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99070046 99,0 PERMIT R_ APPLICATION FOR CITY of CUPERTINO NUMBER INSPECTION DIVISION PERMIT EXPIRAnon 1 REROOF PERMIT (408)777-3228 PERMIT ID(PIRES IF WORK IS NOT BTARTE WITHIN 100 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. BUILDING ADDRESS 10375 welis;5a C+-) cq. X014- '/ RESIDENTIAL �" COMMERCIAL OTHER OWNER'S HAZARDOUS FIRE AREA NAME AW V-enos -F �,�^ ' ••'' YES ❑ e yes—I t6*y a nyq that a Class A Ay 11V ohs f .Tool e—I u" is regWred ADDRESS I03115 MNO ❑ � � . ImOal LC.B.O.R el iG5a C-f-, l_.(JOP,Y' nC) 45C� ,EXISTING ROOF COVERING PHONE 0 - NUMBER OF EXISTING COVERINGS ' CONT 7QR' NAME II TO BE REMOVED I TO BE RETAINED16 _ ADDRESS �/� P F ROOF COVE CITY&ZIP liV l EXISTING PHONE_`i� T�t J� BUILT-UP ROOF LICENSE r1S9Oq NUMBER ASPHALT SHINGLES ❑ LICENSED CONTRACTORS DECLARATION 1 hereby effirm.that 1 am licensed under provisions of Chapter g(commencing with Sa«Iun WOOD SHAKES 7000)of DhWslon 3 of the Busiwss end Professions Code,end my license Is In full force and - edect. WOOD SHINGLES ❑ Ucanw Clas Uc.Number v' Date '1 Contract« OTHER (SPECIFY)_` ` ❑ OWNER-BUILDER DECLARATION &Cavll PROPOSED ILL LJ .thereby 7031..Rhus that 1 am exempt from the e: Any Contractors Ucansa Lew for the following reason.' - LJ (Sec.7031.5,Business ell Profeollm,or re Code: Airy dry or county whim requires also a permit to D coplicanLor er,such Improv,to signed, reny trthat e,Is for tree ts,uanw,els orepulree the BUILT-UP ROOFEl of to nt for such perms to els a haptstatement9(comm that he th meed pursuant to Me pro of the J U L 2 of Me ss and Pr'sm License s Lew(Chapter B ismmencing with orn donand the n Ofor ionthe 3 al the examp„end P fwsbna Sectio or that he le exempt antforam entl the bias,for Me alleged ASPHALT SHIN ES a chat pert Any act aft of anion hundred loyal ($50ntfora perms eugects the applicant to e nWl penalty,of rwl more then IWe huntlretl tlollero($500).): 01,as owner of the property,or my employees with wages as their sale compensation,will do WOOD SHAKE By ❑ the work,entl the structure Is not Intended or offered for sale(Sec.7044,Business and Protest. alone Code:The Contractors Ucenae Law on not appy to an owner of property who builds or WOOD SHINGLES Improves M«ern,and who does such work himself or through his awn employees,proWded that such Improvements ars rot intended or offered for sale.If,lwwever,tiro butding«Improvement Is sold Marla one year of completion,the owner-Wider will have the burden of proving that he dict OTHER(SPECIFY) ❑ not Wild or Improve for purpovo of sale.). ❑1,as owner of the property,am exclusively contracting with licensed comtractom to construct the project(Sec.7044,Business and Profession,Code:The Contractors Llcmm law does not PROVIDE I.C.B.O.REPORT NO. apply to an owner of property who bullets of Improxe,thereon,ark who contract,for such projects with a contractor(s)licensed pursuant to Me Crnirenors License Law. PROVIDE MFGR.INSTALLATION SPECS. [:II am exempt under Sec. ,B 8 P.C.ler this reason Owns r Dele WORKER'S COMPENSATION DECLARATION APPLICATION DATE VALUATION PERMIT FEE I hereby affirm untler penalty of pehury one of the following decleretbn: ❑I have and will maintain a Cedefcate of Consent to see-lnsrre for Workers Compensation, BUI ding a,provided for by Section 3700 of the Labor Cotle,for the Performance of Me work leia r wmkh Mw^A n P ml leawtl. � I I I I `�1 q Seismic J base end will maintain Workers Compensation lrsumr ,an rKulred by Section 3700 of t e,for the Performance of the work for which this permit W Issued.My Workers en tl I{uuronca urrler and Polley number are: TOia Carrier Q►'►a✓� Policy No. VPERMIT AUTHORIZATION DATE CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE N.C.[] (TNS section moo not W completed If the permit is for we huntlred dollars($1 0)or lase.) , I certify(fust In the performance of the work for which MIs permit Is issued, shell Trot employ any person In any manner so as to become Subject to the workers'Compeu,aurn Laws m can All roofs shall be inspected prior to any roofing material being fomla. installed. It a roof is installed without first obtaining an Date Applicant inspection,I agree to remove all new materials for inspection. sub)eW tooEhw o�rkers'APPLICANT: on provisiong ns o�a Labor Coos,you must forthwith comply Applicant understands and will comply with all non point will each Provlekns or thio perrNt shalcbe foamed raroked. -source regulations. I cartity that I have read this application ark state that Me above information Is torten.I agree to comply with ell city entl county ordinances and state laws mimag to building construction,end All roOf Coverings 10 be Ga or better. hereby authorize rowesomadves of Ws city to enter upon the above-mentioned property ler In- species purposes. (We)agree to save,Indemnity ell keep harmless the CIry of Cupertlrw against Ilabllli e,, me grentlots,costs wle Cityt,entl axperues which may in any way ece against isle City of Mo conaevrence T E OF APCANT DATE judgments, ng of this permli. S PRE-INSPECTION: PLYWOOD: 6 IN-PROGRESS: INSP. DATE INSP.—DATE— INSP.—DATE TEAR OFF INSPECTION: BATTENS: FINAL INSP. DATE INSP. DATE INSP.. DATE NOTE: OSHA APPROVED ACCESS TO ROOF SHALL BE PROVIDED FOR INSPECTION OFFICE COPY INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE CITY OF CUPERTINO BUILDING PERMIT INVOICE OPERATOR: christya Sec: Twp: Rng: Sub: Blk: Lct:34245015.00 INVOICE DATE...... : 09/19/1999 REFERENCE ID # ... : 99070046 SITE ADDRESS ..... : 10375 MELISSA Cr SUBDIVISION .. . . . . . CITY .......... . . . : CUPERTINO IMPACT AREA .. . . . . . OWNER ......... . .. : LAWRENCE 6 CINDY WONG ADDRESS ....... . . . : CITY/STATE/ZIP . . . CONTRACTOR .. . . . .. : GORSHTEIN, VLADISLAV LIC # 21035 COMPANY . .. . . . ....: ALL SEASONS ROOFING SERVICES ADDRESS ... . . . . ...: 2640 PACER LN CITY/STATE/ZIP ...: SAN JOSE, CA 95111 TELEPHONE . . . . ....: 4089724455 FEE DESCRIPTION CHK TOTAL FEE PAID-TV-DATE BALANCE DUE --------------- --- --------- ------------ ________-_- BPERMFEE P 177.00 177.00 0.00 BSEISMICRE P 1.20 1.20 0.00 --------- -""""---- ----------- 178.20 178.20 0.00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION ------e- ---------------------------- 305 FRAME 307 INSULATION 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 603 ROOF BATTENS 604 ROOF IN-PROGRESS INVOICE. INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE q CITY OF CUPERTINO ` I 0 BUILDING PERMIT INVOICE OPERATOR: nencyc Sec: Tp: Rng: Sub: Elk: Lot:34245015.00 INVOICE DATE.... ..: 07/26/1999 REFERENCE ID # . ..: 99070046 SITE ADDRESS .....: 10375 MELISSA CT SUBDIVISION ....... CITY . .......... . .: CUPERTINO IMPACT AREA ....... OWNER LAWRENCE & CINDY HONG ADDRESS ........... CITY/STATE/ZIP .... CONTRACTOR .......: GORSHTEIN, VLADISLAV LIC # 21035 COMPANY ..... .....: ALL SEASONS ROOFING SERVICES ADDRESS ..........: 2640 PACER IN CITY/STATE/ZIP ...: SAN JOSE, CA 95111 TELEPHONE . .. . ....: 4089724455 FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE _______________ --- --------- ------------ ___________ BPERMFEE P 177.00 177.00 0.00 BSEISMICRE P 1.20 1.20 0.00 _________ ____________ ___________ 178.20 178.20 0.00 V ID � .. ....... DESCRIPTION.... ... VOICE.ID ......- DESCRIPTION ........ ..... .. .................... FRAME 307 INSULATION 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 603 ROOF BATTENS 604 ROOF IN-PROGRESS 1 3 I Building Permit Fee Code Checklist • Qty. if Applicable Fee ID Fee Description Fee Group PPERMITFEE PLUMBNG PERMIT ISSUE PLUMBING BAPPLOTHER OTHER APPLIANCES BUILDING BBOILERI BOILER <= 100,000 BTU BUILDING BBOILER2 BOILER >100KT0500K BTU BUILDING BBOILER3 BOILER >500K TO 1M BTU BUILDING BBOILER4 BOILER>1M TO 1.75M BTU BUILDING BBOILER5 BOILER > 1.75M BTU BUILDING BCONSTAX CONSTRUCTION TAX BUILDING BCONSTAX CONSTRUCTION TAX BUILDING BELEC1000 ELEC 600V <=1000A BUILDING BELEC1001 ELEC 600V >1000A BUILDING BELEC200 ELECT SVCS 600V <=200A BUILDING BENERGY ENERGY BUILDING BENERGYADD ENERGY ADD MULTI BUILDING BNEWMULTI MULTIFAMILY RES BUILDING BNUMULTI NEW MULIFAMILY RES BUILDING BNUSFD,. NEW SINGLEFAMILY RES BUILDING BOVERTIME INSPECTION OVERTIME BUILDING BPBACKFLOW ATMOSPHERIC VACUUM BUILDING BPCESSPOOL CESSPOOL BUILDING BPERMFEE BLDG PERMIT FEES BUILDING BPERMIT HOUSING MITIGATION FEE BUILDING BPFIXTURE PBLG FIXTURE BUILDING BPGAS GAS PIPING SYSTEM FEE BUILDING BPINTERCEP IND WASTE INTERCEPTOR BUILDING BPLANCHK PLAN CHECK FEE BUILDING BPLANCKADD PLAN CHECK ADD MULTI BUILDING BPLANCKREP PLAN CHECK REPEAT FEE BUILDING BPREPIPE REPIPE OF FIXTURES BUILDING BPSEWAGE SEWAGE DISPOSAL BUILDING BPSEWER SEWERS BUILDING BPSPRINK LAWN SPRINKLER/BACKFLO BUILDING BPSTORM STORM/RAIN WATER BUILDING BPTRAP KITCHEN TRAP BUILDING BPVENT ALT OF DRAIN &VENT BUILDING BPWATER INSTALL/ALTER WATERPIP BUILDING BPWHEATER WATER HEATERIVENT BUILDING BPWSVCS MAIN WATER SERVICE BUILDING BREINSPECT REINSPECTION FEE BUILDING BREMACOVER AC UNIT>10000CFM BUILDING BREMAPPLI APPLIANCE INSTALL BUILDING BREMBUSWAY REMODEL BUSWAYS BUILDING BREMFIXT LIGHTING FIXTURES BUILDING BREMHEAT HEATER INSTALLATION BUILDING BREMMISC MISC APPARATUS BUILDING BREMNRAPP REM NON-RES APPLIANCE BUILDING • BREMPOLE POLE/PLATFORM FIXTURE 1BUILDING BREMPOWER POWER DEVICE/APPARATUS IBUILDING Building Permit Fee Code Checklist , BREMRECEPT RCPTL, SWITCH &OUTLETS BUILDING • BREMRESAPP REMODEL RES APPLIANCE BUILDING BREMSIGNAD RMDL SIGNS ADD BRANCH BUILDING BREMSIGNS REMODEL SIGNS, MARQUEE BUILDING BREMTHEATR THEATRICAL LGHTNG FIX BUILDING BREMVENFAN VENT FAN SINGLE DUCT BUILDING BSCBLVD SCB SPECIFIC PLAN BUILDING BSEISMICOM SEISMIC COMMERCIAL BUILDING BSEISMICRE SEISMIC FEE RES BUILDING BSF&2FAM SINGLE & 2 FAMILY BUILDING BSPECIAL SPECIAL INSPECTION BUILDING BSWIM SWIMMING POOL BUILDING BTEMP TEMPORARY POWER BUILDING BTEMPSVCS TEMP DIST SVCS BUILDING ZADDCHG ADDRESS CHANGE BUILDING EPERMITFEE ELEC PERMIT ISSUANCE ELECTRICAL BMNEWMULTI NEW MULTI-FAMILY RES MECHANICAL BMNEWSF&2F NEW SF&2F RES BLDGS MECHANICAL BREMAI HAN A/C UNITS <= 10.000CFM MECHANICAL BREMFURN RELOCATION OF FURNACE MECHANICAL BREMFURNOV RELO FURNACE > 10K BTU MECHANICAL BREMINHOOD INSTALLATION OF HOOD MECHANICAL BREMRELOCA RELOCATION OF HOOD MECHANICAL BREMREPALT REPAIR/ALTER HEATING MECHANICAL BREMVENSYS VENTILATION SYSTEMS MECHANICAL MPERMITFEE MECH PERMIT ISSUANCE MECHANICAL ZDEVAGREE DEVELOPMENT AGREEMENT PLANNING ZDIRTM DIR TENT MAP PLANNING ZFULLHR FULL APPL BASE + HR PLANNING ZF.ULLTM FULL APPL TENT MAP PLANNING ZFULLUP FULL APPL USE PERMIT PLANNING ZFULLZONE FULL APPL ZONING PLANNING ZGPAMEND GENERAL PLAN AMEND PLANNING ZLIMAMEND LIMITED AMEND PLANNING ZLIMTM LIMITED TENT MAP PLANNING ZLIMUP LIMITED APPL USE FERMI PLANNING ZMATEMPUP MIN AMEND TEMP USEPERM PLANNING ZMINHILLEX MINOR APPL HILL EXC PLANNING ZMINSIGNEX MISC SIGN EXCEPTION PLANNING ZMINTM MINOR APP TENT MAP PLANNING ZMINUP MINOR APPL USE PERMIT PLANNING ZMISCASA MISC ARCH SITE PLANNING ZMISCEXT MISC TM AND UP EXT PLANNING ZMISCFENCE MISC FENCE EXCEPTION PLANNING ZMISCGEN MISCELL APPL GENERAL PLANNING ZMISCPCINT MISC PC INTERPRETATION PLANNING ZSIGN SIGN PERMI PLANNING ZTEMPSIGN TEMPORARY SIGN PLANNING • ZVARIANCE DIRECTOR VARIANCE PLANNING