Loading...
10060132 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10962 NORTHSEAL SQ COP TRACTOR:FOUR SEASONS ROOFING PERMIT NO: 10060132 OWNER'S NAME: DAVID BISTRY PO BOX 1668 DATE ISSUED:06/22/2010 gER'S PHONE: 4082296000 SAN JOSE,CA 95109 PHONE NO:(408)278-0330 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB License Class Lic.# 4 -7> 1©lr MECH RESIDENTIAL COMMERCIAL Contractor Date l J' a---�� 1 hereby urm am licensed under the provisions of Chapter 9 JOU DESCRIPTION:RE-ROOF REMV EXISTING CEMWOOD ROOF.INSTALL (comm i it ion 7000)of Division 3 of the Business&Professions NEVA" GAF GRAND CANYON ASPHALT COMP 50 YR ROOF SYS, Code and that my license is in full force and effect. "STONEWOOD"IN COLOR CLASS A 14SQ 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. 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 permit is issued. Sq.:Tt Floor Area: Valuation:$3188 APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is APNf Number:31640030.00 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 180 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 G- y l p Isst ed by: Date: LJ 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 1 oofs 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, insv Iled without first obtaining an inspection,I agree to remove all new materials for will do the work,and the stricture is not intended or offered for sale(Sec.7044, inspxtion. Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to Sigr afire of Ap nt_ Date: construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three ALL R IRINGS TO BE CLASS"A"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 Cal forma Health&Safety Code,Sections 25505,25533,and 25534. I will maintain I have and will maintain Worker's Compensation Insurance,as provided for by con pliance 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 Safr!ty 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 con: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 maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Compensation laws of California. If,after making this certificate of exemption,I HeP Ith&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 agent;-7::> f J Date: APPLICANT CERTIFICATION ����rfbrmance 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 he eby affirm that there is a constructof 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 Len der's Name rmify and keep harmless the City of Cupertino against liabilities,judgments, ,and expenses which may accrue against said City in consequence of the Ler der'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 un derstand my plans shall be used as public records. Signature Date Lic.-nsed Professional CITY OF CUFERTINO 3 ITEMS OF 18 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 31640C30 . 00 DATE ISSUED. . . . . . . : 06/22/2010 RECEIPT #. . . . . . . . . BSOOOC10685 REFERENCE ID # . . . : 10060132 SITE ADDRESS 10962 NORTHSEAL SQ SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER DAVID BISTRY ADDRESS 10962 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 BO:" 1668 CITY/STATE/ZIP . . . : SAN JOSE, CA 95109 TELEPHONE . . . . . . . . : (408) :?78-0330 FEE ID UNIT QUANTITY AMOUNT 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 L83 . 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 (� ■ r CITY OF CUP:ERTINO REROGF C U P E RT I N O PERMIT APPLICATION AP h # Date: Building Address: ' Owner's Name: + Phone #: provide letter from HOA HOA: Yes No ❑ If yes, p Contractor: ;P5—o� Phone #: 619*t Fax -2 rCupertino Business License #: Contractor License #: 2 i_3�2 -3 Type of Roof C)vering: ii Existing: Proposed: ii Built-Up Roof ❑ Built-Up roof :DAsphalt Shingles Asphalt Shingles D Wood Shakes ❑ Wood Shakes Wood Shingles ❑ Wood Shingles AoOther (Specify) ��/ k–'���5 Other (Specify) umber of existing coverings ❑ Provide I.C.C.E.S. Report # :1 To be Removed ❑ Provide Mfgr. Installation Specs. Job Description: Aoma 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: I Have Read, Understand and Will Comply with Cup(rtino's Tear-Off Policy: Signature Revised 02/05/09