08070219 CITY OF CUPERTINO
BUILDINGDIVI SION PERMIT �.�CONTRAGTOR INFO,RMA�IgN
L
DRESS: PERMRNO� DE FOE DR ALL SEASONS ROOFING SERVICES08070219
AME: PERMIT ISSUE DATE
EN I.,UNIEWSKI 1720 SMITH AVE 07/30/2008
NE: SANITARY NO, CONTROL NO.
ARCHITECrfENGINEER: BUILDING PERMIT INFO
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ups LICENSED CONTRACTOR'S DECLARATION
1 rtby affirm Nal I am licensed under Porro ro of Clupmr 9(commencing lob Description
4 U M
�y with Section 7IX1(f)ofDividon 3 often Business Mail Profcuiam Cade,and my licwelet
°=u in full force and cff Ufs (
y
Z_ Lice Clara Lie.Y
f O DamO Da¢ Contractor a If-4.&M
ARCHITECTS DECLARATION
WI undc,vanJ my pole shall he used u public records
k C G Licensed Professional
5 thOWNER-BUILDER DECLARATION
.� f 1 hereby anam mm
n Nal 1 cPt from the ConuattoYs U..Law for the
C no
following meson.(Section 7031.5,Business and Pmfussioo Calc:Any city or County .
which wool.•Permit in eaotrucl.ohne,improve,demolish,m sped,any ama m
prior in its issoree.alw requires Be applicant for such permit in file a signed stamorml
p �
about M is liccented pursuant an the provisions of the Contractor's Liccoac Law(Chapter 9 Sq.Ft. Floor Area Valuation
y (co mmcncingwiNScction7000)of Divisim3oftMBoinmwdProfustiou Codm)or
$ thin be 4 evrPl therefrmn ami the Buis for the alleged exemption.Any violation of
Section 70315 by any applicant for a permit nbjecta an applicant to a civil penalty of APN Number Occupancy Type
not tome area five hundred dollars(M). P Y YP
I,u mere of Ih Property a my wployeer with wgee u Ne'v sole compewtim,
will do the wort and the strumuse 4 Out intended uronered forsale(Sec.7014,Business
and Prefesdmo Code The Conuwm&s License raw does rot apply in an owner of Required Inspections
properly who builds in impeovu thereon,and who does such work himself or through his
man employees,provided that such imptiwments ere not inmMed orolfered forsale.If.
hounver.the building m imps mnent 4 mid within are yur of completion.the oven,
builder will have de burden of proving Net he did not lend in improve for pur Mc of
sale.).
1,as mwnm of the pope t,sm mcitumn ly contenting wide licensed mwutors in
construct the project(See.7014,Business and Pmfesslons Cade:)The Commences U.
come law data not apply to an owner of property who builds or improves thereon.and
who contract for such projects with a conuacou(s)licensed pumunl to the Contractors
License law.
lameaemptundmsec. .B&PCfmthisresson
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby aRrm under penalty of pmjury one of the fallowing declarations:
I have and will maintain a Cerufursm of Consent to self-iruu c for WmFer's Compcm
num.as provided for by Section 3700 of the labor Code.for the perfoma,rCo Of the
work for which this permit is issued.
I have and will maintain Workers Compensation Iourmce,as minted by Section
3700 of the Labor Code,for Ne Kofoemance of the wont for which Nis permit 4 issued.
My Workers o.N.dnn been c.Cartier and Policy no cr. O�
Cartier. ��'GI- Poliq No.: JrL5
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This sm fir used not hccomplesd ifthe Permit is form hundred dallass($IWI
nr less)
I cenify that in Ne performance a de work fm which this permit is issuN,I shell mot
employ any person in any manner o as to become subject to the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this,Coalition of Exemption,you should
become subject to the Workers Compenssden provisions of Ne Labor Code,you mut
.,O forthwith Comply with each provisions or Nis Permit shall be deemed rooked.
z CONSTRUCTION LENDING AGENCY
[–� I hereby affirm NU Nes 4 a Conssmearn lending agency fm the perfmmance of
lX
an,work for which this permit is issued(Sec.3M,Civ.C.)
kg1 0 fender's Name
U z Landers Aedress
U O I cosily that I have mad this application and sum Nat de above Minnnadm is
U. H torten.I agree m comply with all City and Country Ordinances and sum laws relating to .
�U building construction.and hereby auNorio representatives of Nis city to enmr upon the
Cabove-mentioned property for iopenion purposes
(We)agree to save,indemnify and reap harmless the City of Cupertino against
CA liabilities judgments,costs and cxpenms which may in any way accrue&Saito said City
U Z in cometlumc,of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGUTA'IONS.
yL//icimoC 7-30-0� Re-roofs
Signer rt fApplicaHAZARDOU pram
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Wilby the e Cupid or fou ni building eceupanl port or handle Healdons material
u defined ca dee Cupertino Municipal Code,Chapter 9.13.aM the Health and Safely
Code,Sc<aon 25532(a)7
py,.s 6_1� All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant use equipment or dcvim which If a roof is installed without first obtaining an inspection,I agree to remove
D it h Tardous air cmtaminmts u defined by.Ne Bay Area Air Quo by Management all new materials for inspection.
0 Yes
I leve read Ne hvankvss masrlidlee aromems under Cmow6.95of Ne Califon
ria Health&SafctyCedc,Senium 25505,15533 and 25534.1 understand thuifthe building ;?-3j
dos not currently haw a amount,mal it is my responsibility m wary de oceupml of Ne VV r/
rcymirtmc ��gxe mel priormissuanx ora Certificatemr Ocwpaney. Signature of Applicant Date
2Z�
l
owr or Amman agent
reDate All roof coverings to be Class'a"or better
CITY OF CUPERTINO
• 2 ITEMS OF 8 PERMIT RECEIPT OPERATOR: pdtg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . . 35925031 . 00 -
DATE ISSUED. . . . . . . : 07/30/2008
RECEIPT # . . . . . . . . . : BS000005630
REFERENCE ID # . . . : 08070219
SITE ADDRESS . . . . . : 7624 DE FOE DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . :
OWNER ALLEN LUNIEWSKI
ADDRESS . . . . . . . . . . : 7624 DE FOE DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
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
-- -- ------------- ---------- ---------- ---------- ---------- ----------
113SEISMICR VALUATION 16, 000 . 00 1 . 60 0 . 00 1 . 60 0 . 00
1REROOFRES SQ FEET 34 . 00 442 . 00 0 . 00 442 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 443 . 60 0 . 00 443 . 60 0 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ----------------------------- ------ ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
•
CITY OF CUPERTINO
REROOF
•CUPERT`INO PERMIT APPLICATION
APN # Date:
Building Address:
0
Owner's Name: 400,.�,j Phone #: l�wsf�
Contractor: S�J`Ces Phone #:��lo�r�G171 ci�155
Fax 4: cto5(
Cupertino Business License #:a\p3� Contractor License #:
7 5ct oc�)
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
)kC Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other (Specify) ;K Other (Specify) gW"'e-\ rn
Number of existing coverings ❑ Provide I.C.B.O. Report #F SQ_tyg t
To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description: SV\c.y_e coal . S�5-N \\ 33 • Ise
o 4� YMCA-6\\
Residential Commercial ❑
Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if
Green Building Checklist & attach it to the there are any restrictions: ❑
application or if applicable, include in plan
set & the sheet index.
V a luation:�\
1 Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
Signature
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
• Telephone: (408)777-3228
Fax: (408)777-3333
Building Department
SC Re-roofing policy for the City of Cupertino
--- �.�PsiQr�Q�erait issuance you must agree to comply with 1997 UBC Standards
and manufacturers specifications on re-roofing.
7.. New roof coverings shall not be applied without first obtaining all inspection
and written approval from the building inspector. A final inspection and
approval shall be obtained from the building 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 approval.
2) In-progress inspection approval.
3) Final inspection approval.
a) Spark arrester installation.
;i. 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 performed.
7. [VOTE: If YOU call for a plywood nail inspection and the job is not ready,
you will be charged a re-inspection fee of 51.76.18. The re-inspection fee must
be paid before another inspection can be scheduled
IMPORTANT:
1. Flat roofs must have a minimum of 1/4 " per foot slope and demonstrate
that there is no ponding.
2. An I.C.B.O. report is required to be on the job site at the time on inspection.
I understand and will comply with the above stated policy on re-roofing.
Homeowner's Name: dear sal /�\\e n L-OY\j { SSG
Job Site Address: :1 spa 0PsZD2' a7eQ,enr)r'D
Roofing Company Name: \��� �}Z(/`��S Yzppq ��(�
Applicant's Sib zature:��"" �j&&-e,1ij Date: L>lo
• Greg Casteel
Building Official
Revised 11/2/04
'! CITY OF CUPERTINO
REROOF
WU )HIJINO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1REROOFCOM Re-roof Commercial B ICOMMLROOF
1BSEISMICO Seismic Couunercial B
1REROOFRES Re-roof Residential B ISFDWI.ROOF
IBSEISMICRE Seismic Residential B
1RER00FMRES Re-roof Multi-Family B IMFDWLROOF
IBSEISMICRE Seismic Residential B
1BUSLIC Business License B
•
Community Development
10300 Torre Avenue
- Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408) 777-3333
SCUPEkTINO
Building Department
JOB ADDRESS: PERMIT #
7( y GA4.e
OWNER'S NAME: *445y W j\-i k, PHONE # `707$- E7,go
GENERAL CONTRACTO : A-(1 u vs FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following 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
Mme-
Owner/Contractor Signature Date