03090027 (2) CITYOF CUPERTINO s-«r' xr secs:t - ix�✓.«d-.' `
BUILDING DIVISION PERMIT R CONTRACTOINFORMATION p„
BUILDING ADDRESS: ALL SEASONS ROOFINGe SERVIC g`MITN003O90027
. 160C IAMT�2 TQWN ]DR,
NER'S NAME: 2640 PACER LN PERMIT ISSUE DATE
ONE: 4089724455 SANITARY NO. CONTROL NO.
CHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
):t l_ Q
±0LICENSED CONTRACTOR'S DECLARATION
.7F: 1 hereby affirm Imt 1 am licensed under provisions nr Chapxr 9(commencing Job Description
_Uz with Section 7onn)of to.,
3 of the Business and Professions Cade,and myliccna is
in fun force and effect.
;'qi Licera ue.a . REMOVE WOOD SHAKES
,� O Dax s �._ c_La , REPLACE WITH CONCRETE TILE p��A�E�
�ppn ARCNITECT:D ATION
I W V 1 understand my plans shall he use a puMi rds
_to LiccnadPmfcssionel SEP 1 7 2003
OWNER-BUILDER DECLARATION
<P I hcrchy affirm that I am eacmpt from me Conuatuar License Law for the
OO following reason.(Section 7031.5,Business and Professions Cob;Any city of county
um which requires a permit to construct,alter,improve,demolish.or repair any structure
_zy prior In its issuance,alsurequires the applicant forsuch permit o Glc a signed sulcmenl aul
22o that he islieenxdpummotto(be previsions oftheContractor's License Law(Chap¢r9 Sq. Ft. Floor Area 8
R� (commencing with Section 7")of Division 3 n(lhe Busionsal Professions Code)m OOO
$ Nat he is exempt Ihcmfrmn and the basis for me 9lcgcd caemption.Any violation of rA.D Ai�a,2n��
Section 7031.5 by any applicant fora permit subjects me applicant to a civil penalty or 3�V ILVV�l9'flrO O.. Occupancy Type
not mom than five hundred dollars($500).
❑L e owner of the property,or my employees with wages as mei,sole compensation,
will do the work,and me swetum is not intended of offered for sale(Sec.7W,Business
and Professions Code:The Contractors License Law does not apply to an owner or Required Inspections
property who builds or improve mcreon,and who docs such work himndforthroughhis 305 - FRAME
owncmploy=,provided that such improvements sum ofinendedoroRersd forsale.If. 307 — INSULATION .
however,me building or improvement is sold within one year of completion.the owner-
buimer will haw me burden or proving mal he did not Wild or Improve for purpose or 601 - ROOF TEAR OFF
stale). 602 - ROOF PLYWOOD NAIL
El I,a owner of the properly..B I.sines and contracting with licensed contractors m 603 - ROOF BATTENS
comeconstme Law dproject(Sec.]THA,Businessandrty whoomds or Thews the on.Li
who commets frouppgman ithawner ofpmpors whosedmofimptote thereon.and 604 - ROOF IN-PROGRESS
who contracts for such Dmjects with a contractors)licensed pursuant m the Contractor's
Law.
❑ voC3 I sm
caempt under See. ,B&PC for mit mason -
Dale
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following decimations:
❑1 hart and will maintain a Cerufiesse of Conant to xlf-insure for Worker's Compen-
sation,as provided for by Section 37M of the labor Code,for Be perfamits c of thd
work for which this permit is issued.
I haat and will maintain Worker's Compensation Insunna,as required by Section _
3700 of me tabor Code,for me performance of the work for which this permit is isstied.
My W�aCnmpens M n cc i a monk,au:
oft _
TEOFEKEMPf10NFROM ORKERS'--
COMPENSATION INSURANCE
or Icss.)(This section recd trot he completed if Ik pefruit is for one hundred dollars(gip))
I eerify mal in the performance of the work for which this permit is voted,1 shall not
employ any person in any manner.so as In Income subject to he Workeri Compensation
Laws of California.Dax
Applicant
NOTICE TO APPLICANT:If,after making mit Ccmricate of Escmption,you should
became subject to the Worker,Compensation provisions of me U,,Code.you must
zfoMwith comply wish such provisions or mit permit shall k decreed revoked.
Z� CONSTRUCTION LENDING AGENCY
1 hereby affirm that mere is a construction lending agency for the performance of
y4 > he work for which this permit is issued(See.3097.Civ.C.)
4A Lender's Name
3.3. z fender's Address
J O 1 Modify that I have read this application and sux that be above information is
.i correct.1 agree 10 comply with all city and county ordinal and sox laws misting to
V building conviction,and hereby authori¢r<prexmatives of this city to enter upon she
W -hove-mentioned property for iepenion purposes.
y gy (We)agree to save,indemnify and keep harmless the City of Cupertino against
h liabilitus.judgmeno costs andapenxs which may in any way accme against said Cit
J2, in consequence of the granting of this perm it.
A.
APPLICANT UNDE NDS AND L PLY WITH ALL NON-POINT Issued by: Date
Isnalare pp renVCnntmemr Re-roofs
Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle hvardous ma¢nal
az defined by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
"Ode.Section 25532(.)?
Area All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupanl use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mil hvardous air contaminants a,defined by me Bay Area Air Qualify Management all new materials for inspection.
District?
❑yes
1
1 have mad me hvardous materials requirements under Chapter 6.95 of me Califon
ria HcahhKSafety Code,Seeuon le!i05.25533 and 25534.1 undersuM diviftk Wilding
does not currently haw a xnank that it is my reproMialI o notify Ile cuperm of me
mquinmanour kmet !case of Occupancy.
nature plicant - Date
nee,- Redagenl D„e All roof coverings to be Class "B”or better
CITY OF CUPERTINO
1 of 2 PERMIT RECEIPT OPERATOR: suem
COPY # 1
Sec: Twp: Rng: Sub: Elk: Lot:
APN . . . . . . . . : 36610068.00
DATE ISSUED. . . . . . . : 09/03/2003
RECEIPT #. . . . . . . . . : 23007
REFERENCE ID # . . . : 03090027
SITE ADDRESS . . . . . : 1606 JAMES TOWN DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : HANCOCK PETER G AND TATIANA P
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5315
RECEIVED FROM . . . . : GORSHTEIN/VLADISLAV
CONTRACTOR . . . . . . . : GORSHTEIN, VLADISLAV LIC # 21035
COMPANY . . . . . . . . . . : ALL SEASONS ROOFING SERVICES
ADDRESS . . . . . . . . . . : 2640 PACER LN
CITY/STATE/ZIP . . . : SAN JOSE, CA 95111
TELEPHONE . . . . . . . . : 4089724455
•
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 11,000.00 167.00 0.00 167.00 0.00
BSEISMICRE VALUATION 11,000.00 1.10 0.00 1.10 0.00
---------- ---------- ---------- ----------
TOTAL PERMIT 168.10 0.00 168.10 0.00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
305 FRAME 307 INSULATION
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
603 ROOF BATTENS 604 ROOF IN-PROGRESS
•
CITY OF CUPERTINO -+, 0 'W 900zq
REROOF
CITY OF
• CUPERTINO PERMIT APPLICATION FORM
APN # j / O c1 y Date: _Building Address: l lJ
1606
Owner's Name: Phone#:
T off. z o�
Contractor: Phone #: 5/08 License#:
d/ 7/- OVA '_ /
Contact: Phone#: 'Cupertino Business License#:
--)1055
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
A Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) 2( Other(Specify) eQIZ it fA -1167
Number of existing coverings ❑ Provide I.C.B.O.Report#
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
• I Have Read, Understand and Will Com 1 With Cu ertino's Tear Off Policy:
Job Description:
Residential �[ Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are anrestrictions: LJ
Cost of Project: Type of Construction: Occupancy group:
Qty. if
A licable Fee ID Fee Description Fee Grou
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Ener BUILDING
BSEISMICRE Seismic Fee Res- BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING