12030117 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10957 NORTIiSIiAL SQ CONTRACI'OR:FOUR SEASONS ROOFING PERMIT NO: 12030117
OWNE,R'S NAME': GIBBONS RICIIARD F 1'0[ION 1668 DATE ISSUED:03222012
OWNER'S PHONE: 4089963288 SAN.IOSE.CA 95109 1`110S'ENO:(408)278-0330
42?� LICENSED CO\fRACI'OR'S 1)IiCLA RATION BUILDING PERMIT INFO: BLDG I- ELECT I- PLUMB I_I
License Class e-3� Lie.# 4 -L tow MECH r RESIDENTIAL r_' COMMERCIAL r.
rr ��jj //�x
Contractor f'�/Se4s..s FwiiDate 3^Z2-17—
1 hereby affirm that 1 arta licensed under th provisions of Chapter 9 •JOB DESCRIPTION:SFDWL REROOF,13 SQ.TEAR OFF EXISTING CAL-SIIAKE
(commencing aith Section 7000)of Division 3 of the Business&Professions ROOFING SYS'ITNI,INSTALL 30.#FELT UNDERLAYNIENTS AND
Code and Thal my license is infull force and effect. INSTALL GAF GRAND CANYON SHINGLES,
hereby affirm under penally of perjury one of[tic following two declarations:
I have and will maintain a cerliticale of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
perfrmnnce of lite 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 Flour Arca: \'alualion:$7000
permit is issued.
4�
APPLIC\NTCERTI FICATION AIN Number:31640020.00 Occupancy 9'ypes
I cerlily Thai I have read this applicatibn mad state that the above information is
correct. I agree to comply with all city and county ordinances mid state laws relating
to building construction,mid hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupenino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,the applicant understands and will comply 18O DAYS 2 M LAST CALLED INSPECTION.
with all non-point source regulations per the Cupertino Municipal Code.Section
9.18. y z
3�Z.L Issu d by: C G Date:
Signature Date
❑ O\YN . -R JILDI.R DECLARATION
RE-ROOFS:
hereby affirm[[in(1 nm exempt from the Contractor's License Law for one of All curls shall he inspected prior(rally rooting material being installed Ilya roof is
the following Iwo reasons: installed withola first obtaining an inspection,1 agree to remove all new materials for
I,as owner of the properly,or my employees with wages as(heir sole compensation, inspection.
will do the work,told(he structure is not intended or offered for sale(Sec.7044,
Business&Professions Code) Signature of Applicaul _ ate: 3-2,Z,17-
1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). ALL ROOF CO\'ERIN TO 11E CLASS"A"OR BF.TfER
1 hereby affirm under penally of perjury one of the following three
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's DA'LARDOUS NIATERIAI S DISCLOSURE
Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous maleriads requirements under Chapter 6.95 of the
performance of Ilse work for which this permit is issued California lladth&Safety Code.Sections 25505,25533.and 25534. 1 will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance wilh the Cupertino Municipal Code.Chapter 9.12 and the Ilealth&
Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(x)should I store or handle havnrdous material.
Additionally,should I use equipment or devices which emit hazardous air
permit is issued. connminanis as defined by the Bay Arca Air Quality Management District I bill
I certify that in the performance of One 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 almoner so as to become subject to the Worker's I leafth A.Safety Code,Sections 25505.25533.and 25534.
Compensation laws of Califorma. If.after making this certificate of exemplimn,I t
become subject to the Worker's Compensation provisions of the Labor Code,I must 0 w I I c r or n 1 r
forthwith comply with such provisions or this pernnit shall he deemed revoked Date:
CONS'1'RI1C1'ION' I-ENDING.\GI?NC1'
APPLICANT CER'I'IFICA'HON
I certify ilial I have read this application and state than the above information is I hereby of- m that there is a consirdion lending ngene)•For
the per(onnanee of work's
correct. I agree to comply with all city and county ordinances mid state laws relining for which this permit is issued(See.3097•Civ Q
to building construction•told hereby authorize representatives of this city to enter Lender's Name
upon the above mentionedproperly for inspection purposes.(We)agree to save
indemnify and keep harmless the City ofCupertino against liabilities,judgments, Lender's Address
costs,and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply ARCII ITECPS DECLARATION
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. 1 understand my plans shall be used as public records. -
Signature Date Licensed Professional
CITY OF CUPERTINO
3 ITEMS OF 15 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 31640020. 00
DATE ISSUED. . . . . . . : 03/22/2012
RECEIPT 4. . . . . . . . . : BS000016333
REFERENCE ID # . . . : 12030117
SITE ADDRESS . . . . . : 10957 NORTHSEAL SQ
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : GIBBONS RICHARD F
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-0529
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 7, 000 .00 1 . 00 0 . 00 1 .00 0. 00
1BSEISMICR VALUATION 7, 000 . 00 0 .70 0 . 00 0 .70 0 . 00
1REROOFRES SQ FEET 13 .00 182 . 00 0 . 00 182 . 00 0. 00
TOTAL PERMIT 183 .70 0 . 00 183 .70 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
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO
PERMIT INVOICE OPERATOR: TraciC
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . . 31640020 . 00
INVOICE DATE. . . . . . : 03/22/2012
REFERENCE ID # . . . : 12030117
SITE ADDRESS . . . . . : 10957 NORTHSEAL SQ
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : GIBBONS RICHARD F
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-0529
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 DESCRIPTION DUE FOR AMOUNT DUE PAID BALANCE
--------------------------- ---------------- ---------- ---------- ----------
CAL BLDG STAND COMMISSION F PRINTING PERMIT 1 . 00 0 .00 1 . 00
SEISMIC RESIDENTIAL PRINTING PERMIT 0 .70 0 .00 0 .70
RE-ROOF: RESIDENTIAL PRINTING PERMIT 182 .00 0 .00 182 . 00
---------- ---------- ----------
183 .70 0 .00 183 . 70
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
_!03/21/
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03/21L. ,i2 04: 18,, 4089960226 .� NORTHPOINT11,
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" "on *` �s ontected and apf>raved Four Season's FZoonng to perform re
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CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 10957 Northseal Sq. DATE: 03/22/2012 REVIEWED BY: Sean
as APN: RP#: "VALUATION: 1$7,000
•PERMITTYPE: Minor Building Permit PLAN CIIECK TYPE: Re-roof
PRIMARY SFD or Duplex PENTAMATION 1SFDWLR00F
USE: PERMIT TYPE:
WORK Tear-off existing Cal-shake roofing system, install 30#felt underla ments and install GAF Grand
SCOPE Canyon Shingles (1300 sf), Color: Stonewood.
FEE ID ROOFAREA
s.f.
1REROOFFRES 1,300
dfeeh. Plan Check Plumb. Plan Check Elec.Plan Check
blech.Permit Fee: Plunrh.Permit Fee: Elec. Pernie Fee:
(Ither.;1 f rl�.last;. Other Plumb/,,7,p -E3-L-
,,p. 011ier Etc= hup.
,Uech.hty. Fee: plumb.Inap.Fee: Elee.1nVt.Fee:
NOTE: This estinutte does not include feev due to other Departments(i.e. Planning, Public Works, Fire,Sunitary Sewer District.Schaal
District,etc.). These ees are haled on the prelininan•information nvrdlable and are onh,all estintale. Contact the De t or atldu'I info.
FEE ITEMS (Fee Resohuion 11-053 Eff 711111) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Supp/. 1'CFee
Phimb.Aaech.:'F.lec
Permit Fee: $182.00
SuppL Insp Fee
.PI utnhJiYlech.%Elec
Plunrh. _b1i cH.:Elec Permit Fee:
Construction Tac:
Administrative Fee:
Work Without Permit? O Yes (F) No $0.00
Achtm •eclPlanning Fees:
Trtmel Documentation Fees:
Slrone Motion Fee: IRSEISM/CR $0.70 Select an Administrative Item
Blcle Stds Commission Fee: IBCRSC $1.00
SUBTOTALS: 1 $183.701 $0.001 TOTAL FEE: 1 $183.70
Revised: 1/19/2012
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT••BUILDING DIVISION
10300 TORRE AVENUE •1CUPERTINO,CA 95014'-3255
CUPERTINO (408)777-3228•FAX(408)777-3333•buildinD(dcuoertino.orD
PROJECT ADDRESS _ APNpI / �' jO OD-0
Slew LCA —` C/ L./
OWNEANAME ` ' ^��1 eA PHONE — E-MAIL
STREET ADDRESS CITY,STATE',ZIP
CONTACT NAME \�t�dc 2.a�reS PHONE -O3301
SMALL•
STREETADDRESS CT'.STATE,ZIP FAX
' o Sose Cw. S
TJ I
❑OWNER ❑ O%NEK-BU: ❑ GWNERAGEAT -Er CONTRACTOR ❑CONK CTORAGEAT ❑ ARCHITECT ❑6VGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME WCFNSE NUMBER LICENSE TYPE BUS.WC.tl
COMPANY NAMC r E-MAILS
FAX
STREET ADDRESS CrTY.STATE.ZIP PHONE
Sot HarAlh,9S
ARCHfrEC0EN01NEER NAME 1 LICENSE NUAIBFA ' BUS.LIC,tl
COMPANY NAME r E-MAIL
FAX
STREET ADDRESS - CrFY.STATE,ZIP PHONE
USE OF ❑ SFD Or Duplex H MUltf-Farnily ROOF AREA: .VALUATION:
SIRUCrURE: ❑ Commercial - .� . 'S y 0
00
Tq 1
EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPFW.TSIIINGIFSI ❑WOODSHAKES ❑W00D ;a
SHINOIr (YHER(SPECIFY) AL 5�}A
REJ.10\Ti IRF.PLACEOYES pF NO. PLYWOOD Qw' ❑ PLYWD ❑OSB PITCH: I �Z ROOF A
ESS Ij 5's. fl. -A
l
PROPOSEDROOF'IYPE: ❑BUILT-UPROOF A(ASPIIALT SIIINrT Ff ❑WOOD SHAKES 13 WOOD SHINGLES 110 1 TILER ICC-FS REPORT
DESCRDMON OF WORK: --
n�dr-&IAP ex
r n _
o41{y�aT�- 3 InS4GAF Qrw c�
-1.1-
C o
By my-sigmlure belOW,1 certify W each of the following: Iain the property owner or authorized agent to act on the property oNner's behalf. 1 have read This
application and the information 1 have provided is correct. I have read the Description of Work and verify it is accurate. I agree W comply with all applicable local
ordireulees and state loos relating to building conggift on. thor resenmtivm of Cupertino to enter the above-identified property for inspection purposes,
Signature of ApplicanVAgent: Date:
SUPPLEMENTAL INFORMATION RC D '. OFTICF.USE ONLY
_If building is associated With a Home Owners Association,provide letter "[PLAN CHECK TYPE .ROUTING SLIP
ofappro\•al from HOA. ' -1'9 : IL'❑ 2 OVER-TIIECOUNTER ❑ BUILDING PLAN REVIEW
_Provide Planning approval to verify if there any restrictions. I r'I ," I' , II, I
EXPRESS ❑ PLANNING PLAN REVIEW
PTOVIdC Copy Of MtlnufaClUlCf S IOsIIlIIIlIIOn$peClflCallODS. ❑ STANDARD ❑ FIREOM'
_Provide signed copy of Cupenino's Tcar-Off Policy. ❑ OTNER: .
1
Reroo6App_201 Ldoc revised 03116111