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12050088 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10601 JOHNSON AVE CONTRACTOR:ALL SEASONS ROOFING& PERMIT NO: 12050088 SOLAR OWNER'S NAIVE: CHAO WEI AND CHAN JEANNIE S 1720 SMITH AVE DATE ISSUED:05/082012 OWNER'S PHONE: 4087280141 SAN JOSE,CA 95112 PHONE.NO:(408)9714455 ❑ LICENSED CONTRACTOR'S DECLARATION r r r BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class C —?IF Lic.N .��— —�- _- p_ MECH r RESIDENTIAL r COMMERCIAL r Contractoi/M C—g.qpu 1MnFv'1�hte S O ��/ J" I hereby affirm that 1 em licensed under the provisions of Chapter 9 JOB DESCRIPTION: RE-ROOF REMOVE EXISTING ROOFING AND INSTALL NEW (commencing with Section 7000)of Division 3 of the Business&Professions PLYWOOD AND INSTALL TPO MATERIAL 50 MIL WHITE Code and that my license is in full force and effect. CARLISLE 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 performance 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 performance of the work for which this permit is issued. Sq.FI Floor Area: Valuation:$11950 APPLICANT CERTIFICATION I certify that I have read this application and stale that the above information is APN Number:37527012.00 Occupancy Type: correct.I agree to comply with all city and county ordinances and stale 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 indemnify and keep harmless the City of Cupertino against liabilities,judgments, PERMIT EXPIRES IF WORK IS NOT STARTED costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non-point source regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION. 9.18. Signature —Date- Issued by: �fy7l�!- Date: ❑ OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for one of RF--ROOFS: the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is I,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection. Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: Date: construct the project(Sec.7044,Business&Professions Code). 1 hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 1 have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain Section 3700 of the Labor Code,for the performance of the work for which this compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Safety Code,Section 25532(a)should I store or handle hazardous material. permit is issued. Additionally,should 1 use equipment or devices which emit hazardous air I certify that in the performance of the work for which this permit is issued,I shall conlaminants as defined by the Bay Area Air Quality Management District 1 will not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Compensation laws of Cali forma. If,alter making this certificate of exemption,I Health&Safety Code,Sections 25505.25533.and 25534. become subject to the Worker's Compensation provisions of the Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. 'qe or authoriz d egeat: -7 �/e�z ejiv-a 2aur/a,�te: APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that 1 have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating I hereby affirm that there is a construction lending agency for the performance of work's to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.) upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the Lender's Address granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION 9.18. 1 understand my plans shall be used as public records. Signature Date Licensed Professional CITYTOF CUPERTINO 3 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 37527012. 00 DATE ISSUED. . . . . . . : 05/08/2012 RECEIPT #. . . . . . . . . : BS000016755 REFERENCE ID '# . . . : 12050088 SITE ADDRESS . . . . . : 10601 JOHNSON AVE SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . : OWNER . . ... . . . . . . . . : CHAO WEI AND CHAN JEANNIE S ADDRESS . . . . . . . . . . : 10601 JOHNSON 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 11, 950 .00 1. 00 0. 00 1.00 0.00 1BSEISMICR VALUATION 11, 950 .00 1 .20 0. 00 1.20 0.00 1REROOFRES .SQ FEET 18 .00 252 . 00 0. 00 252.00 0. 00 ------ ---------- ---------- ---------- TOTAL PERMIT :, 254 .20 0. 00 254 .20 0. 00 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 ZC> > REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228• FAX(408)777-3333•buildinO(a)cuoertino.org CUPERTINO PROTECT ADDRESSI APN e -7 '�� OWNER NAME. �� —b1 /PHONE r.-MAIL �l tiTRISITT ADDRESS CI STATE,ZIP F\X ('ONTACT �NAMIS , - i-- PHONE E-MAIL, -G I-u 55 STREETADDRESS CITY.STATE, ZIP FAX 112o 5Yr. ,+a, so 1, L4 OF) 9_36- ❑OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER Cl DEVELOPER ❑ TENANT CON"TRACTOR NAM Ii LICENSE NUMBER LICENSF.TYPE BUS.I,IC Dai 03 ('(MPANY NAMF, E-MAIL FAX STREET ADDRESS .STATE.ZIP PHONE S i-q sS ARCHITECTif:NGINF,ER NAME LICENSE NUMBER BUS,LIC.A COMPANY NAME E-MAIL FAX STREET ADDRESS CITY.STATE,ZIP PHONE USE OF ®.Oor Duplex ❑ Multi-Family ROOF AREA: VALUATION: - STRU(S(IRR: ❑ Commercial RXISI"INGRODPTYPF.rrnn yy BUII.T.UPROOF ❑ASPHALTSHINGLES ❑WOODSIIAKES ❑W'OODSHINGLES 11 OTHER(SPECIFY) RESTOVE,REPLACE 0%YF.S IF NO, PLYWOOD ❑ a" 11PLYWD ® OSB PITCH: ROOF ❑ No nL RS: THICKNESS: ❑ 5is" TYPE: ❑ ('DX _z2_'12 CLASS A PROPOSED ROOF TYPE: 'I RUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTIIER IPO ](C-F.SRHPORTu DESCRIPTION OF WORK: _ k-__1 CA Ti �—MC A •� �.t,,�, r.��'1 ire G.2 I 1 S)e. By my signature below.I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is correct. 1 have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and slate laws relating t building construction. I authorize representatives ofCupenino to enter the above-id milted p operty for inspection purposes. Lie- Signature of Applicant/Agent �l CL+ 0. Date: S � �� SUPPLEMENTAL INFORMATION REQUIRED ., OFFICE USE ONLY If building is associated with a Home Owner's Association,provide letter PLAN CIIECK TYPE ROUTING SLIP of approval from IIOA. U.OVER-THF.COUNTER i ❑ BUILDING PLAN REVIEW Providc Planning approval to verify if there any restrictions.a•05 ❑:EXPRESS�+ ❑ PLANNING PLAN REVIEW' Provide copy of Manufacturers Installation Spec ��soY ❑`ST, DARD ❑ FIRE DEPT C Provide signed copy of Cupertino's Tear-Off Policy. C•��-"�i2 w - ❑ OTHER: -G D p`6` 1 r ReroofApp-2011.doc revised 0311 611/ ppTE CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 10601 Johnson Ave DATE: 05/08/2012 REVIEWED BY: Sean APN: BP#: `VALUATION: $11,950 *PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof PRIMARY SFD or Duplex PENTAMATION 1SFDWLR00F rSE PERMIT TVPE: Remove existingroofing and install new plywood and install TPO material 50 mil white Carlisle. FEE ID ROOF AREA s.f. 1REROOFFRES 1,800 1 fvd,. flan C'h,:rk 1'l urrrh. flan Chat A Ove. Man Cheak ILr.L. Pe"llit Fee: !'lump. Permit h:r: ICl.re. P,., nit Fee: (hhvr,11orh. Ince, Other Plump/ne'p, (Jrher/i(cr.hrcp. ,Ildr h. hrrp. F'.': Phnuh. Lr.,p. Fee: Flrr.hop. NOTE: This estimate does not include fees due to other Departments(Le. Planning, Public Works, Fire,Sanitary Sewer District,School District,etc). These ees are based on the prelimina information available and are only an estimate Contact the De t or addn'l info. FEE ITEMS (Fee Resohi ion 11-053 Eff 7/1/11) FEE QTY/FEE MISC ITEMS Plan Check Fee: .Supp/. P(;hew l'lennh./blech.!lilee Permit Fee: $252.00 Suppl, ln.y Fee /'h u n b_4bl ecic(FICC. 1'lumh.hLlerlr.ililcC I'crmir Fee: Curun uc•1i017 Tax. ilclmim'11,161d Fee Work Without Permit? O Yes (E) No $0.00 Adraneed I'lurmi ig Fees: Trm,cl 000M170110/10u Fc:es: Strone Motion Fee: IBSEISMICR $1.20 Select an Administrative Item Bldc Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $254.20 $0.00 TOTAL FEE: $254.20 Revised: 04/01/2012