06070086OC
Z C
CITY OF CUPERTINO
ONTRACTORINFORMATIQN '`
DUILDING'DIVISICIN PERMIT
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BUILDING ADDRESS:
ALL 6EA6UN6 ROOFING SERVI FgMfi NOIO6O7OO86
908 SAGE CT
OWNER'S NAME:
PERMIT ISSUE DATE
DENNIS HEINTZ
1720 SMITH AVE 07/14/2006
VE:
SANffARY N0, CONTROL NO.
(408)971-4455
ARCHITECT/ENGINEER:
BUIIDING PERMIT INFO
BLDG ELECT PLUMB
MECH
LICENSED CONTRACTOR'S DECLARATION
lob Description
1 bmeby affirm then I am licensed under provisions of Chapter 9 (commcncing
fDivision 3ol JR Business and Prafessuru Code. and myliansc is
ntuls(arte anOE 7000) of
REMOVE 1 LAYER OF COMP ROOF INSTALL 26 SQ.
50 Y
u"nha Ora foie" itCOMP
Date a C'
ROOF. WEIGHT 3.4 CLASS A
DECLARATION ARCHr7ECsS DECLARATION kfJ�CC.S
I understand my plans shall W used as public needs
Licensed Prafcssi... I
OWNER -BUILDER DECLARATION
exempt from Ilse Contractors Contractors License Law for the
1 be.by sperm the' I sun xem
following mason. (Section 7(131.5, Busines and Professions Cade: My city or county
which mquite a pomit to connotes. alcor. improve. demolish, or mpair my mr ctum
prior th its issuance, alsu requires the, applicant for such Permit to file a signed statement
that W is licensed purhaanuotbe provisions of the Contractors License law(Chapter 9
Sq. Ft. Floor Area
Valuat 900
(commencing with Section 7") M Division 3 of the Business and Professtoru Code) or
that he is exempt Nemfrom and the basis for the alleged aemption. Any violation of
pptl�Iy,�erO
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars ($5001
3 55 D 0
❑ I.e owner of the pmpeny.amy employers with wagessslWvsole canpcwJon,
Required Inspections
WIII dolesions andaRSWC ($eco 14. o{
NRtdedofawdo
omUsot
law doe rot apply to an owner
and Prt u Coda: The Canuacmri doesto manner
and is
property who and who doehouchwoh himuJf sur through his
loyem. providedimpr semenuarenot intendedaonered far
rovid d tats such
ownemployers, ping rut
or improvement It owner,.
hunter, thebuildingor improvementuhaltwithinane year of eprovefrdoeowner-
builtler will M1ave Ne burden of proving that he did not Wild m improve for purpose of
{�v�
sale.).
fa
1, as owner of the Property, am exeleively contracting with licensed contactors to
(',{If/ppp��f R�
a'�j ry��
construct the project (Sec. 7004, Business and Professions Code:) The Canmctor's Li
p{��a��{Py{�7
(J
cense law doe not apply in an owner of property who builds or nmprows daemon. and,
who contracts for such project with a centramor(:) liamsed pursuant to the Contractors
_ K tj[sy$r��'
/�
L /
License law.
.K1,(
]Ivm�--nNl SCG . P A P C for thus mase.
2006
OwiKr . t
111ryryryaaa
WORKER'S COMPENSATION DECLARATION
I hamby affirm under penalty of perjury one of the fallowing declarations:
fa
1have and "I maintain aCerdfre+reofCouemmwlWasure forWorkersCompemi
�
ss provided fa by Section 3700 of the Lubar Code, far the perfomurr¢ of tWk
for which this permit u blued.
1 have and will maintain Wather Compensation Insuance, as rtgtired by Section
153131M,1'
of the Labor Code. far Ne performaac ofNe wort fur which this permit u issued.
Worlm's CompensationIncurs 4q1iv and Policy number am:ier.(p',
A��U Polity No.: l�l 1-1850-
S
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
.
This; u tion coed not W completed if Oe permit is foronc hundud dtllae ($100)
or less)
1 ccNfv Nm in the pofu mance of the hash far which this Permit is issued, l shall Trot
employ any person in any manner an as to become subject to de Workers Compensation
Lavas of California. Date
Applicant
NOTICE TO APPLICANT: If, after making this Cenifiem, of Exemption, you should
become subject as Ne Woneens Campmation provisions of de Labor Cade you must
forthwith comply with such provisions or Nu permit shall W deemed revolted.
CONSTRUCTION LENDING AGENCY
s
1 Wmby of nn that then is a coutuction keeling agency for the performarac of
the work for which this permit u Wood (Sec. 3097. Civ. C.)
Landers Name
Lenders Adds
1 edify that I have read Nis application am sate thin the above information is
Correct. I agree to comply with all city and county ordinances and sure laws mlating to
building consu etion. and hereby authorimrepresenutives of this city to enter upon the
abuvc-mjudg tints. cent for inspection Purpowhich
(We) agree to ave, indemnify and kccp harmless de City of Curanine, against
m.
cxperoa which may in anyway mrne against aid City
liabilities.cnquence
m fthecostand
APPLICANT
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE REGULATIONS. R
Re -roofs
�MCcQ
Sgic' arm✓mr tin,c
HA7ZARDOU
Type of Roof
Willapplicantor Troupe Wildingaapmter9.1 sur handle material
Cr defined byy the Cupenina Municipal Code. Chapter 9.13. and theHealth and Safety
Health
25533(a)?
Crate, Section El Y.
�Ycs �vVo
All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant use equipment or devices which
If a roof is installed without first obtaining an inspection, I agree to remove
went hazardous air contaminants m defined by the Bay Arca Air Quality Management
all new materials for inspection.
District?
—jdNe
❑ Yes
1 have Rad the hoembecsmverhis mmimmenesi ndcr Chap nli.95 of the Califon
nia Hmhh&Safety Ccdc. Sections 25505, 25533 aM25534. 1 uMcrsmed thetifthc Wilding
dace her cwenay hast a teemi that it u my mspumibility ro testify the occupant of tic
irtmems which muBWmet primmisstana tr. ardrRate traapanty.
Signature of Applicant Date
CA
All roof coverings to be Class "B" or better
g
/�
Owner or authorisd ascot Date' '
LWA
em 1 of 1
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 35906012.00
DATE ISSUED.......: 07/14/2006
RECEIPT #.........: 35255
REFERENCE ID # ...: 06070086
SITE ADDRESS .....: 908 SAGE CT
SUBDIVISION ......
CITY CUPERTINO
IMPACT AREA ......
OWNER DENNIS HEINTZ
ADDRESS ..........:
CITY/STATE/ZIP ...: ,
OPERATOR: amyw
COPY # : 2
RECEIVED FROM ....: ALL SEASONS ROOFING
CONTRACTOR .......: GORSHTEIN, VLADISLAV LIC # 21035
COMPANY ..........: ALL SEASONS ROOFING SERVICES
ADDRESS 1720 SMITH AVE
CITY/STATE/ZIP ...: SAN JOSE, CA 95112
TELEPHONE ........: (408)971-4455
•FEE
ID UNIT
-----------------------
QUANTITY
----------
AMOUNT PD -TO
-DT
THIS REC
NEW BAL
BPERMFEE VALUATION
9,000.00
--------------------
158.76
0.00
----------
158.76
----------
0.00
BSEISMICRE VALUATION
9,000.00
0.90
0.00
0.90
0.00
TOTAL PERMIT
---------- ----------
159.66
0.00
----------
159.66
----------
0.00
METHOD OF PAYMENT
-----------------
AMOUNT
NUMBER
------------
CHECK
159.66
------------------
19754
TOTAL RECEIPT
159.66
n
U
•
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax(408)777-3333
Building Department
JOB ADD ESS:
LA 0':j� S G. Cr�-
PERMIT #
OWNER'S NAME: Gv,r;s z
PHONE #
GENERAL CONTRACTOR: L 1 so i� ooh
FAX #
Scc�tceS _ q�
I am not using any subcontractors —. -A / i ��i� Ll b L
Signature Date
Please check applicable subcontractors and complete the following information
Owner/ Contractor Signature
�' I -( 10!0
Date
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
�' I -( 10!0
Date
0
•
CITY OF CUPERTINO
D ` REROOF
CUPERTINO PERMIT APPLICATION FORM
APN #Date.
Bldg Permit Fees
Building Address:
BENERGY
Owner's Name:
Phone #:
_
Contractor:
A\\
License #:
-i
Contact:
A � �.G, 5xo,C,s
Phone #:
Applicant/Contractor:
Fax #:
\� S (Loo e Jv
4c7 — C�
ding Permit Info:
Bld Elect Plumb Mech
Jo Description: Gass A�
Residential: R Je jr commercial:
Sq.Ft. Floor Area: 19C00,0
$/Sq.Ft.:
Architect/Engineer:
Valuation:
'`6 lCto�
Type of Construction:
Occupancy Group:
v
Qty. if
A lIca ble
Fee ID
Fee Descri tion
BPERMFEE
Bldg Permit Fees
Fee Gcuu
BUILIDNG
BENERGY
Energy
BUILIDNG
BSEISMICRE
Seismic Fee Res
BUILIDNG
BSEISMICOM
Seismic Commercial
BUILIDNG
BPLANCHK
Plan Check Fee
BUILIDNG
BUSLIC
Business License
BUILIDNG