03080143 CITY OF CUPERTINO � x^'?•e9 ;r,L +. x mvar, ,rua�x h. rs'^v
BUILDING DIVISION PERMIT CONTRAGTORANFORMATIQN '
BUI LDING ADDRESS: ALL SEASONS ROOFING SERVIC gRMITND03080143
R'S NAME: 2640 PACER LN PERMIT ISSUE DATE
°NE;
4089724455 SANITARY NO. CONTROL NO.
ARCHITECTAINGINEER: BUILDING PERMIT INFO
BGS ELS PLUMB MECH O
+00 LICENSED CONTRACTOR'S DECLARATION
to Job Description
I hereby affirm that I am licensed under provisions of Chapter 9(commencing p
£2� with Section]BtI03 of Division Jor NC Busine dProfcssinns Codc,end myliccnse is
'.`oh
in full rtk<and erreuL 3r75 Jn5/ REROOF
su'1? Lieenu eT�s L 1 Lic.
'F a Datc Cunt Ior
� V]�J ARCHITECTS D RATIOf N
f u I1Adrs1md my plans shall be used asp lie records
'l- Licensed Professional
g OWNER-BUILDER DECLARATION
<P 1 hereby affirm that i am exempt from the Contractor's License Law for tbe
00 fin owing tenon.(Section 7031.5,Business and Proot.sions Cook:Any city ar county
< yum which rcres a permit m construct.also,improve,demolish,to repair any nrucmro
dmi prior it)its issuance,also beauirestM applicant for such permit to Glc a signed statement
;go
that he is licensed pursuant to the provisions of the Contractors ucenssuw(Chapter 9 Sq. Ft. Floor Area - Valuation
d� Icummencing with Section 7001])of Division 3 of the Business and Processions Code)or
fast he is too mpl thcmfrom and the basis for me alleged exemption.Any violation of 3 2
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of ApN Number
not mora than five hundred doilars(s500). __. . Occupancy Type _
❑I.as owner of the pmpeny.mmyemployees with wages as their sole compensation,
will do the work,and the swcture is not intended or offered for sale(Sce.)Bi4,BusinessOS — FRAME
and Professions Code:The Contractors License Law does not apply to an owner of Re sired Inspections
property who builds or improves thereon.and who does such work himselfor through his 307 - INSULATION
own employees,provided that such improvcmcnu are not intended or offered future.If, 601 — ROOF TEAR OFF
however,the building or improvement is sold within one year of completion,me owner-
builder will haw de,burden or proving that he did not build or improve for puryme of 6 02 - ROOF PLYWOOD NAIL
sok.),
❑I,as owner or do moarty,am exclusively conducting with licensed co intrucrs to 603 — _ROOF_ BATTENS
comuuct de project(Sec.]044,Business and Professions Code:)The Condacmr's Li- 604 — ROOF IN-PROGRESS (�
cove Law docs not apply to an owner of property who Wilds or improves menton,and
who contracts for such projects with a condactor(s)licensed pursuant to the Conoacloi s /
License Lowexempt <"(
❑lam cacmpt underSm. ,B&PC for this msson //J
WORKER'S COMPENSATION DECLARATION
I hereby M.under penally of pc j.,ono or de following declaratioas: _.. _ _ _ - - _ 2
f37W�fft
ve and will maintain a Cerdificme of Consent u self-Rom.for WorlerkCompen-
as provided for by Section 37M of the Labor Code,for the performance of the
or which this permit is issued. - -
ve and will maintain Worker's Compensation Insurance,as required by Section
laWrCode.for the prormnomee of,hc work fofwhich thispermilis issued.
rkcr's Compensation lnsurana cart an olicy number am:. J7.i rel '//
CEIFFFICATEOFEXEM ION FROM WORKERS
COMPENSATION INSURANCE
QTis section need not he completed if the Permit is for one hundred dollars(Sl W)
or lcsx)
1 certify that in the performance of the work for which this permit is issued.I shall not
employ any Penson in any manner so as W become subject o the WOrkeri Compensation -
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Cenincate of Exemption,you should
become subject to the Worker's Cam pcwtion provisions of the,Labor Code,you must
Z, forthwith comply with such provisions or this permit shall he deemed revoked.
Z'O CONSTRUCTION LENDING AGENCY
I hereby affirm that dere is a construction lending agency for tW performance of
1' the work for which this permit is issued(Sec.3097,Cr,C.)
1.1 Lender's Name
Lender's Addrw V
�z
J Q I certify dot 1 have read this application and seats that de above information is
Correy E builds.1 agree to comply with all city and county ntati mOf and sate laws orating to
aboningcnnswnim,vtd hereby anthorimmoses. Lives of this city to enter upon me
yahovcmentionedproperty for inspection which
(We)agree to save,indemnify and keep harmless the City of Cupertino against
Z in COifiexjudgment.nCCOfthe costsandOr this cswhich may,. a accrue against Said City
;,J Z A PLIC uence UNDERSTANDS
A permit &'��Jy
^ APPLICANT UNDERSTANDS AND WILL COMYYr WITH ALL NON-POINT Issued by: Date
SOURCE R U
9�� t5-'zt'cj Re-roofs
TS gn.oil or einalsComraCmr Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant smrc or handle hanAous material
of wd by the Cu actino Mu al Code,Chapter 9.12,and sW Health and Safny
CO..c35532(x)?
❑No All roofs shall be inspected prior to any roofing material being installed.
Will the tic t done din Occupant use e m If a roof is installed without first obtaining an inspection, I agree to remove
PP s p y pmcm or Jcvices which g
is I t hvaNnux air conn defined by the say Arca Air Quality Management all new materials for inspection.
❑yes
1 have read de havrdnmsmamrials mqulmments under Chapter 6.95 of the Califon
Tia Hcaldlk Safety Code,Secdoes 25505.25533 and 25534.1 understand that if the Ni ding
_,_) �
does not currently haw a enan4 thus it is my respmssihility noury the ecomat or the V/�f•-f F/.). V J
requirements whi h must met prior to issuance of a Cerufm of Occupancy,
Z6-v.3 gnat e of Appli' ant Dale
wnerorMoomiAdasenl Da1C All roof coverings to be Class "B"or better
CITY OF CUPER'rINO "
BUILDING DIVISION PERMIT. C�NI�RACTnRhNh� MATI'� s
BUILDING ADDRESS: ALL SEASONS ROOFING SERVIC glllT"°03080143
9_310 HOMESTEAD RD
OWNER'S NAME: 2640 PACER LN PERMITISSUEDATE
"E' 4089724455 SANITARY NO. CONTROL N0,
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MEcfl
0 Q
ioa LICENSEDCONRACTOR'SDECLARATION
-
F❑ 1 ion 7 affirm that 1 am licensed ander provisions or Chapter 9lrommenci is lob D> p[ion
with Section arrifDivisionmliccoBusind rvmfcssiof CJ,O9(cmmencing
mfull rkeaddrre .,; 757REROOF
a z Lam s L 1 secs
spa Data Carer tar L
ARCHITECTS DE RATION
I 1"mlacrstanJ my pla^s aM1all M used asp lir om r of
or /
JyU
r p,� Libemod Professional D
Og OWNER-BUILDER DECLARATION'
aI 1 hereby.!Firm that 1 am exempt from the Cnmmcmr's License Law for the
Ct o following reason.(Section 7031.5.Business and Professions Code:Any city or county .
<m which mquima a permit to construct,alter,improve,demolish,or repair any xuumurt
prior In its inionnee.also requires the applicant for such poral to rile a signed statement
< that he islireroad pursuant mmeprovisions ofthe Contmror'sLiwase Lin,(Chapter 9 Sq. Ft. Floor Area ' Valuation
Z- (commencing with Section 1000)of Division J of the B usimsr and Profdssiom Cartel or
Nat he is exempt thdrefrom and Nre d
e hot for Blcgcd exemption.Any Arbil- a of 32659057 . 00
Section 7031.5 by any applicant for a permit subjccm the applicant to a civil penalty of Apt Number Occupancy Type
.at are than Rve hundred dollars(t50I).
❑ I,as owner of the pmpeny.or my employees with waguu Neir sole compensation,
will do the work,and the awctum is not intended or offered for sale(Sec.7044,Business 305 — FRAME
and Professions Cade:Thr Contort License Law does nor apply to an owner of
Required Inspections
property who builds or improves themon.and who does such work himsdfor though his 307 — INSULATION
awn employees,provided that such improvements are not intended arrested for sale.If, 6O1 — ROOF TEAR OFF
however,the building or improvement is sold within one year of completion.the owner.
Insider will have Ne burden of proving that he did not wild or improve for pmpear of 602 — ROOF PLYWOOD NAIL
Lite].
❑ 1.as owner or the properly,am exelpsivrly contracting with licensed contractors to 603 — _ROOF BATTENS _
coostmu
che project(See.7044.Business and Professions Code)The Contramr's Li. 604 — ROOF IN-PROGRESS
rue law docs not apply to an owner of property who wilds or improv themon,and,
who contracts for such projects with a contraam(s)licensed pursuant to the Contractor'a
License Law.
❑I am exempr under See .B 6 P C far his rtuon _ _-
Owner Date
WORKER'S COMPENSATION DECLARATION -
1hereby af rid under penalty of perjury one or Ne following declarations: ..
I have and will maintain a Certificate of Consent o selGinsum fur Worker's Cothran-aides,
as provided for by Section 3700 of she labor Cade,for the perronnance of the
k for which this permit is issued.
1 have and will maintain Worker's Compensation Insurance,as required by Section
or Nr labor Code.fm the performance of the work for which this permit is issued.
sicr. 044EFtTl olicy No.:
CCeIONFROM
WORKERS'
COMPENSATION INSURANCE
Ohissectim need rot oc completed if the permit is for one hundred d^Ilars(SIB(1)
or Icss.)
I codify Out in the performance of the work for which this permit is issued.I shall not . .
employ any person in any manna,sit.to become subject to tw Workers'Compensation
Laws of California.Date .
Applicant
NOTICE TO APPLICANT:If,Co making this provisions
o du Eabor Co,you should
become h comply
it Worker Compensationermitiom of Nerved rCode,. must
�O forthwith comply witM1 such provisionsec,this permit shall wdcemcd revoked.
ZN CONSTRUCTION LENDING AGENCY
I hereby affirm Nal them is a eonawctinn lending agency for the perro mann Lir
M> the work for which Nis permit is issued(Sec.3097,Civ,C.)
Yl Q Under's Name3.
z L rid is Address
0 I certify that 1 have read this application and state that the avec irdmarraitan
ng is
�. f•' building l agree ct comply with all city and county ordinances of and sum laws mining r
V above-mentioned
he¢byactimsp representatives of this airy to toter upon Nc
DO
ahovcmcmiuncJ property for inspection purposes.
(we)agree m save,indensnify and keep harmless the City of Cepcdmo against
r� liabilltictjudgmcnu,cosuendcxpcnso which in,
y in 0 eccroc against old City
J z
APPLICANT
of UNDERSTANDS
ng of Nis permit.
^t APPLICANT UNDERSTANDS AND WILL CO WITH ALL NON-POINT Issued by: Dale
SOURCE R U
Re
S'gnaoro or Inca Contractus Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant sore or handle ha,ardous mmerial
sa derided by the Cupedino Mu ' al,Code,Chapter 9.11,and the Health and Safety
Code.Section 25531(a)ko�"
All roofs shall be inspected prior to any roofing material being installed.
Oyer
Will the appleJingpsexuipment or Jcviccs whichIf a roof is installed without Frst obtaining an inspection,I agree to remove
mit nazaMnus sir canlved by the Bay Arca Air Quality Managcmrm all new materials for inspection.
District?
❑Yes
Ihave mad the wraN^at ons 2555.255ls uiamc 5534,1tanker deChapter
rtand O5 of the Califon '2g4ate^ice a notnX emly Calc,tecdom155115s my and155]4.1 unJcrsun the mthe wilding Jos ntn cuvently have a¢nant,.Na it is my responsihilityt nntiry Iw mcupantof Ne
rc uenontswhi hmail mnprioroissunecof.Cedefc rdfy pa^dy. gnat e o Appl' an[
041_C15 - All roof coverings to be Class "B" or better
weer Lir atibrawcd agent Date
AUG 26 2003 9: 03RM HP LASERJET 3200 P. 1
E'.rrarl ;65C) 917-991_1
raa E•:EYr 444 w� rst Street 'A FAX 917-9991
• oec�a:n _os altos CA 94022
PROMPT, COURTEOUS SERVICE -- UNIFOR4I ENFORCEMENT OF RULES -- IMIACULATE ENVIRODMENT
FAX COVER SHEET
Date : fi
TO : /Ttt : l✓�E n'
COMPAIN-Y :
FA-. # :
FROM; e of d dirT1 h
Pages being transmitted: _
(T-ncl ,ding Cover Page)
Original will be sent by mail .
Original :vi 11 no Int .
IE there are problems in receiving this transmi ssiSECLOP0111
) 9'17-9911.
Co-mments :
The Woodspring HOA represents all the homeowners in the complex
The HOA board has approved to have the complex re-roofed with a new Presidential Shingle (color: Shadow
Gray) APPAOVED
IIN.At DAN Wl H "E CITy br
E N'. �RDINAI�CES
OATZ—
SIGNED `
This set plans and�pEafCahollS MHS )
be kept n the job at all times and it I�.i1h
lawful to make any changes dt 31t�to(IBw yv1
on same without written ,perfflissidfl ffBR
the building Dept., Olty Of L#01 118:
The stamping of this plan end lip.t;'. 'fln-, ` r
SHALL NOT be held to perhllt of ld 13@ 3f
approval of the violation of @fly 0r6Yi§IBR,
all any City Ordinance or Stat® Low
AUG 26 2003 9: 03AM HP LASERJET 3200 p. 2
From.9,a0 Myer TO:Nag,Cnaml Dab:423/2053 Lme:9:47:22 AM nage 2 of 2
,�,�� � ` � 'WFRTr AODREFI: _ :ITrr TI►
MIOIA COmn: WORK IHMM[R); PARER MISM �tll
MEW ANilR ORDE 0; O ROP NEW ROOF: APPAOX.START OATS APPROXI[
1 }-.�rir'F114ii +11tr-
,".J�"L�r { Ir rte r( Lr' iry�41 Jai ±h
r
.. ''= �,-�"r-�. -J1"i�1f_ .�:rl�` �'7+.PeT�-1+ ". 1��, -r'- �-�{ yr r• ir'-(H
T�l; i . tea r r
• 111 Lil ��r�, _ � TI `
TT
1 'ai ,M r
7•"C
?�r��r1'''I�'Lt -.. �,'.F HT!� . -1� . .L✓-:_ r C. .� T�.'_-tf~..._ Z'j.. '
• Sloped roof areas are going to have new Presidential Shingle installed
(Shadow Gray color)
• Shad-Aeas are the.flat roof sections that are going to have a roof coating
s} tel OT, FLANS vEp
RO
RATE p�DROP, WISNI IRDINANCES
UE
N ' N DEPT.
pPT�--
DATE. iicaCwns
r SVGNEU�; as m.a s,
This set of P 'lei). .• q'e?wc:and it un
• r3r G. DEPT. be kept on enc t1um. : at nitoratlon.
lawful to maac anY trt,,i%"ul trctT
pp same wdhout r:rittan t' ,.ttilW•
Gdl of it q•-
Oapt•I 1a+,.end ap+,Ili w
the building of tS+s P „ �p
The stamP10 be held to Port'vi.of tltnvlolnn'
Stlnl h NOT
violation of nny P
opproval of the II Salto LuYt.
at anY City Ordinance
?ITY OF CUPERTINO D 3
REROOF
• CUPERTINO PERMIT APPLICATION FORM
APN 0 32- D S� Date: S 3
Building Address:
Owner's Name: Phone 5 #:
90 �•
Contractor: Phone#: License#:
971• y 0 s5 o 9/
Contact: Phone #: Cupertino Business License#:
co 09• 971, sS- 03
Type of Roof Covering:
Existing: Proposed:
/, Built-Up Roof y_ Built-Up roof
❑ Asphalt Shingles -A Asphalt Shingles
$t Wood Shakes ❑ Wood Shakes
❑ Wood Shingles - ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings C1Provide I.C.B.O.Report#
To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description:
`2lz GCA�
Residential ❑ Commercial �f
Fire Zone: Yes ❑ No Confirmed with PlanningDe I. if
there are any restrictions:
ost of Project: Type of Constructi Occupancy grog:
r-00
Qty. if
Applic IC Fee ID Fee Description Fee Group
BPERMFEE Bid& Permit Fees BUILDING
BENERGY Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Pian Check Fee BUILDING
BUSLIC Business License BUILDING
•
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