08070216 CITY OF CUPERTINO
BUILDING DIVISION PERMIT- fCL1NTRACTOR I1�IFORMATION' '
i .'.i5'.',°..
Bj)ILDING ADDRESS: n PERMIT NO.
1.21.0 BELKNAP CT ALL SEASONS ROOFING SERVICEE 08070216
OWNER'S NAME: PERMIT ISSUE DATE
rn I., 1,13E 1720 SMITH AVE 07/30/2008
NE: SANITARY NO. CONTROL NO.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
RE—RF 1LYR EXTNG SHKRF& BLDG ELECT PLUMB MECH
D O O O
o O LICENSED CONTRACTOR'S DECLARATION
I bes by ador I am Hatred under pm.;simu of Chapter 9(=mmcming ^••^ �. ,. _ Job Description
ffirm
with Smdon7000)of Division3ofthe Ru3ineuu Professions Code,-Mmylicenseu
^ N in full fare and effect, 75so 91
j q z License Clyss Lm.g
n F p Dam ! common. l l v
7W ARCHITECTS DECLARATION
11< 1 undersand my pWu Nall be used as Public acrods
Jy
xot Licensed Pvfmionel
t C3 0OWN.11..BUIIDERm CLARATION
C I hereby so .(Sero Nal I I exempt from tiro Canusmers Code:A n e law far 1W
3 p 0 following rtnson.(m=utt 7 onstr 6uainm and Pnafvdov h.oAny city or county
$ which require;•e.&lm ac cmn9ma alter,improve,demolish.i or mash alt's ned um num
_ZT primtoslicened mrssumquite the applicant the suchCon Permit in rileasLaw(omment
y�S< thuWis licensed purnunt tithe of Ditlmaof the Comaacbsand Pro(laons Codmr9 Sq,Ft.Floor Area Valuation
(commencingwithSection Tanto Divisionr themegedmsantl Prof miter Cede)or
Wt be V exempt therefrom and ate bvu far de alleged eamption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil Penalty of APN Number Occupancy Type
nm mall urn Bw hnMrtd do11>n(swm. Pane Y YP
❑I.uawmr of the pmpusy.amy aoplaym w'ah wagau Ne'u am wmpemeon,
willdetheworlestd Neiu urunetintendedaofferedforsale($=.1014,Businm
and Pmless ons CMr The Contractor's License Law does net apply an an Owner of Required Inspections
propertywho builds or improves thereon,andwW doessacli work himself mthrough his
owm employees.provided Nat such improvements art Out intended mofferM for sale If.
hawever.the building or Gnpmvement is sold within am year of completion.dm mvner-
builder will have the burden of moving this he did not Wild or improve for purpose of
tile.).
Q 1.as owner of the property.w exclusively contracting with Hamed rotator to
mnswn f pojcn(Sec.1014,Business am Prefmions Cade:)The Cmuanm'a Li. .
cove raw does not apply ban owner Of property who Wild.Or tel o ms thmet.and
whocomracts for such pmjecu with a conaacbr(s)licensed pursuant in the Chairman's
License law.
❑I am a map,under See .B tier P C fm the reuan
Owner Dam
WORKER'S COMPENSATION DECLARATION
I hereby�m under pwlry of perjury oro of da falbwing d=luauov:
1 hew and will mamas,a Certificate of Cement to self-Wum for WoldersCompeer-
sati=n,u pmvidcd for by Section 3100 of the Labor Code,fur the perfonmamce of ell
were for which this permit is issued.
❑1 have and will mainuin Welders Compensum.Nuance,as required by Section
3100 a(the Labor Code.for the pedivers,oeof dm work for which this permit u iasme. '
My Workers CCofpensauon Iv rang artier end Policy numbaerr art:
Cartier. CI+N'iC_ n� Poliry No.:IX3!!"'���J 72V
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
Crus secllon need not W completed Hthe permit is froom hundred dollen(SIM)
or less)
I certify that in dm performs=c of the work Ire which this pumil is issued,I shall as
employ any person in any merman u at became sobj=t bete Warken'Comparomml
Laws of Califomis.Dam
Appliant
NOTICE TO APPLICANT:If,after making this Cenifnate of Exemption,you should
became subject b the Wm er's Compensation provisions of the labor Code,yeti mus
., O folLwith comply with men provisity m
or this permit shall W deemed rawked.
'Z y CONSTRUCTION LENDING AGENCY
[-� 1Wreby-from the thea ua cmismmtimn lending agemy far the pnfamsax of
ai> thm wort fur which Nis permit Is issued(See.3097,Civ,C.)
41 O Lmdc`3 Name
z Lenders Addrm
VO 1 cal Nat 1 have rod Nis aymlicat W arm dot the above wonamdur is
Is.E correct.1 agree b comply will,all city and coumy ardimumm aM sum laws relating b
.C) Wilding consuuction,and herby authafio oprmnosires of bac city bcnmrupnn ex:
bmcmenudgm property lar inspection Purposes
F y a (We)agree b save,indcmNfy and keep humlm the City of Cupertino against
Ter inconsequence
judgmentsecote W expmsvwbich may in my way attla sgainstseid City
U aZ APPLICANT
UNDERSTANDng of S AND
per mit.
^t APPLICANT UNDERSTANDS ANO WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOUR�e���O�
Signaturt�Appinan ommemr Damommem, Dam Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Ne applicant or future Wilding aa<epmtfbm Or handle havAow mamriod
u defined by der:Cupertino Municipal Code.Chapter 9.11 tib the Healul and Safety
Cade.Section 255324)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yv B�
Will em applicant or future Wilding Occupant use eyaimmcm or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it haraMv air cmmninsnts u dcrincel by de Bay Area Air Quality Management all new materials for inspection.
Disuses?
❑Yes 99.
(here owl the uadwsm materials rChammr6 fm Wil
dSafnvv5SG.2d15534.1 dN . Wilding
does not cuRCnlY have A WNn.dhst it Y MyresppminllilYW muffy e OWNI
Of de
mr,themcnuw Wmetpd.,toisana
uor.Omrfc.m.,"Cpm "� Signature of Applicant
Date
,\f
ow rermaemaeredagem Dam All roof coverings to be Class'%."or better
CITY OF CUPERTINO
. 2 ITEMS OF 8 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36210027 . 00
DATE ISSUED. . . . . . . : 07/30/2008
RECEIPT # . . . . . . . . . : BS000005630
REFERENCE ID # . . . : 08070216
SITE ADDRESS . . . . . : 1210 BELKNAP CT
SUBDIVISION. . . . . . :
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : M L LEE
ADDRESS . . . . . . . . . . : 1210 BELKNAP CT
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4904
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
--- ------------- ---------- ---------- ---------- ---------- ----------
IBSEISMICR VALUATION 15 , 000 . 00 1 . 50 0 . 00 1 . 50 0 . 00
1REROOFRES SQ FEET 31 . 00 403 . 00 0 . 00 403 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 404 . 50 0 . 00 404 . 50 0 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
--------- ---------------------------- -------- -----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
•
091>7 0.,?-/ (io
CITE' OF CUPERTINO
REROOF
UPERT`INO PERMIT APPLICATION
APN # Date:
0 ,2- 7- e-) °
Building Address:
cl sol
Owner's Name: \ Phone #:
Contractor: \ �Sov�S foo c:✓�S�c�ii Ce s Phone #: (Ltov, 01-7
Fax #:
Cupertino Business License #: a\�3S Contractor License #:
-1 X11
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles X Asphalt Shingles
Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other (Specify) ❑ Other (Specify)
Number of existing coverings ❑ Provide I.C.B.O. Report #
-- To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description: �Zc w\o'3e_ \\oye r SV"C'VcC_
O ca-n63o_'Sia SO c- cow^ p
Residential Conunercial ❑
Green Building: Please complete relevant portion of the Confirmed with Plaming Dept. if
Green Building Checklist & attach it to the there are any restrictions: ❑
application or if applicable, include in plan
set & the sheet index.
Valuation: S \S,Oco
I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
•
'A-�' /J
Signature
CITY OF CUPERTINO
REROOF
OF U )BI TINO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1REROOFCOM Re-roof Cormnercial B 1COMMLROOF
1BSEISMICO Seismic Commercial B
1REROOFRES Re-roof Residential B 1SFDWLROOF
1BSEISMICRE Seismic Residential B
1RER00FMRES Re-roof Multi-Family B 1MFDWLROOF
1BSEISMICRE Seismic Residential B
IBUSLIC Business License B
•
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
Fax: (408)777-3333
Building Department
Subject: Re-roofing policy for the City of Cupertino
_-- --J_ Prior-to-pum—it issuance,you must agree to comply with 1997 UBC Standards
and manufacturers specifications on re-roofing.
2. 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.
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 performed.
7. NOTE: If you call for a plywood nail inspection and the job is not ready,
you will be charged a re-inspection fee of$176.18. 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: L.2.e.
Job Site Address: k ;\O 'Q>Pi\\,-fin p Cr-r C-y .rte ✓gyp It 5141
Roofing Company Name: / l
Applicant's Signnature:'�LL� 8 Date: l�Qlp�
• Greg Casteel
Building Official
Revised 11/2/04
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
WUPERTINO
Building De artment
JOB ADDRE • PERMIT # /
/2lC� v4 k,1 ,1 G } 0 �—,62 O Z ( 6
OWNER'S NAME: l,ol« ti-ePHONE # cz5-3— 7 U9
GENERAL CONTRACTOR: 4// FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
21 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
bwner/ Signature Date