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11040117 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10904 NORTHVIEW SQ CONTRACTOR:FOUR SEASONS ROOFING PERMIT NO: 11040117 OWNER'S NAME: VACCARO GEORGE V PO BOX 1668 DATE ISSUED:04/18/2011 01"'IER'S PHONE: 4084465060 SAN JOSE,CA 95109 PHONE NO:(408)278-0330 ❑ ICEN CO CTOR'S DECLARATION r 4 01O BUILDING PERMIT INFO: BLDG ELECT PLUMB License Cl s i .# MECH F_ RESIDENTIAL COMMERCIAL Contractorate ;� I hereby a arm that I am license er the provisions of Chapter 9 JOB DESCRIPTION:RE-ROOF REMOVE EXISTING CEMWOOD ROOF& (commencing with Section 7000)of Division 3 of the Business&Professions INSTALL NEW 30#UNDERLAYMENT&GAF GRAND CANYON ASPHALT Code and that my license is in full force and effect. SHINGLES.COLOR:STONEWOOD,HAS EXISTING PLYWOOD 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. 1 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.Ft Floor Area: Valuation:$4400 APPLICANT CERTIFICATION I certify that I have read this application and state that the above in rmation is APN Number:31636058.00 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 prope spection purposes. (We)agree to save indemnify and keep harmless the ity o Cupertino against liabilities,judgments, PERMIT EXPIRES IF WORK IS NOT STARTED costs,and expenses ich may crue a ainst said City in consequence of the granting of this pe it. Additio lly,t e applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non-points a regulat s er the Cupertino Municipa Code,S ction 180 DAYS FROM LAST CALLED INSPECTION. 9.18. Date:Si nature Date Issued b OWNER-BUILDER G A- t` DECLARATION I hereby affirm that I 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 1,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 Appli Date: construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three OOF COV INGS TO "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. 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&Safety Code,Sections 25505,25533,and 25534. I 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 Health& Safety Code,Section 25532(a)should I store or handle hazardous material. permit is issued. Addition should I equipment or devices which emit hazardous air I certify that in the performance of the work for which this permit is issued,I shall contami a s as deft ed b the Bay Area Air Quality Management District I will not employ any person in any manner so as to become subject to the Worker's main'tai mplianc with he Cupertino Municipal Code,Jhapter 9.12 and the Compensation laws of California. If,after making this certificate of exemption,I Health Safety Cod S tions 25505,25533,an 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. wne r authori agent: 'Vt/ ate: APPLICANT CERTIFICATION CONSTRUCTION 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 affirm 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, C, and expenses which may accrue against said City in consequence of the Lender's Address L ig of this permit.Additionally,the applicant understands and will comply witti 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 Date Licensed Professional CITY OF CUPERTINO 3 ITEMS OF 12 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 31636058. 00 DATE ISSUED. . . . . . . : 04/18/2011 RECEIPT #. . . . . . . . . BS000013210 REFERENCE ID # 11040117 SITE ADDRESS . . . . . : 10904 NORTHVIEW SQ SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . OWNER . . . . . . . . . . . . : VACCARO GEORGE V ADDRESS . . . . . . . . . . : 10904 NORTHVIEW 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 4,400 .00 1. 00 0. 00 1. 00 0.00 1BSEISMICR VALUATION 4,400.00 0.50 0.00 0.50 0.00 1REROOFRES SQ FEET 14 .00 182. 00 0.00 182 . 00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 183 .50 0.00 183 .50 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 734 . 00 #010749 --------------- TOTAL RECEIPT 734 . 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 0// 7 y REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 GUPERTIN0 (408)777-3228 • FAX (408)777-3333 • building(cDcupertino.org PROJECT.ADDRESS / l 10!2O .,?,q-4uJCQ 5&— APN# / r �n �✓> OWNER NAME PHON7 s / `i E-MAIL P p V. V. c� STREET.ADDRESS CITY, STATE,ZIP FAX APPLICANT NAME \ CA�af r0/,/,�` 3� �3 TE MAIL STREET.ADDRESS rD L `�(�i j` CITY,STATE, /C� U��. C+�^ l� FA .� z? ❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME (�� 2�e C LICENSE NUMBER 7 ` D LICENSE TYPE BUS.LIC # COMPANY NAMEr Sem. E-MAIL C� Pp` �5`? -7 Q-0� STREET ADDRESS p 1[ CIT ,STATE ZIP P O / O S6 Z arrLin 'ST. C� `l aS�-27�-o3�cs ARC HITECT;ENGINEER NAME LICENSE NUMBER BUS.LIC # CO.MP.ANY NAME E-MAIL, FAX STREET ADDRESS CITY,STATE,ZIP PHONE LSE OF ❑ SFD or Duplex Multi-Family ROOF AREA: VALUATION: Ell STRUCTURECommercial / GlJ EXISTING ROOF TYPE ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES RlfflfU R(SPECIFY) RENIOVE'REPLACE ,Io.Yi s IF NO, PLYWOOD ❑ /," ❑ PLYWD 1-1OSB !PITCH: (((•��^^CC ROOF El NO #LAYERS THICKNESS El 5/8', TYPE: C1CDX 12 CLASS A PROPOSED ROOF TYPE ❑BUILT-UT ROOF ;?<S�PHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT# DESCRIPTION OF WORK. (� n '►.,: 1-�S � (off� `- �vn.e t��cx� -- � axil � ! �.!� By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is correct. I 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 b ding nstruction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicanr/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED 'Mo>fflceus'ow e, .�. If building is associated with a Home Owner's Association,provide letter s -PLANOHECICTYPERouTiNGSLIPe of approval from HOA. ❑ OVERTHE•COUNTX'W' ❑ BUILDING PLAN REVIEW Provide Planning approval t0 Verify if there any restrictions. ❑ EXPRESS ❑ PLANNING PLAN RE VIEW Provide copy of Manufacturer's Installation Specifications. ❑ STANDARD ❑,'FIRE'DEPT _ Provide signed copy of Cupertino's Tear-Off Policy. ❑ OTHER' ReroofApp_2011.doc revised 03102/11