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10060134 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10944 NORTHSEAL SQ CON'CRACTOR:FOUR SEASONS ROOFING PERMIT NO: 10060134 OWNER'S NAME: SRINIVAS NITHYANANDAM&D SUBRAMIANIA PO BDX 1668 DATE ISSUED:06/22/2010 1ER'S PHONE: 4082296000 SAN LOSE,CA 95109 PHONE NO:(408)278-0330 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT r- PLUMB License Class Li � MECH I- RESIDENTIAL� COMMERCIAL Contractor Date I hereby a a GAF licensed under the provisions of Chapter 9 JOB DESCRIPTION: RE-ROOF RMV EXTNG CEMWOOD ROOF.INSTALL NEW (commen rn Section 7000)of Division 3 of the Business&Professions G GRAND CANYON ASPHALT COMP SOYR ROOF SYSTEM Code and m license in force and effect. "STO 1EWOOD"IN COLOR CLASS A 14SQ 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 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:$3188 permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is APN Number:31640027.00 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 the City of Cupertino against liabilities,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 18O 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 Issu-d bv: -- Date: V Q OWNER-BUILDER DECLARATION — I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS: the following two reasons: All r)ofs 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(Sec.7044, inspcction. Business&Professions Code) Date: I,as owner of the property,am exclusively contracting with licensed contractors to Sign rture of Appli construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS T ..BE CLASS"A"OR BETTER 1 hereby affirm under penalty of perjury one of the following three C 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 I ha✓e read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. 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 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 I certify that in the performance of the work for which this permit is issued,I shall cont aminants as defined by 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 mai rtain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Compensation laws 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 permit shall be deemed revoked. Owner or thorized agent: 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 hei eby 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,vhich this permit is issued(Sec.3097,Civ C.) upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name inify and keep harmless the City of Cupertino against liabilities,judgments, 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. I unierstand my plans shall be used as public records. Signature Date Lia!nsed Professional CITY OF CUFERTINO 3 ITEMS OF 18 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 31640( 27 . 00 DATE ISSUED. . . . . . . : 06/22/ 2010 RECEIPT #. . . . . . . . . : BS000( 10685 REFERENCE ID # . . . : 10060134 SITE ADDRESS . . . . . : 10944 NORTHSEAL SQ SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPER"INO IMPACT AREA . . . . . . OWNER SRINIITAS NITHYANANDAM&D SUBRAM ADDRESS 10944 NORTHSEAL SQ CITY/STATE/ZIP . . . : CUPER"INO, CA 95014 RECEIVED FROM . . . . : FOUR :SEASONS ROOFIN CONTRACTOR DIAZ, ALFRED LIC # 21323 COMPANY FOUR :SEASONS ROOFING ADDRESS PO BOH 1668 CITY/STATE/ZIP . . . : SAN JOSE, CA 95109 TELEPHONE (408) :278-0330 FEE ID UNIT QUANTITY AMO'JNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---- ------ ---------- ---------- ------- 1BCBSC VALUATION 3, 188 . 00 1 . 00 0 .00 1 . 00 0 . 00 1BSEISMICR VALUATION 3, 188. 00 0 .50 0 . 00 0 . 50 0 .00 1REROOFRES SQ FEET 14 . 00 L82 . 00 0 . 00 182 . 00 0 . 00 ---- ------ ---------- ---------- ---------- TOTAL PERMIT 183 .50 0 .00 183 . 50 0 . 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF CITY OF ` CD t � ( j I Z)q CITY OF CUP ERTINO l V V � REROCIF C U P E RT I N O PERMIT APPLICATION ,gyp'.N T Date: / Building Address: O\rner's Name: , ` Phone #: �l',�,�f� S � fG. Lcvl .CiiPY1 )!5_-5— )L to HOA Yes (� No ❑ If yes, provide letter frc m HOA Phone #: C -® 3 3 `� Contractor: X7o oaf y Fax -;2 79- Cupertino Business License #: Contractor License #: Type of Roof Covering: Existing: Proposed: Built-Up Roof ❑ Built-Up roof Asphalt Shingles k Asphalt Shingles Wood Shakes ❑ Wood Shakes � Wood Shingles p/ - o Wood Shingles Other (Specify), �2r��oa�J�G� o Other (Specify) j 'umber of existing coverings ❑ Provide I.C.C.E.S. Report# To be Removed o Provide Mfgr. Installation Specs. tub Description: Residential Commercial Green Building: Please complete relevant portion (f the Confirmed with-Planning Dept. if Green Building Checklist & attach it to the application or if there are any restrictions: ❑ applicable, include in plan set & the sheet index. Valuation: 1 Have Read, Understand and Will Comply with Cupt rtino's Tear-Off Policy: Signature Revised 02/05/09