08120007 CITY OF CUPERTINO a-� 4.r
BUILDING DIVISION Pili RMITCUNT, AC6TOR IN yURMATION $:
BUILDING ADL-ESS: PERMfr NO.
954 VERNIE CT ALL SEA
OW NEWS NAME: SERVICES FERMTT ISSUE DATE
'INE: A 'CONTROLNO.
(408) 971-4455
ARCHITECNENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
I� l�
tion
LICENSED CONTRACIDRSDECLARATION Job Description
1 hereby affirm Nat I w licensed under provisions of Chapter 9(commencing
vide Sacdon70110)of Dlvirinn 3.fde Rusin sed PmfG.a...,.Cade.m mylicenseu
+ „ bfull rweeaederteci
RE-RF RMV EXT SHK RF INSTL 24SQ CLS A OSB & 40YR
03 ucens a . Uc.a
Dale IV egjUaab ContractorrJ,-G 't a COMP RF
ARCHITECTS DECLARATION 5
1 understand my plans shall W used as public"c
5Eu
k C Licensed Prul.woned
3 OWNER-BUILDER DECLARATION
E I hereby affirm Nat 1 am exempt from the Conirmtor's Lic men Law for the
cc following won.(Section 70713,Bunwss and Profesdan Code:My city or cmhmy
4.-8! which requires a Permit to crmsm ca shoe,impmw.demolish.or repair any suonuse
prim to its issuance.also requires tie applicant for such permit in file a signed sulemcnt
S
<
that ire is licensed Pursuant so the pmvisloru of the Comrwmrs Lice=Law(Chaper9 Sq.Ft.Floor Area Valuation
,5 that(commencinghextempt Section,andtfDivision si3 ofdeeeged csandrmfemian Cude)w
i�3 dist k u exwpr deerefrom and Bre bnu fon Ne alleged eumptiom MY violation of $9500
Section 7031.5 by airy applicant for a permit subjects the applicant N a civil penalty of APN Number Occupancy Type
not more N,n RK hundred dollar.($5M. 35922049 . 00
❑I:as owner of the property,or my employees wide"goal n their auto compensation,
will do dee work,and It spYclum is not intended ar offered forest.(Sec.7014.Business
and Pmfenmm Code:Tire cum scopes License Law ones Out apply m an"net of Required Inspections
propertywho Wilda wimpmves themen,antl who doessuchwork himselfor through his
Own employees,provided that such improwm<ms am not intended wo@red forsale,E.
however,the building or improvement u sold within one yew of completion.Ne owner-
builder will haw Ne Wren of proving that he did not build w impmw fon purpose of
sale.).
❑I.n owner of Ne property.w excluswly eansuving with Beano mntracters b
construct the project(See 70th,Business and Rofusvoes Code:)The Coousctola LL
cern law does nut apply an an owmar of property who Wilds or impresses Hereon,and,
who co...for such projects wiNaeanvacNr(s)licensed Pumwnt to the,ConsanwS _
Lleewe law.
Ismexemmunder See .B&PCrerthannar.
Owner Data
WORKER'S COMPENSATION DECLARATION
I homey ale mover penalty of perjury,mre of He following declarations:
I haw ami will maintain a Certificate oI.Cmdam,to self-insure fon wwkcYs Comprn-
ien,as provided fon by Section 3700 of dee Labor Code.ler the Performance of dee
work for which Nu Permit is treed. .
❑1 haw and will maintain WwOm,Compensation Insurance.n mquhed by Section
5700 of the Mbar Code,fon the pwfarmawe of dee work fonwhich this permit is handed.
My Wmkes CompensationIwrs.carrier aed Policy number art:
Cartier. 51�1-P F /tS;l Policy No.: -0Q 012$1,09
CERTIFICATE OF EXEMPTION FROM W 0 ERS'
COMPENSATION INSURANCE
(Thu sccUm need cot be completed lithe permit is foronohundred dollen($100)
or leas)
I ceWCv that in We perfmmaree of dee work fon which this Permit is issued.l coal ma
employ any person in any manner au as an become subject to Ne Werkers'Compcnation -
Laws of Califomia.Dae
A,U.t
NOTICE TO APPLICANT:If.after making this Certificate of Exmn(dion,you should
become subject to Ne WmkeY,Compensation pmvuiom of vin Labor Cade,you mus,
O foMwith comply with each pr.,We.or Nu permit shall Weemedvok
dreed.
Z "i CONSBUCITON LENDING AGENCY '
(-ham I hereby affirm that Vert is a construction lending agency fon the parlonnmw of
E
7 dee murk fur which this permit is issued(Sec.3097,Civ.C.)
0 Undoes Name
z Lendels Add.
V0 1 mtify Nat 1 haw read this application aad see vim He Wow informants,u
LLQ E caused I agree m comply with all city and county ordimm�es and sate taws rtladng b
.0 CrJ^ Wilding cowsuction,and hereby audmrie,mpresentativesof this city to.=.nn de ,
r{Ll show-nentiortl property fon inspection purposes
gy (W.)agree to saws indemnify and keep hermles dee City of Cupertino against
H h liabilities.judgmens,eossmoexpen— which mayin anyway aceme ajamst.&M City
V z in consequence of dee grsnbng of this permit
^� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:9 Date ZI
SOpgcE REGULgTIONS. A
/1/e i su ArO �i//e(A /7� 9/�F Re-roofs
SignmSignm fAo�onuauwr Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the appluml or furans Wilding aneupantmo.orhandl.harudow material
as deUacd by the Cupertino Municipal Cade.Chapter 9.13.and dee Health and Safely
Cade.Section 35533(,)+ All roofs shall be inspected prior to any roofing material being installed.
❑Y dNo
Will He applicant or future Wilding oecnpant use,equipment m device,which If a roof is installed without first obtaining an inspection,I agree to remove
it havaMm
air exr umirunu as dcftncd by He Bay Area Air Quality Management all new materials for inspection.
ttt
r]Y. Nu
I haw mad the hammcut maeriau m,piromens under Chumsm 6.95 of to Csliror- (,
.is Health&Safctycotl..Section 25505,25533 end 25534.1 understand!Nm if de Wilding /��l.I, /YA ��Of/A�� // �a/1' /s'
does taut emlansly haw I.nam.Net it is my Mpanibiliq m notify Ota.ccuPmn of Ne P is V t OOO V 1/L- /'_ (/ l
rNi nor which m WMet priorbissuanccofaCutificamofOccupa9cg/ Signature of Applicant Date
owner suthcried agent /()mAll roof coverings to be Class'W or better
CITY OF CUPERTINO
• 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: pdtg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN I . . . . . . . : 35922049 . 00
DATE ISSUED. . . . . . . : 12/01/2008
RECEIPT # . . . . . . . . . : BS000006715
REFERENCE ID # . . . : 08120007
SITE ADDRESS . . . . . : 954 VERNIE CT
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : CHEN MEI-YU
ADDRESS . . . . . . . . . . : 954 VERNIE CT
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4346
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
------ ----- ---------- ------- -------- ---------- ----------
IBSEISMICR VALUATION 9, 500 . 00 1 . 00 0 . 00 1. 00 0 . 00
1REROOFRES SQ FEET 24 . 00 312 . 00 0 . 00 312 . 00 0 . 00
TOTAL PERMIT 313 . 00 0 . 00 313 . 00 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 313 . 00 #25075
---------------
TOTAL RECEIPT 313 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
---------------------------- -------- -------------- --------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
e
Community Development
10300 Torre Avenue
t Cupertino CA 95014
;;' Telephone(408) 777-3228
CITY OF Fax(408)777-3333
WUPERTINO
Building Department
JOB ADDRESS: PERMIT #
eSY 1,erv�: �i - o� /a oo 0 7
OWNER'S NAME: v PHONE #
GENERAL CONTRACTOR: 1 a _,' s #
I am not using any subcontractors:C/�2 i 1r6 bizft6LC C
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
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-roofing.
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 building 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, the following steps are
required:
1) Pre-inspection and/or tear off approval.
2) In-progress inspection approval.
3) Final inspection approval.
a) Spark arrester installation.
5. If plywood is installed, a plywood nail inspection 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 of$176.18. The re-inspection fee must
be paid before another inspection can be scheduled.
IMPORTANT:
1. Flat roofs must have a minimum of 1/4" per 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: 'N\e\ -iV (\Ales
Job Site Address: O�5L-\ 'Q 2.c`4-6e— c-\,
Roofing Company Name_: A{�\\ SEG�Sb�S �oO�J` SP�fViCSC
Applicant's Signature: `N Q 61 � Date:lj 1 l O,�Y-
• Greg Casteel
Building Official
Revised 11/2/04
CITY OF CUPERTINO
E REROOF
CUPEkTINO PERMIT APPLICATION
APN # 12 a 9 . o Date:
Building Address:
Owner's `Name: Phone #:
Contractor: Phone #: (❑\ZV) 0�1\ yy5�
,N\\ S2l�so�S ��� j Sc c ��e�S
Fax #: (L1c�r)
Cupertino Business License #: Contractor License #:
X035 ^IS,�A(D \
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)
Number of existing coverings 1 ❑ Provide I.C.B.O. Report #
>(' To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description:
f_-eiv ,J&-- ;r\5 5N'W\
yc y(' C04\^p cook (art'�-
Residential X Commercial El
Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if
Green Building Checklist & attach it to the application or if there are any restrictions: ❑
applicable, include in plan set & the sheet index.
Valuation:
moo\ Soo
I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
Signature
Revised 6/16/08