05110053 CITY OF CUPERTINO rrwYiarE.av�lra�`'��"r '•'r'yt' "�" "7y ,w BUkno
ILDING DIVISION DIVISION PERMIT *+�!1'1:`J. �+ Q ,� .
evILDINO ADDRESS: ALL SEASONS ROOFING SERVI EMP"NG'0511O053
10160 MELLO PL
Ow NEWS NAME: PERMIT ISSUE DATE
GARY HIROTSU 1720 SMITH AVE 11/10/2005
NE: SANITARY NO. CONTROL NO.
(408) 971-4455
ARC HITECDBNGINEER: BUILDING PERMIT INFO
BLDG O lO MECH
joo LICENSED CONRACTOBS DFCLARA71ON lob Descr7 tion
1 1 hereby affirm then I am Iimmnd under provhiona of Chapter 9(commmueing p
wbe Section 7")afDlvialon Sof the Bminess and Professions Cade.and my liana is
Wfull roneeand eff REROOF-T/O SHAKE INSTALL�yMP.
e Dam AECTs DECLrr ARAflON
lunderunJ my plans
WWI br
Q SGCJ:
used upublic reL"ea
D
eu� LkeProfesdond F
y N 3 OWNER-exemp ER DECLARATION �/�/� C
5 0 1 herehY,(Sm on 1 1. exempt from the Cuntracm o :My Law for tie • (:/� ,'`
a o following mason.(Section 7 omm Business;and w.dem li Code:My city or comedy t= X
which requima a permit m<rtnawcL alma improve,demolish,or repair any sweture 1225
iy prior an its iauanee,also requires led applicant for such permit ro file,signed statement
<
that nekli«t,mdpermmtmumprovidansord,eCamrrmraumm Law fcnepmr9 Sq.Ft.Floor Area f Valuation
�o (commencing with 9ecdmn7000)of Division 7 ofthe Business and Rofetiona Code)or
$ that he is exempt tboefrom and the bash f"the dbeged ceemptim.My sialWon of
Section 7071.3 by any appnam for a permit subjects the applicant m a civil paucity of r upancy Type
no more than live hundred dollar(5300). gl
❑I,Mo ofthaprOPmty,"MYMPIOy"awaitwageeuthek WWcompenadan, tl
will do the mock,and thesuunure h nmimended"offered fmsale(5ec.701d,Business
na t.e
and PraressiaCode:The Commre License Law does not aPPkf to an ow"r Of Required Inspections
property whm huuds"improw deamm ane wan ave auclt won himwr"throagn his
mart emplayeca,prodded that such Impervanenh are Out intendnd"oResed for rata U.
however,the building or Improvement Is said within o"year of cumpktiom.the own"-
builder will hew dm burden of proving that he did ter Wild"improve for pugm of
ate.).
❑1.as owner of the properly,am eulmively cmnmming wide licensed mnuammrs an
comtruct the project(Sec.7044,Buum a and Nnfmsiom Code:)The Cmmcmrs Li-
cense Law does mot apply to an awr¢r,or pmputY'who buiRls"improws Neter,and.
who contracts for such projects with aeamract")Ikrnaed Former an the Comramors
Lkeme raw.
Qlam eumpr undo See .BRPCfrrthhreason
Own" DoAdkka c
WORKER'S COMPENSATION DECLARATION 0.
141 i hardly Nim under penalty of perjM arc of the following declaraOasc
I tum and will maintain.Certificme of Covent to self-insane for Workers Compco-
sulm,u provided for by Section 7700 of the lab"Code,f"the performance of the
won for which this permit Is issued.
hew and will maimson Wm see,Comperuation Insurance,as rqu icul by Section
of the labor Code.for the perf"mance,of the work for which this permit Is kneed.
My Wor; Conpema((ti��an�Imo_rssrJm caro and Policy number am:
Cartier.S'�(/vv� RJ VY l Poliry Na:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPFNSA71ON INSURANCE
mils sectors nese rot beconpkwl aided permit Is mare hundrNdo0us(5100)
"tesa)
1 ceNfy dant in the perf"muve ar the won f"which thio i meal,is Issued.I Nail ort
employ any person in any mamerso a to become subject to the Waren'Compensation
Laws of L'alif"t11L Dam
Applkam
NOTICE TO APPLICANT:IL after making this Ccrfncem of Eumld on.you should
become subject to the Workers Compensation provWona of the Labor Code,you ante
.,O foMwide comply with ash Provisions ser Into permit shall W deemed Mveked.
z` CONSTRUCTION LENDING AGENCY
E1 bemby n thtit
alnrat re ts a construction lending agency for tie pmf"mame of
> thO wan for which this permit is issued(Sec.7097,Ch.C) '
0 Lenders Nurse
z Lenders Address
U Q i certify that I have rand this application and sou teas tie above itfamnatiun is
IL E conte.i agree m comply with all city and county Ordinances and tete laws rehdng m
Q rl'! building eonsunedon.a ad hereby suth"im repmvntnives ofthis city to enter upon ft
w above-mendmed property for Inapecdm purposes.
116 (We)agree Or ave,indemnify and keep harmka the City of Cupotino apimt
r;y rrA Iisbillda;judgments.emu and espemm which may in my ivy same against said City
O in consequence of the granting of this pomit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Signature of APPIkaudecostracter Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WIII dee epplicent"fut"e hullding aaupant atom"haMle haadom material
led,fined by Ilan Cupertino Municipal Code.Chapter 9.13.and tin Health and Safety
e.Section 2537x(,)7 All roofs shall be inspected prior to any roofing material being installed.
❑N111 dee applicant or(ulore building Oaupmtsew equlpmmt"devioa whichIf a roof is installed without first obtaining an inspection,I agree to remove
mit hazardous air contaminants a defined by the Bay Area Air Quality Management all new materials for inspection.
m i"I❑Yea WNuI have mad the hwrdoummerlals mqulemenn under Chapter 695 aft a Califnr.a HcJth d:SafOIY COM.SOcdms 23303.25577 and 21374.1undcntsnd thmlftie builoi -iv tet cumemly haw a mnams.that it h my responsibility m Witty tie mecuPant Of the jremcwwnau maBMnm 'armlaWame ora eernnam mram)uney. ignature of Applicant Dateaner rr amhm6, agate Dam All roof coverings to be Class nBn or better
Community Development
i 10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPEkTINO
Building Department
JOB ADDRESS: PERMIT
mc\\o v
OWNER'S NAME: PHONE # .y og -7 o
GENERAL CONTRACTOR: AA1 s� FAX # l o C► 3& - L111
I am not using any subcontractors---A z--Les o -eACA0,64 -A i I i,, n !S�--
Signature bate
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring. Carpeting
• Linoleum/ Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
CITY OF CUPERTINO o �� ovs��
REROOF
CUPER,TINO PERMIT APPLICATION FORM
APN#
Date:
36
3 G �l �S- oz. s //—,l o- a.r
Building Address:
� 0� U "
�DO
Owner's Name: Phone#:
CDC,kw \ Lkp$ -�SOSO
Contractor: Phone#: License#:
Cgntact: J Phone#: Cu CTG-3`5 Business License#:
J-WCANu, . TX03`5
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ /Asphalt Shingles Asphalt Shingles
p Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide 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: V-x�C�cD CotrRl350 COX q"w06r-1
L, c Cow.
Residential Commercial ❑
FireZone: Yes ❑ No,Ig- Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of roject: Type of Con truction: Occupancy group:
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE B1dR Permit Fees BUILDING
BENERGY Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING