03090120 (2) �rCY OP CUPEW11NO "" s
BUILDING DIVISION PERMIT -CONTRACTORIINTORMATION.,�
BUILDING ADDRESS: SECURITY ROOFING AIR SYSTE gmmn Nb 3090120
OWNER'SNAME: 677 KINGS ROW PERMIT ISSUE DATE
ow,o (408) 971-1777 SANrrARY NO, CONTROL NO.
ARCHITECT/ENOINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB lot
100 LICENSED CONTRACTOR'S DECLARATION O O O
� P I hereby at hom that I am Bcemcd under provisions of chapter 9(commencing \ Job Description
Zsu1h with Section?M))uf Division 3 of me Business and Professions Code,and my license is
'may in full force and effen p
Sqg Lieense Class x' 35 Lie.x tib 5' REROOF '•L' }�I,i
DamContractorE RATION
wU I undcrsland my plans hfal the d as public h cards AUC 2004!
°ay Licensed Purbefoonal -� L t•
tl0, OWNER-BUILDER DECLARATION a �;tl(�'"!"P I hereby iflima that 1 am exempt from the Contractor's Licenae Law I'or the itllt
<m a
nl1)!i':
00 flnwing rcavian.(Second 7031.5,Business ad Pmfem CodeAny cIynr county
y
which mlosses
P+
a e.also fa con s[lie alter,intpfnve,demnli it,or repair any strudurc
�Z} ent
thatpriohnsloits seuane e,alanrenitl the lneium mus of rnr Contractor's
Eense Lw(Chapter9
axe mat he ishnttseepnrnanttomeprovialonaonnScamesnarsuanteLaw(cnapmrt Sq. Ft. Floor Area Valuation
Z.0 (cammcncl ng with Section 7M))of Division 3 of the B ushers and Professions Code)to
aj that he is exempt themfrom and me basis for(lie alleged exemption.Any violation of 32652032 . 00
Section 7031.5 by any applicant for a permit subject the applicant to a civil penalty of APNNumber OCCU
am more flood five hundred dallars(E5W) Occupancy Type
❑1,as owner of the property,or my employees with wages as their safe compensation,
will do the work,and the samelure is not intended or offered tarsale(See.7844,Business
and Professions Goods:The Contractor's License Law docs not apply to an owner or Req�wired Inspections
property who builds or improves thereon,and who dims such work himselfor through his 307 — INSULATION
own employees.pravidedthatsuchimprovementsarenotintndedorofreredforsale.B' 601 — ROOF TEAR OFF
however.Ne building or improvement is sold within one year of comple,on,the owner.
builder will have the burden of proving that he did not build or improve for purpose of 6 02 — ROOF PLYWOOD NAIL
Bali)as owner of Me 603 — ROOF BATTENS
❑ property.,B exclusively confessional with licensed contractors i.
use La the es not (Sea o air Business and Professions ds or i The Contractors Li 6 04 — ROOF IN—PROGRESS
cense law Nos not apply m an ith a of propcny who builds rs improves Comoro,and
who monoses for such projects with a enmmemr(s7licenseJ pursuant to the Comeseor's
Llccnsc Law.
E] am exempt under See. ,B&PCfor this rcazon
Owns! Date
WORKERS COMPENSATION DECLARATION
1 hereby affirm under penalty of pc jury one of the fallowing declarations:
1 have and will maintain a Cent of Consent to self-insure for Worker's Gant
smiad,as provided for by Section 37W of Ne Labor Code,for the performance of the
work fur which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,as required by Section
37W of the Labor Code,rnr me perfmmv¢c of the work for which Nis perm;,is issncd.
My Worker's Comp sntiuresurance canier and Policy number mr-
( 1 r
Cartier, b)'It � k d PDON Na:
CERTIFICATEOFSATINION PROM WORK •
COMPENSATION INSURANCE
(This section need not los cnmpleac l if the permit is far one hundred dollars($100)
r less,)
1 certify Net in the performance of the work for which this permit is issued,I shall not
employ any person in any manner so az to become subject to the WorkersCoMe ensalian
Laws of California Date
Applicant
NOTICGTO APPLICANT:If,after making this Cenilicate of Exemption,you ahuild
become subject to the Worker's Compensation provisions of the Labor Code,you must
z forthwith comply wish such prnv;sinns ar this permil shall he ticcmcd mvnkcA.
OCONSTRUCTION LENDING AGENCY
I hereby eflscm that there is a central lending agency for the persimmons,of
yi 7 the work far which this permit is issued(See.3097,Civ.C.)
i] Q Lender's Name
Z)
� z lender's Address
J Q 1 ecrafy Nati have real this application and stain that me above laws
island,is
y Ubunch,I agree o comply wire all city and county ordinances and store lows relining e
V sheve-grd tined propend for insau ceprposesenmtivesul'thiscloy menorupon the
ahnvctmcmioncd property far instance purposes.
ti 4. (We)agree m save,indemnify and keep harmless the City of Cupertino against
Z in
equuce enotd!`the crisis and expensesmit, they in any way seems against said City
J z in consequence of the granting of this permit,
^' APPLICANT UNDERSJANCS AND WILL COMPLY WITH ALL NON-POINT Issued by. Date
SOURCEREGULAT]
rRC'� � 9 -1t -3
�Y�r/ Re-roofs
Signature of ApplicanpCamractor Dale
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant tors or handle haszrdoos mmeriui
az defued by the Cupnninn Municipal Cndc,Chapter 9.11,and the thrift and Safety
Code.Section 25532(id?
❑Ye, ki. All roofs shall be inspected prior to any roofing material being installed.
Will mea beam of future nodding If a roof is installed without first obtainingan inspection,I agree to remove
pp g by
Bu see.Air
P �'
nit hacamnus air cnnmminans az dcfncd by Nc Bay ArcuAir Qualify Management all new materials for inspection.
isvict? 1
71 Yea ,I'-I No
Irv&Sdct Nchammnams mis 255 15,5533 rcmens4,1 u Chapml6h5 if NC Cafiror
kidding
ant Hcalh&SafelyCbde,havea tenant,
s2st it
MYoutdd15lally In millet to de Ne Melding 1 1/�,,, �J•,••� t/'// (",Ifs //
J,cs not curzenlly have a tenant,mat it is my respans;bility m no,ily the twcupnt nl Ne �
regmrementswhichmustgelpa
poor Greenmail, Signature of Applicant Date
—Ir
Owner naumnri,.edagnt Dane All roof coverings to be Class "B" or better
CITY OF CUPERTINOCITY Of
CODE% REROOF
CUPEf�TINO PERMIT APPLICATION FORM
APN # _ �'l_ Date:
Building Address: �03 "I � IV\
Owner's Name: I Phone#:
C14� Df 4A)-2-4 110A 801
Contractor: Phone#: License#:
Ssc.0 X iz
Contact:� Phone#: Cupertino Business License#:
�-
Type of Roof Covering:
Existing: Proposed:
Built-Up Roof Built-Up roof
❑ Asphalt Shingles O Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) Cl Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report#
❑ To be Removed ❑ Provide Mrgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑
Job Description: 2
,1/1 fioj,11,11
Residential ❑ Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with P_)an ' e t. if
there are any restrictio sa
( f Proje Type of Con ton Occupancy grou .
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Ener BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
2, 3166
z 8-�, -3
September 17, 2003
Santa Clara County Assessor
Attached, please find the plans for 9 re-roof permits issued by the City of Cupertino on
September 16, 2003.
I wanted to bring to your attention that the roofs are being replaced on 9 separate
buildings. We were unable to find an address for the main Casa de Anza Homeowners'
Association. The only way we were able to find addresses was to pull up the parcel
number for one unit in each building, and use that address for the entire building. We
want to make sure, however, that if this changes the assessed value of the property, the
one unit will not be charged the assessed the full value. The change in assessment
should be shared by each unit in the building.
• This is a very unusual procedure, but we were unsure how to determine addresses for
these buildings. If you have any questions, please call me at (408) 777-3297.
Thank you.
Sincerely,
Nancy Czosek
Administrative Secretary
Community Development Department
•
ACIFIC
TATTES
MANAGEMENT COMPANY.
2510 Stevens.Creek Boulevard
San Jose,CA'95128
Fax: (408)885-9125 +
(408)R95-9160
September 15,2003
City of Cupertino
ft: Casa de Anza Homeowners Association
Roof Work
Dear Sirs,
This letter serves as confirmation th it the Casa de Anza Board of Directors has awarded
Security Roofing Services the contract to pe low the roof work.
Please let us know if you have any c uestions or need additional information.
Sincerely,
Pacific States Management
2003
��
btF 1 6
Sjeffia C. Coffee
BOD
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•
- - - _• - COMPILED IN CONFONMANCE VIT14 SEC 327
- OF TME REVENUE AND TAXATION CODE
- _ EFFECTIVE DATE MARg 1,1975
DWIGHT L. MATH IESEN-ASSESSOR
ACIFIC
TATES
• MANAGEMENT COMPANY.
2510 Stevens Creek Boulevard
San Jose,CA'95128
Fax: (408)885-9125 s
(40R) R95-9160
September 15,2003
City of Cupertino
Re: Casa de Anza Homeowners Associs tion
Roof Work
Dear Sirs,
This letter serves as confirmation th 1t the Casa de Anza Board of Directors has awarded
Security Roofing Services the contract to pe-form the roof work.
® Please let us know if you have any c uestions or need additional information
Sincerely,
Pacific States Management
�a c: cofTee
SC:sI
BOD
SEP 1
2003
By.
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3
COMPILED IN COIIFORMANCE YITN SEC-327
OF TME REVENUE AND TAXATION CODE
EFFECTIVE DATE MARCH I,IST5
DWIGHT L.MATH IESEN-ASSESSOR