12050087 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 18884 LOREE AVE CONTRACTOR:ALL SEASONS ROOFING& PERb11T NO: 12050087
SOLAR
OWNER'S NAME: CHIN PATRICIA P 1720 SMITH AVE DATE. ISSUED:05/08/2012
OWNER'S PHONE: 4088067808 SAN JOSE„CA 95112 PHONE NO:(408)971-4455
❑ LICENSED CONTRACTOR'S DECLARATION r f r
�� 7 �G Q / BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic.q 7
yyI1
1/ MECH r RESIDENTIAL r COMMERCIAL F
ConlractorA Sc-n%Md Y-dA'�e S/
J;
hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION: RE-ROOF TEAR OFF EXISTING ROOF COVERINGS AND
(commencing with Section 7000)of Division 3 of the Business&Professions INSTALL NEW PLYWOOD AND IB 50 MIL WHITE AND A 2X2
Code and that my license is in full force and effect. SKYLIGHT
1 hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performancc of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the perfa mince of the work for which this Sq.FI Floor Area: Valuation:$12080
permil is issued.
APPLICANT CERTIFICATION APN Number:37515015.00 Occupancy Type:
I certify that I have read this application and stale that the above information is
correct. I agree to comply with all city and county ordinances and state laws relating
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. �f
Signature/'//ej n ;2.51 Issued by: fi��/✓ �7G Date:
❑ OWNER-BUILDER DECLARATION
RF:ROOFS:
1 hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is
the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
1,as owner of the property,or my employees with wages as their sole compensation, inspection.
will do the work,and the stmcturc is not intended or offered for sale(Sec.7044,
Business&Professions Cade) Signature of Applicant: Dale:
I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code).
ALL ROOF COVERINGS TO BE CLASS".P'OR BETTER
I hereby affirm under penalty of perjury one or the following three
declarations: HAZARDOUS MATERIALS DISCLOSURE
I have and will maintain a Certificate of Consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the 1 have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California Ileallh&Safety Code,Sections 25505,25533.and 25534, 1 will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Section 3700 of the Labor Code,for the performance of the work for which(his Safety Code,Section 25532(x)should I store or handle hazardous material.
Additionally,should 1 use equipment or devices which emit hazardous air
permit is issued. contaminants as defined by the Bay Area Air Quality Management District l will
I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's lleallb&Safety Code,Sections 25505,25533,and 25534.
Compensation laws of Califomia. If,alter making this certificate of exemption,I
become subject to the Worker's Compensation provisions of the Labor Code,I must O r or sulho 'zed agent:
forthwith comply with such provisions or this permit shall be deemed revoked. D
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
I certify that I have read this application and slate that the above information is I hereby affirm that there is a construction lending agency for the performance of work's
correct. I agree to comply with all city and county ordinances and stale laws relating for which this permit is issued(Sec.3097,Civ C.)
to building construction,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned properly for inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments. Lender's Address
costs,and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply ARCIIITF.CT'S DECLARATION
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. 1 understand my plans shall be used as public records.
Signature Date Licensed Professional
� � v0 �1
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228• FAX(408)777-3333• buildinclacuoertino.ora
CUPERTINO
PRI 11iCT AUURIi55I nPNa I ,i 0 I \
OIVNIR NA11I PHONE F-MAI(. J
�joaOm 79D
SIRFI;IADDRESS1 Lo Q CITY. STATE,ZIP C1 J C FAX
('ONTACT NA.M PIIONE E-MAIL
rm/2� -Q71—Ll 55
STREET ADURESS (TTI',STATE. ZIP FAS
I.7o20 `JGu'Ic�OSD Cc._. / -9M-9 1-7
❑OWN'IiR ❑ ON'1FR-0UJI.DFR ❑ OWNER AGENT ® CONTRACrOR ❑CONTRACTOR AGENT ❑ ARCIIn'G(.T ❑ENGINEER ❑ DLYPI OPI.R ❑ TI SANT
CONI RAE:IOR NAME LICENSE NUMBER-7,5131 O9 LICENSE IN BUS,LIC.n ^/0 35
l'OMI•ANI'\'AMI! EMAIL FAX O(
7
STRFFT AODR 1 CITY,STATE,%IP PHONE
7/_
ARE'I UJ H( LENOINHISR NAME LICENSE NUMBER BUS.I.R.n
COMPAN)"NAME E-MAIL FAX
SHUT I ADDRESS CITY.STATE.ZIP PIIONF
USI, OF [a (get DupICX ❑ MBIII-Family ROOF AAIUFA: 70?
UATION.
STRUCTURE ❑ Commercial C) k
EXIS I'IN'(i ROOF 1)mi. ❑BUICr-UP ROOF ❑ASPI IALT SI IINGLES 13 WOOD SI IAKES ❑WOOD$(IINGLES ❑OTIIIiR ISPCCIFYI
RE\IOVEJU PLACH CRYIiS IFNO, PLYWOOD ❑ 'A, ❑ PLYWD ® OSB PITCH ROOF
❑ NO ri LAYERS: THICKNESS: ❑ SIR' TYPE: ❑ ('DX __4L :12 ('LASS A
PROPOSED ROOF"iNPB: 'I BUILT-UP ROOF ❑ASPIIALTSIIINGI.r.S ❑WOODSHAKES ❑W'OODSIIIN(LES MOTHER jg •A 1('C-IIS REPORT n
DIiSI'ICIPTION OF WORK'
'�J"-G Ick. un'.irF r n o oA" 3An-- ( I k rru u> O1 Ia7 ocd
_ancl_S.g_5D_►•�:,d,_�'►i-kQ c�.n•d_n a x a a�y_ldn
BY my signature below,1 certify In each of the following: 1 am the property owner or authorized agent In act on the properly owner's behalf. 1 have read[his
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and,Slate laws relating o building construclion. I authorize rcprcsen1tativcs of Cupertino to enter the above-identifiedI )perry for inspection purposes.
Signature of Applicant/Agent: \� Dale: 0
SUPPLEMENTAL INFORMATION REQUIRED OFFICE use ONLY
_ If building is associated with a Home Owner's Association,provide letter PLAN CHECK TYPE ROUTIN;SLIP
of approval from I IOA. OYER-THIS-COUNTER PLAN RF.I'IF.IY
Provide Planning approval to verify if there any restft_cJit)gin PLS J❑EXPRESS ❑ PLANNISG PLAp'REI'R:N'
Provide copy ot'Manufacturer's Installation Specificaj V l V
�C((E]D By. ❑ STANDARD ❑ FIRE DEPT
Provide signed copy Of Cupertino's Tear-Off Policy. S I]i ElOTBER:
OATS 1
CANNI�NG�},�DEPT.
G'SLIM Reroof.4pp_201 Ldoc revised 03116/11
DATE
CITY OF CUPERTINO
FEE ESTIMATOR— BUILDING DIVISION
ADDRESS: 18884 Loree,Ave DATE: 05/08/2012 REVIEWED BY:, Sean
APN: BPP: 'VALUATION: $12,080
*PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Duplex PENTAMATION 1SFDWLROOF
USE: PERMIT TYPE:
WORK Tear off existih 'roof coverin sand install new plywood and IB 50 mil white and a 2X2 skylight.
SCOPE
FEE ID ROOF AREA
s.f.
1REROOFFRES 2,000
M vch. Plan Check Plumb. flan Cheek F.lec. PPun Cherk
;L/rub. Permit Fee.' Plumb, Permit Fce: lilac. P.rnuir Fre:
Odrer Mer'h. Imp. Other Plumb Incp. Other tiler.Insp. ED
,tech. hop. Fr'c: Plumb. lrrsp. Fee.: lace.ln.ip.Frac:
NOTE: This estimate does not includejees due to other Departments(i.e Planning,Public Works, Fire,Sanitary Sewer District,School
District,etc. . Thesefees are based on the prefinddha information available and are only an estimate Contact the Dept for addn 7 info.
FEE ITEMS (Fee Resohdion 11-053 Elf. 7/l/l 1) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
.Supp/. PC Fce
Phanb.41•tech./0ec
Permit Fee: $280.00
.Supp/. hr.cp l'ee
Pl u j n h.514ech./ISP ec
I'/unrh.!rldec11JElec Permit Fee:
Construction 7,41.1:
Admini.clrnlive 1''ec:
Work Without Permit? O Yes, 0 No $0.00
Advanced Phmnir�Ices: '
Truro DOcuurentatiun Fees:
s
Strong Motion Fee: IBSPISMICR $1.21 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: 1 $282.21 $0.00 TOTAL FEE: $282.21
Devised: 04/01/2012
CITY OF CUPERTINO
3 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 37515015.00
DATE ISSUED. . . . . . . : 05/08/2012
RECEIPT #. . . . . . . . . : BS000016755
REFERENCE ID # . 12050087
SITE ADDRESS 18884 LOREE AVE
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : CHIN PATRICIA P
ADDRESS . . . . . . . . . . : 18884 LOREE AVE
CITY/STATE/ZIP. . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . .
CONTRACTOR . . . . . . . : GORSHTEIN, VLADISLAV LIC # 21035
COMPANY ALL SEASONS ROOFING & SOLAR
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
---------- ------------- ---------- ---------- ---- -------
1BCBSC VALUATION 12, 080. 00 1. 00 0. 00 1.00 0. 00
1BSEISMICR VALUATION 12, 080. 00 1.21 0. 00 1 .21 0. 00
1REROOFRES SQ FEET 20.00 280. 00 0. 00 280 .00 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 282.21 0. 00 282 .21 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 536 .41 #33454
---------------
TOTAL RECEIPT 536 .41
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
---- ---- ---------------------------- -------- ----------------------------
309 EXTERIOR LATH 311 SCRATCH COAT
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF