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07100113 CIT� OF CUPERTINO ' BUILDING �IVISION PERMIT �� ~ : ,,, ;_.. ........: . • , PERMIT IYQ. Bu '� ° �3�� ES �UMFORD DR ALL SE��SONS ROOFING SERVICE 07100113 � pERMIT ISSUE DATE OWNER'S NAME: • . SHEK ANTHONY P AND MARY S TR US 1720 SPIITH AVE 1 1 SANTTARY NO. CONTROL NO. �NE: BUILDING PERMCf [NFO ARCHITECC/ENGINEER: RE � RMV 1 LAYER EXSTNG BLDG ELECC PLUMB MECH � � 0 � LICENSED CONTRACTOR'S DECLARAT[ON � ;oo ,.,._., ��,._.r__r _ ,,,. .... Jah.Des�ription , m F 1 hcrcby a[firm that I am licenscd unJcr provisions af Chaptcr 9(commcncing : z� with Sccdon 7o00) of Division 3 of thc Busincss and Pr� �/, �/ and my liccnsc is �� y in full Corce and ef(Fq�� ' V � v� Z Licensc C�ess [ L�. x p Dam /N� Coatnaor�f/s� o .1 ; �"' � p HCR�17'ECI'S DECLARATION ;� .a U 1 undcrstanJ my plans shall be uscd as public rcconLs ' u y Liccnsed Pcufcssiona� • � < OWNER-BUILDER DECLARATION � <� I hcrcAy alTirm that 1 am excmpt (mm thc Contractor's Liccnsc Law for thc p O Collowing reason. (Scction 7Q31.5, Busincss and Profcssians Ca1c: Any city or rnunty �,°, �i which ccquires a pertnit to conswct, altcr. improvc, dcmol'vsh, ar repair any swcwcc prior ui iis issuancc, alsu rcquires the applicant for such permi� to filc a signcd stalement ;; Ft. Floor Area Valuation -=< ihat hc is IieenscJ pursuani �o thc provisions o( thc Conuacu�r's Liccnsc Law (CAaptcr 9 � t �(commencing wiih Scction 7000) of Division 3 of lhc Busincss and Profcssions Codc) or i�� ihat he is exempt thcrofrom and ihe basis (or the alicged excmpUon. Any violazion a[ ApN Number Occupancy Type Section 703 i.5 by arty applicant for a pertnit subjecu the applicant to a civil penalry af not morc than fivc hundred dollars (5500). ❑ I. as owner o[ [Ne property. or my employces with wages as tlx'u wlc compensation, will do thc wark. and �he stcudwe is not inundcd or offercd forsalc (Sec.7044. Business Required Inspections and Peofessons Code: The Conuxwr's License Law dacs not apply �o aa owner o( propeny wha builds or improves thercon, and who does such wort himself or ttwuglt his own employccs. Providcd chat such improvemen�t are not intended or otCered Cor sala I[. however. Uu building or improvement is sold within one year o! compleuon, d�e owner- builder will have the burdan oC proving �hat he did no� build or improvc for purpose of sakJ. ❑ I. as awner of the property. am uctusively convacting wit6licensed conuxtars W wnstruct the project (Sec. 7044. Business aad Pro[essions Code:) The Cootrxtur's Li- cense Caw docs not appiy to an owner of propeny +vho builds or improves thneon. aad . who conuacu Car such projecLS with a contractor(s) licensed pursuant to �he ConvacWrs License Law. ❑ I am uempt under Sec . B& P C for this �cason Owner Date . • _ WORKER'S COMPENSATION DECLARA170N I hercby affim� under penalry of perjury one of ttm following declaralions: ❑[ hsve and will maintain a Cenificam ot Conscnt to ulf-inswe for Worker's Comp:n- sation, as providcd for by Section 3700 of the Labor Code, for the peefortnancc o( the work for which this permit is issued. ❑ I have and will maintain Worker's Compensation Insunnce, as �equired 6y Section , }700 of thc Labor Codc, for ihe per[ormance af the work for which this pecmit is iswed• My Workefs Compe Insurance cartier and Policy number are: Cartier.�R�� PolicyNo.:��n-CJC CERTIFlCA1'E OF EXE1v1Pf[ON FROM WORKERS' , COMPENSAT(ON INSURANCE (fhis scction necd not bc comple�cd if tlx permit is for anc hundred dollars (SI00) , orlcssJ I certify thct in thc performancc of ihc work [or which Ihis permi� is issucd, I shall rrot employ any persan in any manner so as to become subject to �he Workers' Compensa�ian L.aws o( Califomia. Datc Applicant NOTICE TO APPLICANI': if, altcr making �his CcniCca�c of ExempGon, you shau�d become subject to �he Worker's Campensauon provisions of the Labor Code, you muu , z fonhwith comply with such provuions or this permi� shall bc dccmcd icvokcd. z � CONSTRUCTION LENDING AGENCY [.~.� ►�-. I hcrehy afCirtn ihat thcre is a consuuction Icnding agcncy lbr thc perf�rtnancc uf � (� � ihe xrork Cur which �his pertnit is issued (Sec. 3097, Civ. CJ , W Q Lendefs Narnc � z Lcnder's Address I ccrtify iha� 1 havc rcad this application and sutc that thc abovc info�matiun is w� corrcct. I agree �o comply with all city and county oniinances and s�a�e laws �claung a � U building conswction, and hcreby authori�t represcnu�ivcs of �his city to cntcr upon Nc � W abovc-mcntiuncd properry for inspccuon purposes. a (We) agrce �o save, indcmnity and kecp harmless the City of Cuperuno against �,E'"„� � liabiliues, judgmcnts, costs and ezpcnscs which may in any way ucruc against said City / V Z �� o�� ar m� g ��g or m�s a ��. Date �Q�( � � APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POIIYI' Issued by : SOURC ONS. ' /v-�� "� Re-roofs �— S' n ofAp IicanUConuactor � T Of �:OOf HAZARDOUS MATERIALS DISCLOSURE YP Wi11 Uu applicant or futurc building occupant store or handlc harardous matcrial u dcfincd �y the Cupenino Municipal Codc. Chaptcr 9.12. and thc Hca��h and SafetY c«� Scction 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑ v� C,� • Will thc applicant or fuwrc 6uilding occupant usc cyuipmcnt or dcvicct wh�c6 If a roof '.s installed without first obtaining an inspection, I agree to remove emii harardous air conuminan�s as cicfincd by the Bay Area Air Quality Managcmcnt all new r, iaterials for inspeciion. District? ❑ Ycs �� 1 havc rcaJ U�e ha�ardcws ma�crials requircmcn�s undcr Chaptcr 695 o(�he Califor- nia Hcalth & Satety Codc. Sections 25505. 25533 aiul 25534.1 undcrstand thu i( ihc build'm8 docs not curtcnt�y havc a tcnan4 Ihat it is my responsibility lo noufy thc oaupant of �he rcyuiremcn st bc met prior w issuancc of a Ccnificatc of Occupancy. S1gIIStUTt; Of ApP1tC1Rt Date �� All roof coverings to be Class "B" or better Owncr r authorizc agcnt Datc _ � o�� -�,, CITY OF C UPERTINO .��'r ��:��' CUPER�TINU PERMIT APPL�[CATION FORM APN #�� r O � ` t �� -- � J Date: � �C� (�-- ( � - -t!� Building Address: � � 1 L � �� — \ Owner's Name: Phone #: W�ti � ��-- ti�5 - 3�� -- �s � � Cq�tractor: License #: 1�� -� li�.St��S ��cir� 5r%�.i �• �1'S O� 1 Co act: Cupertino Business License #: \ i c� c,-� �'�c.\r•� 5 Type of Rc�of Covering: Existing: Proposed: D Built-Up Roof ❑ Built-Up roof 0 Asphalt Shingles �"� Asphalt Shingles 'l�; Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other (Specify) ❑ Other (Specify.) Number of existing coverings 0 Provide I.C.B.O. Report # ❑ To be Removed ❑ Provide Mfgr. Installation Specs. I Have Read, Understand and Will Com ly With Cu ertino's Tear Off Polic : Job Description: eiw�c •x.., � �(;w��.< C� x � `� t=.,nsj 5��e �C' �v�5 �t �� \ �O O � �e1L��'j c1 i� �o cc.r. �:�a � ' S ✓4 - Residential Commercial ❑ Fire Zone: Yes ❑ No Conf'umed with Planning D�t. if there are any restrictions: LJ Cost of Project: Type of Cons tion: Occupanc gro . � �- r �� - �_ �- -�. Qty. if Applicable Fee ID Fee Description Fee Group BPERIV�EE F41dg 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 L►epartment Subject: Re-roofing policy for the Ci.ty of Cupertino 1. Prior to permit issuance, you must agree to comply with 1997 UBC Standards and manufaciurers specifications on re-r�ofing. 2. New roof coverings shall not be applied without first obtaining all inspection and written approval from the building :nspector. A final inspection and approval shall be obtained from the buil �ing inspector when the re-roofing is completed. 3. All roofs shall be inspected prior to any :�oofing 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 fv�st obtaining an inspection, will require the removal of all new mate rial down to the sheathing, so a proper City inspection can be perfo�•med. 7. NOTE: If you call for a plywood nail in:>pection 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 t�e scheduled. IMPORTANT 1. Flat roofs must have a minimum of 1 /4 ":�er foot slope and demonstrate that there is no ponding. 2. An I.C.B.O. report is required to be on tt�e job site at the time on inspection. I understand and will comply with the above ;;tated policy on re-roofing. Homeowner's Name: � (i�. � tJ� � Y� (' �L Job Site Address: �-� �� Jw��+� S ��- ` LV R�� f`G �� `� Roofing Company Name: /� \ � S . v� �c� �,`� > ��`��, ��c'v � �' e S Applicant's Signature: Date: �� Greg Casteel Building Official Revisec� 11/2/04 CITY OF CUPERTINO 2 ITEMS OF 2 PERMI�� RECEIPT OPER.ATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: Bll�: Lot: APN ......... 32�i41050.00 DATE ISSUED........ 10,'16/2007 RECEIPT #.........: BS�)00002997 REFERENCE ID # ...: 07__00113 SITE ADDRESS .....: 21:385 RUMFORD DR SUBDIVISION ....... CITY .............. CU]?ERTINO IMPACT AREA ....... OWNER ............: SH]�K ANTHONY P AND MARY S TRUS ADDRESS ........... MAItY SHEK CITY/STATE/ZIP ...: SAI7 FRANCISCO CA, 94117 RECEIVED FROM ....: AL)� SEASONS ROOFING CONTRACTOR .......: GO]ZSHTEIN, VLADISLAV LIC # 21035 COMPANY ..........: AL]� SEASONS ROOFING SERVICES ADDRESS ..........: 17::0 SMITH AVE CITY/STATE/ZIP ...: SAt1 JOSE, CA 95112 TELEPHONE ...... (4�)8)971 FEE ID UNIT QUANTITY :�MOUNT PD-TO-DT THIS REC NEW BAL BPERMFEE VALUATION 10,700.00 180.36 0.00 180.36 0.00 BSEISMICRE VALUATION 10,700.00 1.10 0.00 1.10 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT : 181.46 0.00 181.46 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 181.46 #22507 --------------- TOTAL RECEIPT : 181.46 Community Development � � 10300 Torre Avenue � z� Cu ertino CA 95014 �" , ;s� ,' P Telephone (408) 777-3228 CITY OF Fax (408) 777-3333 �UPEi�TINO Bt111C�111 De artment JOB ADDRESS: PERMIT # �S ,nti-�r � ✓' - � D f �� OWNER'S NAME: (, PHONE # y(� ��' / S� GENERAL CONTRACTO : � � ; �� FAX # I am not using any subcontractors: � �� Sig nature Date Please check a licable subcontractors and com Lete the followin 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 `�lU - �7 Owner/ Contractor Signature Date