06030005 CITY OF l'UPERTINO +r ✓' �"` R ° ' 1,' 4
BUILDING DIVISION PERMIT , COIv,TI2ACTQR4NF0RMATIO,
BUIUHNGADDRES3: ALL SEASONS ROOFING SERVI EiN"O"O'06030005
21825 ALMADEN CL
OWNERS NAME: PERAQf L'SUE DATE
ALBERT YOUNG 1720 SMITH AVE - 03/02/2006
HONE SANnARY NO. CONTROL NO.
(408) 971-4455
ARCHH=fFNGINEER: BUILDING PERMU INFO
BLDG ELE 717 PLUMB MECH
30$ UCFNSEDCONIRACIDR'S DECLARATION Job Descrition
u 1 hmcby Drum Nn 1 m Iiccvsil under prmium
' ,of Cb,gc c Wo
9(,mnrbb
$ P
" WNSallwi]d1o)of Divim3of rbc Buaw,na Ra(usbn,Code.,na mr0a�b
?'�i in4ota�elreaL �UI 75r7C791. REROOF-REMOVE (E) -INSTAJLE® COMP ,
-Z-yL Cmucurtw._n..ih
ARCHr1ECR DECLAMTION
UI undere,M my plaou abll be tr cd a public road,
U vu Cpm oUov
APRo- 1006
OWNER-BUILDER DECLARATION
.�x 1 bcreby alRm Ihel I em c.empt num Ue cob . cos Uc"W Law for de
a0 fel oalr:mama.s cUun 7m 13,Bos nns and Pmfodom Code:Any Cay of county
S9 which m,,oUes.permit b cmauuq ew.imprme,dcmdMh,or rtWr any urucmm 4 8 6
xi priorbiuiuwncc..larryuima Nc,pplicuuforach pumilb Rk,ai$oN Bamnrnt NNy
< dw hculkcod pmmnl bene Pandora of Ue Cmanctor's Lforra Law(Chyvcr9 Sq.Ft. Floor Area a
(eaonmexdn$WN Scria07000)a Dbdwn 3 of Ne Busbm and PmfeWam Codo)m
l]C113 by,y applicant l fpmonl abjrL a cu N Ipk. �i ccr
y 4oladon of
Secdm03lWl P—UY of
wt more than nae b.odmd dollar,(SSOOL r Occupancy Type
❑Lnowner of Ue pmpWy.or my mployaa Wth walla,thak ak c Pmu,dm.
and Prftwort and We, ContbarelInerdcdaa.do fora>apply
7014,a of
and Ihofmslaa Cade:TIe rnalMah Lkens Jaw mm eel.pply k a awxr a Required Inspections
pmny wbo build,or impro o;Ihmmn,and who dousoh work hir.aRutbau$h hu
awe mpby 'pmnded and ach Unpmnowro,m not Inkudrd oroQerM for ale U.
hawercs,the buildl.0 or hogo,e uvn I.cold wIW o ore Y.of ampkdaa 0u—
bW Wm will bare WTI laden of pon.{thad le did not W IW or hnprme for pmpoa of
ak.).
❑Ladowner.f the property,m.ftWnIY co.o.cd.$vebb Ikc.aa[Onu.clm b
eeavrvee We pojxl sm 7044,BuUnea,nd Profeadom Code:)The Cwtr.cws U,
oras law door ea apply b a owner of propefy wbo bund,Or impro.e,Oermn,ad,
who conu.cu for ach projmt WN a convxwp)Booted W^„n in the Cortbly
Isms law.
❑I m comp unaer See .B d P C for Ods mason
Ow a Due
WORKERS COMPENSATION DECLARATION
1 kneby affront under actually of perjury one of Ne fink tdecWUmu
Ilyae.ndwOlmainWn.Cm ri=GfCam wro f-m,urtfar WorYd,Cm n-
admL u provided fu by Secdm 37011.!ibe labor Code.fa the perfmmava of Ne
wok for a,hht aha permit is snood
❑1 ban and anti mmmain Worker's Cmepenalloe Inuavcc.u mq.imd by Scabn
71/00 N the labor Code,for de prformaxn of We work for whirls this pumit i,land.
My Worker,CmpcmWoon brm,m ani.mal Pdiry Amba am:: '
C.nier: �i-�. 16 F ,rd Talky No.: 1)17 65J
CER'URCATF OF EKEMMON FROM WORKERS
COMPENSATION INSURANCE
OLu ieNm.od ort be codpkd if We pamh 1,foram buedmd mll.n($IW)
or icer)
1 codfy Wt M 0e performo xt of Ue work for which UU,permit is fur I due not
mplay any Aran In any miner an,u to become tobja7 to Ne Woolen'Cmpmaulm
Jaw,of C.Iifamit Dale
Applkan
NOTICE-POAPPLICANT;If,.fsr matin$Nis Ce Ulkac a E PUmm,yoomoold
become abj=to NC WO .Cmpcnadm poviLom athe labor Code.you man
.,O fanhWth comply Wlb sch prrnidmu or Nu puma shall be doorW m 4.
z TIIN
CONSTRUCTION LENDING AGENCY
E'h Iher,"afrm do Uem Is.caamunlan kndln$a$cxy for Ue prfom.no a(
C r> de work for wNch WI,peak It laucd ISM 3M,CN.C) ,
ILl Q LaMc'a Nude
Z Landcr's AONcu
U O 1 cmUfy Out I bre and int.appUrnim.na,ue Wu the.W rc infom,Um u
C) noildM Lltlb, y wirobyaulyuq camynuoina of.nanue laws opon$b
hui .nrtoramnlm,wd hcmIm,xcm ire,.i. ud sofNu city Wenm uPm Ne
W aMrc.(Wcianed to un for Impeedm ”bar
(We)acroba ind!exp udtrop y in
UeCity a(Cnpanvoid City
U Ii,bNda,,}ud$mcou.co,u W efperr¢,which may In M'w,yuzrm.$alen Wa Cay
U7 1.cmICAN'r of rhe R:ZANaf Ni,D WIL
r1- APPUCANf UNDER ANDS AND WILL COMPLY WfIH ALL NON-POINT •ISSUed by: DflIC
SWR S.
-2-0& Re-roofs
si$e,ttK 6fAppIkAtPCon=W Dae
HALIRDOUs MATERIALS DISCLOSURE Type of Roof
Will Je appllanlafumrc buUdmP d p,ntane orbrdk hL door m.erW
as deNd by the Cupenom Muni i,al Code.(]aper 9.II..M Ne H.ldt and Safety
Coal, seNm n5...... All roofs shall be inspected prior to any roofing material being installed;
❑ a
Will Uc.pplk or fubm Wilding amupam uc equipment or dai¢a wbkh If a roof is installed without first obtaining an inspection,I agree to remove
r roll lo,,mj a.Ua woiomet a dcnxd by Nc Bay Aru Alf Quality Mrtf-W x all new materials for inspection.
,I Distrim7 •:
❑ye o
1'4 Ih&Safa Cod CLS ou,m i_505. 533an emu3nder(tipC6.95 MNe boiWin -''/'./rIC!�� •'��^,
/ wHCINB WaYlon.Scclio find
and 257N.imhrsrd iha i(Nc buiMWq
deer nor c+emmlY bs.max col Il u my ncipmvlbllly n may Nc oavp,nt U Nle
ryalrt pbrmiavacal.G.Umaearotwxy'. n o Apr (cant Date
l z All roof coverings to be Class"B"or better
nor 'rod, t - Dem
CITY OF CUPERTINO
i
to, 1 of 1 PERMIT RECEIPT OPERATOR: suem
COPY # 3
Sec: TwP: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35715087.00
DATE. ISSUED. . . . . . . : 03/02/2006
RECEIPT #. . . . . . . . . : 33422
REFERENCE ID # . . . : 06030005
SITE ADDRESS . . . . . : 21825 ALMADEN CL
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : ALBERT YOUNG
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-2803
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
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 11, 000. 00 180.36 0.00 180.36 0.00
BSEISMICRE VALUATION 11, 000. 00 1.10, 0.00 1.10 0.00
TOTAL PERMIT 181.46 0.00 181.46 0.00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ -_----_-----------
CHECK 181.46 18995
TOTAL RECEIPT 181.46
Community Development
� 10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
IWUPEkTINO
Building Department
JOB t SS: , dw ll�„� PERMIT # O/63M 5
OWNER'S NAME: Q { 'Fo i PHONE # y l� I-yy5 S
GENERAL CONTRACTOR- (411 $� FAX # �j-
I am not using any subcontractors:
i ature Date
Please check applicable subcontractors and complete the following ' ormation:
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 k' / w s O /
Septic Tank
Sheet Metal
Sheet Rock
Tile
3 a -06
/Contractor Signature Date
i
`�� CITY OF CUPERTINO
REROOF
CUPERTINO PERMIT APPLICATION FORM
A PN # 3 5 ) /5 Date: a
. 2.0
Building Address:
.
Owner's Name: Phone #:
a\ ( HAo" 53-
Contractor: License #:
A\\
C ,tact: Cupertino Business License #:
�C,\C. \A
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof O Built-Up roof
❑ Asphalt Shingles 'g Asphalt Shingles
19 Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specily) ❑ Other(Speci ly)
Number of existing coverings ❑ Provide l.C.B.O. Report#
'S To be Removed ❑ Provide Mfgr. Installation Specs.
1 Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: Ix
,lob Description: e*gvve— \\cw\e"c- t,� a5
Sb = ti
Kesidential Commerci ❑
Fire Zone: Yes ❑ No [2,� Confirmed with Planning Det. if
there are any restrictions: LJ
Cost of Project: Type of Construction: Occupanc gr10ow
�
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Fner y BUILDING
BSEISMICRF Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING