONT'RACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB I—
LicenseClass C^39 Lic.q 4-70L (Gk
n 6 --r �� MECH r RESIDENTIAL r COCOMMERCIALr
�±
Contractor r S 1_ Dale,
hereby affirm that l am licensed under the provisions of Chapter9 JOB DESCRIPTION: RE-ROOF'I'EAR OFF EXISTING CAL-SIIARE ROOFING
(commencing with Section 7000)of Division 3 of the Business&Professions SYSTEM.INSTALL 30R FELT I1NDERLAYMFNT AND INSTAL t. .I r✓v.,.
Code and that my license is in full force and effect. GAF GRAND CANYON SHINGLES.COLOR:STONEWOOD CLASS A I9 Y'
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 wwork for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 orthe Labor Code.for the performance of the work for which this Sq.Ft Floor Area: \'aluntion:$6500
permit is issued.
APPLICANT CERTIFICATION APN Number:31638026.00 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 building construction,and herebyauthorize representatives of this city to enter
upon the above mentioned properly fix inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED
indcmndyand keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may accrue against said City in consequence of the
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
Issued by: l Li// �/1
9.18. /Gi7�� 7-G/l Date:
Signature t�l Date �_S._
�L
❑ OWNER-BUILDER DECLARATION
RF.-ROOFS:
hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior m any rooting material being installed If a roof is
the fallowing two reasons: installed without first obtaining rut inspection.I agree to remote all new materials for
1,as owner of the property,or my employees with wages as their sole compensation, inspcct1011.
will do the work,mid the structure is not intended or offered for sale(Sec.7044,
rIBusiness&Professions Code) Signature of Applicant: Dale: —y-
1,
,as uwner of the properly',ani exclusively contracting with licensed contractors to
construct the project(See 7044,Business&Professions Code)- ALL ROOF COVERI, " O BE CLASS"A"OR BETTER
1 hereby affirm under penaly of perjury one of the following three
declarations: IIA%ARDOUS MATERIALS DISCLOSURE
have and will maintain a Certificate of Consent to self-insure for Worker's
Compensation,as provided fix 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 Ibr which this permit is issued. California lleallh&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 Health&
Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should 1 store or handle hazardous material.
Additionally,.should 1 use equipment or devices which emit hazardous air
permit is issued. conlaminanls as defined by the Bay Area Air Quality Management District I 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 Incas of California, If,after making this certificate of exemption.I
become subject to the Worker's Compensation provisions of the Labor Code,I must Owe ppnl:
forthwith comply with such provisions or this permit shall be deemed revoked. ner int . Date;�'S �2..
C.ONSI'RIICTION LENDING AGF.NCV
A PPLICANI'CERTIFICATION
I certify that I have read(his application and state that the above information is 1 hereby affirm that there is a construction lendin_agency for the performance of work's
correct f 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 properly 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 accrue against said City in consequence of the
granting orchis permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code.Section .\RCIIITF.C7"S DECLARATION
9.18. 1 understand my'plans shall he used as public records.
Signature Date Licensed Professional
CITY OF CUPERTINO
3 ITEMS OF 18 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 31638026 .00
DATE ISSUED. . . . . . . : 06/05/2012
RECEIPT # . . . . : . . . . BS000017000
REFERENCE. ID # . . . : 12060025
SITE ADDRESS . . . . . : 10959 NORTHSHORE SQ
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : SHETTY VASANTHA AND PREMLATA
ADDRESS . . . . . . . . . . : 10959 NORTHSHORE SQ
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : AL DIAZ
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
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: 10959 Northshore Sq DATE: 06/05/2012 TREVIEWED BY: Sean
APN: BP#: 'VALUATION: $6,500
*PERMITTYPE: 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.
FEE ID ROOF AREA
s.f.
1REROOFFRES 1,400
e - -
:lldrh. flan Ch, k Plumb. Pian C'hcek
a6•elr_ I'rrwir Fee: Plumb. Permi!Pee: Ehw It•rruir Fre:
Odrer.Ve,h. Imp. Other Plumb Insp. Ocher Ehv. leap.
,I kch. Imp. Rx: Plumb, hup. I've: !filer.Imp. I",%.:
NOTE: This estimate does not include fees due to other Departments(ie. Planning,Public Works, Fire,Sanitary Sewer District,School
District.etc. . Thesefees are based on the prefinzina information available and are only an estimate Contact fire De t or addn'I info.
FEE ITEMS(Fcc Resohuion 11-053 EB' 711111) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Suppl. PC 1•'cw
I'lrnnh.,'cllech.;lac•c
Permit Fee: $196.00
Supp/. hisp Fee
/'hunh.i alech.:/i lcc
l'llanh./d lech.%Elee Perwi!Fee:
C onslruciion Tics:
11clwini.silyinve Pec:
Work Without Permit? O Yes Q No $0.00
ildvom ed Phuming Pees:
Trural DOCnl MI(Ililn'l /Maes: A
Strong Motion Fee: IBSEISMICR $0.65 Select an Administrative Item
Rlde Sids Commission Fee: IBCBSC $1.00
SUBTOTALS:
$197.651 $0.001 TOTAL FEE: $197.65
Revised: 05/01/2012
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RE-ROOF PERMIT APPLICATION
'=0'-!f:1UPtff Y DEVELOPMENT DEPARTMENT. • 5UILI )
^. JING DI`.i510N
Ii✓''" 10300 TORRLAVENUE -CUPERTINO, CA 9-01 1-3255
CUPERTINC 11 (408)777-3220_• FAX(40D)777-3333 • buildinnGairerlinu.orn
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