06050076 (2) CITY OF CUPERTINO x" t°,�< Asa k.k:.:;-ss,t'„ +�r l ';s"' g�L `.
BUILDING DIVISION PERMIT kCQNTRACTCIR INFORMnQN `
BUILDING ADDRESS: ALL SEASONS ROOFING SERVI .grr"'O'06050076
10281 PHAR LAP DR
OWNER'S NAME: PERMIT ISSUE DATE
JOHNSON MARION F TRUSTEE 1720 SMITH AVE 05/09/2006
Eo SANITARY NO. CONTROL NO.
(408) 971-4455
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
;Op LICENSED CONTRACTOR'S DECLARATION
w 1 icmby affirm Nat I am licensed under provisions of chapter
(eamm.ncing Job Description -
t2 with Section 7")of Division 3 of the Business and Professions Code,and my license is
a« Io fail fort mdeIT q REMOVE 1 LAYER EXISTING SHAKE ROOF. INSTALL 38
; _ Li"nes l Lle." QUAKES . 7/16" OSB & 38 SQUARES 50 YEAR COMP
F a Dam Contractor
�� ARCHITECTS DECLA TION ��.JC
I a I understand my puns,hall W used u public mcorda 5
yyU
'a Licmup d Professional
3 OWNER-BUILDER DECLARATION
I I hereby affirm Nat 1 am exempt form Nu
e Conamr's cLicense Law for the
Ma o following won.(Section 7M IJ.Business and Profession Code:My city or county
which requires a pemtit to convect,alms,improve,demnluh,nr repair any stmemm
prior m its issuance.also requires the applicant for such permit to file a signed statement
< that W is licensed p..I to the provisions of the comantu'.Brave Law(Omplcr 9 Sq.FC Floor Area Valua[ 3800
If 0 (commencing with Section 7=)of Division 3 of the Business and Pmressimu Count or
i that he Is exempt N.rcfmm and the Was fa the alleged uemption.Any violation of
Section 7031.5 by any app[i.,for a parmiuubjcas the applicants m a civil penalty of e
3 2 6 3 9 t��7 . 00
Occupancy Type
not more Nan Bre huMrtd dollars(5300). '
L as owner of six PaoPertY,m my aoployw with wages u th'u sale compenotion,
will W Newark and the structure 4 not intended or offered for sale(Sec.7004,Business
and Pmfecrions Cade:The Conoacmr's Licosa Law clue rot apply m an owrmr of Required Inspections
property who Wiles orimgorcs there rm,and whodoessues work himselforNmugh his
Own emplawes,provided that such improvements are notintended aro@red for We.If.
however,Ne building or improvement is sold within arm year ofcompletion.the owner.
builder will saw six burden of proving Nat W did rot Wild or improve fa purpose of /
mk.1.
0 1.all owmr of the property am exclusively conuacting with liaved enmraemrs m
convect the project(Sec.7004.Business and Professions Cade:)M Conmacmri U.
come Law does not apply to an owner of property who Wild,or improwa Neman,and. L
who contracts for such projects with a eonuacter(s)Batued pursuam W the Conwaoh -
(.icnaLaw.
Lilsm exempt under See ,BdPCfor this won C
Owner Data
WORKER'S COMPENSATION DECLARATION X
1 hereby afEren under penalty of perjury ens of the following declarations:
1 haw and will by=
aCodGam of Covets Code,
tfor Worker's C,of the (�
sedan,r provided for i Section 3'1110 of the labor Cade,for the pcsfarmana of 1W
work for whits this permit is issued.
0 1 haw and will maintain Worker's Compensation Insurance.as required by Section
37M of the Label Code,far Ne performance of the work(which this permit is Issued.
My Worker's Compermatov hmutatxe artier and Palicy number art:
Cartier. Paliry No.:�'1 1'1`KSO^a(p
C RTIFlCATE OF EKEMFTION FROM WOI'
COMPENSATION INSURANCE
(Thu xalen need nmtbecampleted ifthe permit Is forma honthed deffm($100) r
or less.)
I ceadfy that in to.paltsersnea of use,war"far which this permit u island,I shall not
employ anypeamn in any maxmer art u to b.cam.subject to the Warears'Competences
Laws or California.Data
Applicant
NOTICE TO APPLICANT.IL after making this Ce"ificate of Exemption,you should
became subject In the Woher's Compensation provisions of the tabor Code,you mese
.,z forthwith comply with such proinums or this permit shall W deemed mated.
Z " CONSTRUCTION LENDING AGENCY
F IWreby whaRsmthem mit ascd(Sec.30lending agency for N.Performance of
D: Le wort for which our permit ts issued(Sec.]097,Civ.CJ
Q.
Lenders Name
=z Lender's Address
U 0 1 certify that 1 haw read this application and sole that the aWw information is
LL r correct 1 agree to comply with all city and county ordinances and sots laws relating to
OU Wilding convection,and hereby autharirz repremnutivesof this city,.tato upnn the
W above-mentioned property for inspection purposes.
(•"gL (We)agree to save,indemnify and keep harmless dm City of Cupotino against
y Iiebilities,Judgments.com and expenses;which may In my way amts against said City
U z in consequence of the gtaming of this Permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOU RFGGULATIONS.
Re-roofs
Si umof ApphanuConuanor te
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the appliemt m forum Wilding oaupmt store orhandle barardous material
u deRrxd by the Cupenin t Municipal Code.Chapter 9.13,and the Health and Safely
Cock,$coon 35532(,)?
❑Yes �No All roofs shall be inspected prior to any roofing material being installed.
40 ,
Wit]the applicant or future building Occupant use,equipment or devices which If a roof is installed without first obtaining an inspection,l agree to remove
.mit hevardnv it contaminator u defined by tW Bay Ama Air Quality Management all new materials for inspection.
District? 's<,�
oyes ,51 Nu
I haw mal the Aa wsm=fi.iamquircmeoounder Chapmf6.95 often Califor.
nia Fast"SOrCLYCad..SecEons 25505,25533 md25534.1 ondcrsmd Naifthc Wilding
,tees trot cooently have a tenml ler it u my responsibility m ratify do a¢upanr or the
myu"mm.nu whklt muss W mel rwivaaOcc ofa CadRcam of Occupancy. Signature Of Applicant Date
ctor:atharitedagent Dam All roof coverings to be Class "B"or better
Community Development
10300 Torre Avenue
fes. Cupertino CA 95014
^µu Telephone(408)777-3228
CITY OF Fax(408) 777-3333
ffUPEkTIN0
Building Department
JOB ADDRESS: PERMIT#
- Co 6Z� �6G76"
OWNER'S NAME: PHONE # wog l-q q 75,t5-
GENERAL
—
GENERAL CONTRACTOR: , 4i FAX #
Q'Cc S
I am not using any subcontractor§'7p U� /,ak n _
Signature Date
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
1 of 3 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 32639047 .00
DATE ISSUED. . . . . . . : 05/09/2006
RECEIPT # . . . . . . . . . : 34320
REFERENCE ID # . . . : 06050076
SITE ADDRESS . . . . . : 10281 PHAR LAP DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : JOHNSON MARION F TRUSTEE
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
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
4tEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 4 , 000 . 00 104 . 76 0 . 00 104 . 76 0 . 00
BSEISMICRE VALUATION 3 , 800 . 00 0 . 50 0 . 00 0 . 50 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 105 . 26 0 . 00 105 . 26 0 . 00
CITY OF CUPERTINO
5,-120 REROOF
CUPEkTINO PERMIT APPLICATION FORM
APN # 'bq OLM Date: �j Ca
Building Address:
02-:i \ Yui,
Owner's Name: Phope#:
Contractor: License#:
A\\SertiSo<\S ���ci S �) SA\OCA\
Contact: Phone#:
Applicant/Contractor: Fax#:
s Ivoi ( 40X °\3`6-'1\��
Building Permit Info:
Bldg Qc)q Elect Plumb Mech
Job Descriptipn: zrS���t 38 �c ce
t«iw�o�7e- \amu ex�_\i S�lw.ke �oo� , S°1 S
Residential: a crM Commercial:
Sq.Ft. Floor Area: `"' %tYM='%,% $/Sq.Ft.:
3On
Architect/Engineer: Valuation:
O
Type of Construction: Occupancy Group:
� Cc0
Qty. if
A licable Fee ID Fee Description Fee Group
/ BPERMFEE Bldg Permit Fees BUILIDNG
BENERGY Energy BUILIDNG
BSEISMICRESeismic Fee Res BUILIDNG
BSEISMICOM Seismic Commercial BUILIDNG
NG
Plan Check Fee BUILIDNG
BUSLIC Business License BUILIDNG