10060133 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10952 NORTHSEAL SQ CON'rRACTOR:FOUR SEASONS ROOFING PERMIT NO: 10060133
OWNER'S NAME: WHEI-MEI LIN PO BOX 1668 DATE ISSUED:06/22/2010
QER'S PHONE: 4082296000 SAN LOSE,CA 95109 PHONE NO:(408)278-0330
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
License Class 4K Lic. MECH RESIDENTIAL r r
COMMERCIAL
Contractor Date 1,
I hereby a a rcensed under the provisions of Chapter 9 JOB DESCRIPTION:RE-ROOF REMV EXISTING CEMWOOD ROOF.INSTALL
(comme r Section 7000)of Division 3 of the Business&Professions GAF 3RAND CANYON ASPHALT COMP SOYR ROOF SYSTEM,
NEW
Code and tha my rcense is in full force and effect. "STO VEWOOD"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
Sq.F t 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:31640028.00 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 } J Issued by: Date: 2 2—ec
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 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, inspection.
Business&Professions Code)
Sign�tu Applica . Date:
I,as owner of the property,am exclusively contracting with licensed contractors to –'
constrict the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three ALL RINGS 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 ha ve 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
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
Safc 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 corn 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 stain 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
Ow;rer or au ed
forthwith comply with such provisions or this permit shall be deemed revoked. Date' C
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 he-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
Purify 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 understand my plans shall be 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 31640C28 .00
DATE ISSUED. . . . . . . : 06/22/2010
RECEIPT #. . . . . . . . . BSOOOC10685
REFERENCE ID # . . . : 10060133
SITE ADDRESS . . . . . : 10952 NORTHSEAL SQ
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER WHEI-DIEI LIN
ADDRESS 10952 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 . 00 182 . 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
CITY OF CUP ERTINO
REROCIF
C U P E RT I N O PERMIT APPLICATION
APN .� � l �1 , c� Date: C �C1
Building, Address.
l�9 5
Owner's Name: Phone #:
q c( t_r - 01 C>-1
HOA: Yes No ❑ If yes, provide letter from HOA
3 3
f�w,� Phone v
Contractor: �," �a-s ops y
Fax
Cupertino Business License #: Contractor License #:
Type of Roof Covering:
Existing: Proposed:
:iBuilt-Up Roof ❑ Built-Up roof
Asphalt Shingles Asphalt Shingles
Wood Shakes ❑ Wood Shakes
Wood Shingles / - ❑ Wood Shingles
( Other (Specify,), �Gr��oa �G� ❑ Other (Specify)
umber of existing coverings ❑ Provide I.C.C.E.S. Report#
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description:
S /771(_
Residential Commercial
Green Building: Please complete relevant portion of the Confirmed with-Planning Dept. if
Green Building Checklist & attach it to the application or if there are any restrictions: El
applicable, include in plan set & the sheet index.
rValuation:
Z:1... /�O
I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
S 1gnature
Revised 02/0 /09