07090088 CITY OF CUPERTINO
BUILDING DIVISION PERMIT
BUIL�L1 G D,i�ESS: PERMIT NO.
�i �U RIFREDI CT ALL SEASONS ROOFING SERVICES 07090088
OWNER'S NAME: PERMIT ISSUE DATE
SHIRLEY CHEUNG 1720 SMITH AVE 09/14/2007
NE: SANITARY NO. CONTROL NO.
ARCHITECTIENGTNEER: BUILDING PERMIT INFO
REMOVE 1 LAYER EXISTING COMP BLDG ELECT PLUMB MECH
C7 D O D
p Q LICENSED CONTRACTOR'S DECLARATION ,ktt -Job puscriptlon
U I hereby affirm that I am licensed under provisions of Chapter 9(commencing — -^'^— ^ ^^��^ ^^^^
:y�d with Section 70(IU)of Division 3 of the Business and Professions Code,and my license is
y infull force and of c C, '� C)
Z License CL► s Ltc.# `
,F W Datc Contractor `' )C C-J N`r'S
to RCHITECI'S DECLARA ON
i C< I understand my plans shall he used as public records
�uJ
'
U. Licensed Professional
y OWNER-BUILDER DECLARATION
I hereby AITrmi that I am exempt from the Contractor's License Law for the
a0 following reason.(Section 7031.5,Business and Professions Code:Any city or county
m rZ which requires a permit to construct,alter,improve,demolish,or repair any structure
Z y� prior to its issuance,also requires the applicant for such permit to file a signed statement
that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation
.Elm
(commencing with Section 7000)of Division 3 of the Business and Professions Code)or
°, that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not more than five hundred dollars($500).
❑1,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections
and Professions Code:The Contractor's License Law does not apply to an owner of q P
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for sale.If,
however,the building or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑I,as owner of the property,am exclusively contracting with licensed contractus to
construct the project(Sec.7044,Business and Professions Code:)The Contractors Li-
cense Law does not apply to an owner of property who builds or improves thereon,and.
who contracts for such projects with a conuwwr(s)licensed pursuant to the Comracmes
License Law.
❑I am exempt under Sec B&P C for this mason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
L]I have and will maintain a Certificate of Consent to self-insure for Worker's Compen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑I have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Workers Compensation{{` auran carter and Policy number am: _
Cartier. ��r. t13✓l�� Policy No.: 1Q
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars($100)
or less.)
I certify that in the performance of the work for which this permit is issued.I shall not
employ any person in any manner so as to become subject to the Workers'Compensation
Laws of California.Date_
Applicant
NOTICE TO APPLICANT.If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
Oforthwith comply with such provisions or this permit shall be deemed revoked.
Z CONSTRUCTION LENDING AGENCY
[~—c CA 1 hereby affirm that there is a construction lending agency for the performance of
(Y, > the work for which this permit is issued(Sec.3097,Civ.C.)
W Q Lender's Name
a z Lender's Address
V 0 1 certify that 1 have read this application and state that the above information is
LL r--r correct.I agree to comply with all city and county ordinances and state laws relating to
O building conswction,and hereby authorise representatives of this city to enter upon the
Cfa above-mentioned property for inspection purposes.
a (We)agree to save,indemnify and keep harmless the City of Cupertino against
Hliabilities,judgments,costs and expenses which may in any way accrue against said City
U Z in consequence of the granting of this permiL
►� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by Date
SOU CE REGULATIONS.
1q( Re-roofs
Si natureof pp rcanUContractor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupantstore or handle hazardous material
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Code,Section 25532(a)? All roofs ;hall be inspected prior to any roofing material being installed.
❑Yes �7.
Will the applicant or future building occupant use equipment or devices which If a roof i;installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminants as defined the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes �JJo
1 have read the hazardous materials requirements under Chapter 6.95 of the Califon-
nia Health&Safety Code,Sections 25505.25533 and 25534.1 understand that if the building C ` (J
does not currently have a tenant.that it is my responsibility to notify the occupant of dtc
require cots which must be met prior to issuance of a Ccmficatc of apar3oy l� Signature o Applicant Date
�I A'o'er 1 All roof coverings to be Class"B"or better
Owner or authorized agent Date
CITY OF CUPERTINO
2 ITEMS OF 4 PERMI`[' RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Bl:c: Lot:
APN . . . . . . . . . 35'716109 . 00
DATE ISSUED. . . . . . . : 09 /14/2007
RECEIPT #. . . . . . . . . : BS000002642
REFERENCE ID # . . . : 07090088
SITE ADDRESS . . . . . : 21320 RIFREDI CT
SUBDIVISION . . . . . . :
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : SH:CRLEY CHEUNG
ADDRESS . . . . . . . . . . : 21320 RIFREDI CT
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2852
RECEIVED FROM . . . . : ALL SEASON ROOFING
CONTRACTOR . . . . . . . : GORSHTEIN, VLADISLAV LIC # 21035
COMPANY . . . . . . . . . . : ALL SEASONS ROOFING SERVICES
ADDRESS . . . . . . . . . . . 1710 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 5, 000. 00 115 .56 0. 00 115.56 0. 00
BSEISMICRE VALUATION 5, 000. 00 0.50 0. 00 0.50 0. 00
----------- ---------- ---------- ----------
TOTAL PERMIT 116. 06 0. 00 116 . 06 0. 00
CITY OF C'UPERTINO
REROOF
CUPER`TINO PERMIT APPLICATION FORM
APN# Date:
a� r7 I (.P f (49 , O C� 9\V�Ao-�
Builda! Address: G\ LA
Owner's Name: Phone .
U-6) S5 (D
Contractor: License#:
Contact: r Cupertino Business License #:—
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
Asphalt Shingles .< Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
N nber 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:
00w\_ roc='c" G`55
Residential Commercial ❑
Fire Zone: Yes ❑ No Confirmed with Planning Dt. if
there are any restrictions:
Cost of Project: Type of Construction- Occupancy grou
W.S_ 0oc) C��oc vt j �2 -
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Itldg Permit Fees BUILDING
BENERGY Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
Fax: (408)777-3333
Building Department
Subject: Re-roofing policy for the City of Cupertino
1. Prior to permit issuance,you must agree to comply with 1997 UBC Standards
and manufacturers specifications on re-r:)ofing.
2. New roof coverings shall not be applied without first obtaining all inspection
and written approval from the building Inspector. A final inspection and
approval shall be obtained from the buil ling inspector when the re-roofing
is completed.
3. All roofs shall be inspected prior to any roofing installation.
4. To receive a final sign off from the City, he following steps are
required:
1) Pre-inspection and/or tear off appro-,•al.
2) In-progress inspection approval.
3) Final inspection approval.
a) Spark arrester installation.
5. If plywood is installed, a plywood nail vispection is required.
6. Any roofing which is applied without first obtaining an inspection,
will require the removal of all new material down to the sheathing,
so a proper City inspection can be performed.
7. NOTE: If you call for a plywood nail inspection and the job is not ready,
you will be charged a re-inspection fee cf$176.18. The re-inspection fee must
be paid before another inspection can lie scheduled.
IMPORTANT:
1. Flat roofs must have a minimum of 1/4" 3er foot slope and demonstrate
that there is no ponding.
2. An I.C.B.O.report is required to be on the job site at the time on inspection.
I understand and will comply with the above ;stated policy on re-roofing.
Homeowner's Name:
Job Site Address: d W y ac) �\ �'�- ,c ►�O C
Roofing Company Name: f_1�N �P__L�` Y�S
Applicant's Signature: Date:
Greg Casteel
Building Official
Revisec 111/2/04
_ Community Development
a
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY Of Fax(408)777-3333
-UPEkTINO
Building Department
JOB ADDRESS: CA 501`( PERMIT # O
\--Z� ' O � k.
OWNER'S NAME: ' \ , PHONE # - c
GENERAL CONTRACTOR: N\\% FAX # —
e��t C 4!tS"
I am not using any subcontractors:
Sig nature Date
Please check applicable subcontractors and com Tete 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
U
Owner/Contractor Signature bate