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07110032 CTTY OF CUPERTINO ` ' BUIL^ING DI�:SION PERMIT �� ` <: -.> . .. ..; . . . .. < PERMIT NO. BUILDING A D ESS: 114�� CHARSAN LN ALL SEASONS ROOFING SERVICE 07110032 . PERMI'f L56UE DATE �ER'S NAME: SO HONG—TO AND LIN LEE—WAI 1720 SMITH AVE � 11/07/2007 SANITARY NO. CONTROL NO. PHONE: BUiLDING PERMIT INFO ARCHITEC[YENGiNEER: RM�J 1 LAYR EXSTNG SHAKE RF sLDC E�cr PLUMB MHCH � � 0 � uOp LICENSEDCONTRACCOR'SDECLARA'C T ..� „,�.� ,.,„ „�bDescription ;� �� I hcrcby affirm Uwt [ am licenacd unJcr provisions oC Chaptcr 9(commcncing ^^ -"' �"' � z� wilh SccGon 70(M)) of Division 3 of ihc Businest and Profcssians Code, and my liccnsc is �� y in (ull forcc and e([ec4� � � � Z Licen Clu V L�• x � F ;, r p Dalc Conlraclur_ � + ^ � ARCHITECI'S DECLARATION �-� I undcrs�and my plans shali bc uscd as public rccards �yU ; �. y Licenscd Rufcssional ' y � OWNER-BUILDER DECLARATION I hcrcby al7irm Ihat i am czcmpt [n�m thc Con�rsctor's Liccnsc Law far thc � p O Collowing rcuon. (Scetion 7031.5, Busineu and Pro(cssions Ca1c: My eity or counry ,� $� which rcquires a pcimit to conswc4 a�tcr, improvc, dcmalish, cu repair any suucturc y Z� prior w ils issuancc. �Iw rcquires Uic applicam for such pertnit to filc a signed su�cmcnt G q , Ft. Floor Area Valuation _< that he is licensed pu[auant ta �he pmvisions of the Conuactor's License I�w (Chapter 9 y F- �(commcncing wi�h Sccdon 7000) of Division 3 of ihc Busincss and Profcssiona Code) or y �.. that he ia exempt themtrom and the basis for �he alleged exempdon. Any violation of Section 7031.5 by airy applicant for a pemiit subjecu �he applicant to a civil pcnalty of APN Number Oeeupancy Type not mo�e �han five hundred dollars (SS00). ❑ I, u owner o[ Ux propeccy, or my employces with wages aa ihe'v solc wmpensadon, will do we work, u+d ihe stcucwce is not ineended orotie�ed torsatc (Sa. �os4. B�siness Required Inspections and Rofessiona Code: 71x Conuactor'a License Law dars not apply w an owner of property wha builda or improves therwn, and who does such work himael[ or ttuough Ais own employces, provided that such improvemen�s are no[ in�ended or oRered for sale. If, however, the building or improvanen� is su�d wi�hin one yeu oC comple6on. �he owner- buildu will have the burden oC p�oving Wat he did not buitd or improvc for purpose of sakJ. � 1, as ouvnec o( the property, am exclusively conuacting wi�h Iicenaed ronuacwrs W wnsuuct the projea (Sec. 7044. Business and Pro[essions Code:) The Contrxtor's Li- cenx [�w does no� spply w an owner of propeny who builds or improves the�eon, and , who convacts Cor such projects wiih a contncar(s) licensed pursusnt to tAe Convactor's Litense Law. 1 am exempt under Sec . B& P C for this �caton .�nw Date WORKER'S COMPENSA770N DECLARATION I�reby alTirm under penalty o[ peryury one o[ the follawing declaradons: ❑[ hsve and will mainuin a Cenifiate o( Cansent to self-inswe for Workers Compen- sation, as providcd for by Secdon 3700 of the laba Code, for ihe performancc of thc work for which this prrmit is issued. ❑ I have and wil! muntain Worker's CampensaUan Insunnce. u required by Section . 3700 of ihe Labor Codc. Cw the performantt of �he work for which this pecmit is issued My Worlce�s CompegsaGo�urana rtier and Policy number are: �� Cartier: � ��%� Policy No.: b"��( �X� "� � CERTIFICATE OF EXEMPTION FROM WORKERS' COMPFNSATION (NSURANCE (This sectian need not bc completed it t6e permit is for onc hundred dollus (f I00) . or Icu) 1 cenify �hat in thc performancc of Wc work far which �his pertnit is issucd. 1 shall not e:nploy any person in my manncr w u m becomc wbjcct to ihe Workers' Compensation Laws of Califomia Da�e Applicant NOTICE TO APPC.ICANT: 1f, atYcr making U�is CcrtiGcatc of ExempGon, you shoulJ become subject w ihe Worlcer's Compensation provisions of �he IBlwr Code, you must , z fonhwith comply with such provisions or this permit sha116c dccmcd mrokcd. z O CONSCRUCf10N LENDING AGENCY [-�i � I hcrcby a[firm Uut thae is a conswction knding agcncy for thc perfortnance uf . �„ � the work for which ihis permit is iuued (Scc. 3097, Civ. C.) a Q Lendcr's Namc L.cnders Address V 0 1 cutify �hat I have read this application and s�aic ths� 1hc above informaGun is w � cortect I agrce w comply wi�h all rity and counry ordinances and suk Isws relating W � U building consuuction, and hercby auehorim mpresentativcs of this ci�y to cntcr upan ttic � W alwve-mcnuoned property for inspeaian purpasea a (Wc) agree �o save. indcmnify and keep harmless the Ci�y of CuperUno against �� liabilitiu, judgmcn�s, cosu and expe which may in any way accruc against said City V"� in consequence oC tAc granting oC permiL � _�/CJ � � APPI.ICANT UNDERSTAND ND WIL OMPLY ALL NON-POINT Issued by: Date � SOURCE REGULATlONS. ' �� „O �� Re-roofs �� Signuurc of Applian on wr �°� T of R� �of HAZARDOUS ATERIALS DISCLOSURE YP Will �he applicant or futwc building occupmt storc or handlc ha•rardous ma�crial defined by the Cupenino Municipal Codc. Chap�cr 9.12. and �he Hcalih and SaCcty ,� Scction 25532(a)? All roofs : hall be inspected prior to any roofing material being installed. � Ycs '�No If a roof is installed without first obtaining an inspection, I agree to remove �11 ihc applicant or Cuturc building occupant usc cquipmcnl or dcvices which , emi� ha air con�uninanu as cicfincd by Ihe Bay Area Air Quality Managcmcm all new m; iterials for inspection. ��s�;�� Q Ycs �Q�7u ✓ � havc read the hvardous ma�crials immcnts under Chapicr 6.95 of �hc Gli[or- nia HcalU� & SafctyCodc, Sixtions 25505. 533 a+r125534.1 undcrsund that iC ihc huilding dacs noi curtenUy havc a tcnan4 ihat i my responsibiliry ta nodfy the axupem of Nc rcyuircmen�s which must bc me� pri o[a Ccnificam of Occ�p�pc�r� S�gnature �f Applicant Date �� All roof coverings to be Class "B" or better Owncr or au�horizcd agcnt �� CITY OF ��UPERTINO 2 ITEMS OF 8 PERMIT RECEIPT OPER.ATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot: APN ......... 36210048.00 DATE ISSUED.......: 11/07/2007 RECEIPT #.......... BS000003183 REFERENCE ID # ...: 07110032 SITE ADDRESS .....: 11435 CHARSAN LN SUBDIVISION ....... CITY .............. CUPERTINO IMPACT AREA ....... OWNER ............: SO HONG-TO AND LIN LEE-WAI ADDRESS ..........: 11435 CHARSAN LN CITY/STATE/ZIP ...: CUFERTINO CA, 95014-4981 RECEIVED FROM ....: ALL SEASONS ROOFING CONTRACTOR .......: GORSHTEIN, VLADISLAV LIC # 21035 COMPANY ..........: ALL SEASONS ROOFING SERVICES ADDRESS ..........: 1720 SMITH AVE CITY/STATE/ZIP ...: SAI� JOSE, CA 95112 TELEPHONE ........: (4C8)971 FEE ID UNIT QUANTITY �MOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- BPERMFEE VALUATION 11,700.00 191.16 0.00 191.16 0.00 BSEISMICRE VALUATION 11,700.00 1.20 0.00 1.20 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT : 192.36 0.00 192.36 0.00 O`7 � � c'� �' � �--. CITY OF C UPERTINO �"� ��.��' �� . CU��R`T�1vt� PERMIT APPLICATION FORM ApN Date: �. � � 0 � . OC Building Address: � �, C.�.� ,. � >ol Owner's Name: Phone #: �, �-i. <-�S�`� l7 3 `- C%�.°i � Contractor: License #: A� � - 'r�. ��-�� cPs ��\ � ontact: Cupertino Business License #: ��C'�C� � � -- � type of Ro �f Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles � Asphalt Shingles � W ood Shakes ❑ W ood Shakes Wood Shingles ❑ Wood Shingles ❑ Other (Specify) ❑ Other (Specify.) Number of existing coverings ❑ Provide I.C.B.O. Report # ❑ To be Removed 0 Provide Mfgr. Installation Specs. I Have Read, Understand and Will Comply With Cu f;rtino's Tear Off Policy: Job Description: �' � vtic� �� l 1 ��C" � � �`� �ti�� 1�cJ- �cx� . S �5-i�. \ \ �-`'► � 'c' ��'°' � ��'1 � '►� �=e;ri rv�e. C• � . � �o � = Residential Commercial ❑ Fire Zone: Yes ❑ No �� Confirmed with Planning D�t. if there are any restrictions: LJ Cost of Project: � Type of Con��iction: Occupancy��up: . � � � Qry. if Ap licable Fee ID Fee Description Fee Group BPERMFEE Bldg Permit Fees BUILDING BENERGY Fnergy BUILDING BSEISMICRE �>eismic Fee Res BUILDING BSEISMICOM �;eismic Commercial BUILDING BPLANCHK I'lan Check Fee BUILDING BUSLIC ]3usiness License BUILDING Community Development Departrnent ' ' Building Division City of Cupertino 10300 Torre Avenue Telephone: (408) 777-3228 Fax: (408) 777-3333 Building I)epartment Subject: Re-roofing policy for fhe City of Cupertino 1. Prior to permit issuance, you must agre�� to comply with 1997 UBC Standards and manufacturers specifications on re-:-oofing. 2. New roof coverings shall not be applied without first obtauung all inspection and written approval from the building inspector. A final inspection and approval shall be obtained from the bui:_ding 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 appro��al. 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 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 c�f $176.18. The re-inspection fee must be paid before another inspection can l�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 t�ie job site at the time on inspection. I understand and will comply with the above :;tated policy on re-roofing. � Homeowner's Name: �,� c7J�l! � �7C Job Site Address: � �� v \ C�, �5 �Y� L✓� u�,' ��i" ,r� Roofing Company Name: `� � � �� ?i('� i ��' S . Applicant's Signature. ,,��'� �!��_ Date: �' � -� Greg Casteel Building Official Revised 11/2/04 Community Development �, -' 10300 Torre Avenue ,�' a ,s� - Cupertino CA 95014 Telephone (408) 777-3228 CITY OF Fax (408) 777-3333 CUPEI�TINO Buildi:n De artment JOB ADDRESS: PERMIT # �� 3 , llk3s � h�e�o � OWNER"S NAME: G(z �� G S O PHONE # -� YS`'.s" GENERAL CONTRACTOR: S c, FAX # —'-C t"17 I am not using any subcontractors: Sip;nature Date Please check a licable subcontractors and com �lete the followin information: SUBCONTRACTOR BUSIrfESS 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 ' �p� l -��- o � Owner/ Contractor Signature Date