Loading...
03090028 CITY OF CUPERTINO BUILDING DIVISION PERMIT CONTRACTOR INTORMATION BUILDING AD REss: ALL SEASONS ROOFING SERVICMIr ND03090028 NER'S NAME: 2640 PACER LN PERMIT ISSUE DATE PHONE: 4089.24455 SANITARY NO. CONTROL NO. ARCHITEC(ENGINEER: BUILDING PERMIT INFO BLDG ELECT' PLUMB MECH i ULICENSED CONTRACTOR'S DECLARATION £w❑ I hereby affirm That 1 am licensed under provisions of Chapter 9(commencing Job Description iW with llfoce]deffecDivisionlof NC Busine santl Profcssinns Codc,and my license is s<6 in(Ill force and effect. ;�i uaen Cla ue.n REMOVE BUILT—UP ROOF -moo ,am �. '1T_� Camra -REPLACE WITH SAME �, ARCHRECI-S DEC RATIO ■ ALWO 4 W V 1 understand my plans shall W used as public rds L.N �aG Licensed Professional OCT fi 2003 OWNER-BUILDER DECLARATION �<S 1 kreby affirm Ilial 1 am exempt from the Contractor's License Law for the ' 00 following moon.(Section 703 L.5,Business and Pmfessinns Code:Any city or county `<m which requires a permit to construct,alar,improve,demolish,lir repair-any Stmelur u�< primto its issuance.aLwraquimstheappeicanl fmsuch permitmfleasignedsutement ;i Oat Mislicensed pursuant othe Provisions nrthe Contractor's License Lew(Chapter 9 Sq. Ft. Floor Area a Lia SOO kFG (commencing with Section 7")MDivision 3 of the B usinese and Professions Crvk)or $ dal he is exempt Dominica and the basis for the alleged exemption.Any violation of Section]011.5 by any applicant for a permit subjects the applicant to a civil penalty or no,mo3 7A1$VL�DgrO O. Occupancy Type re Nan fm handled dollars(5500). - 0 1,as Owner of ft Pooperly.or my employees with wages u theircole compensation, will do NI work.and Ne swclum is not iinendcd or oRmed hotels(Sec.7014.Busi. slid Professions Cade:The Contocmr's License Law does not apply to an owner of Required Inspections pmpeny who builds or improves thereon,and who doessuch work himeelfordtmugh his 305 — FRAME own employees,provided that such improwmenta art not intended mortared for sale.If. .307 — INSULATION however,the building or improvement is sold within aro year of completion,the owner builder will have the burden of proving Nat he did not build or improve for purpose of 601 — ROOF TEAR OFF Sam.). ❑ I,as owner ofthe pmpeny,amexclusively contracting with limaxedcontractors to 602 — ROOF PLYWOOD NAIL construct the pmjccl(See.7004,Business and Profusions Code:)The Convector's Li- .. .. 6 03 — ROOF BATTENS. cake Law does not apply to an owner of property who Wilds or improves Nemon.and who comracu for such projeca with a contractor(s)licenmd pursuant to the Convadori 604 — ROOF IN—PROGRESS Licenselsw. ❑ 1 am exempt under Sec. ,B h P C for this reason Dal WORKER'S COMPENSATION DECLARATION 1 kreby affirm under Penalty of perjury one of the following declarations: ❑I haw and will maintain a Cenilmateof CrmenOo self-imur for workeraeompca. cation,as provided for by Section 3311(1 of the Labor Code.for the co om mind of the work for which this permit is issued. ❑1 haus and will maintain Workcri Compensation Haurarm,as required by Section 17B0 of he later Code.for the performanec of the work for which this permit is issued. ' My Workcr'a cn lion sues try number art: X C c� s olicy No.: C CATEOFEKEMPI'1 OM WORKERS' COMPENSATION INSURANCE (This action need not W completed if the Permit is(mom hundred dollars(SIM) lir less.) 1 eenify that in the performance of Ne work for which this Permit is issued,1 shall not employ any person in any manner M so to became subject to the Workers''Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If.after making this Cer iGeam of Exemption.you should became subject in the Worker's Compeesztion pmvisions of the laser Code.you must . . 2 forthwith comply with such provisions lir this Permit shall W deemed revoked. yO CONSTRUCTION LENDING AGENCY 1 krby alram Nal ft.is•eomesuclum lending agency Int lk perfaraoac of y one work for which this peril is issued LSCC.Sall.Ci,C.) 3t Under's Name - z Lender's Addreu J Q 1 ccnify that I have read this application and sate that Be above inforauun is 'y F^ colica I agree to comply with all city and county ordinances and sure laws rearing to JU building construction.and hereby authorim reprmmausdiwe of this city to com,upon Ne abe.e-ms,judg d pmpeny for inspection oms purposes (y (We)agru m save,indemnify end keep ham less Ile City of Cupertino against Z liabilities, grading of cs which may in any way accmc against City .J z in conscyuenec of the graining of this peril. ^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:- 6 Date SOURCEREG nawreo man Comraclor Re-roofs sg Data HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicam or v future building occupant store or handle hardous material asciefinedli,thocCii,anintiviloncIoll ode.Chapter 9.13,and the Health and Safcty de. emimn riY.3ss33(nn All roofs shall be inspected prior to any roofing material being installed. ❑Yu Will the applicant or future building occupant use e If a roof is installed without first obtaining an inspection, I agree to remove p Area uor Management g p emit Gaardnus air contaminants u dcfrPcd by Be Bay Arta Air Quality Managcmant all new materials for inspection. District) ❑Ycs 1 have rand the hasuo n ismaterials requirmenu under Chapter 6.95 of the earful. _ nia Health d Safety Corm,Simon-25505.35533 slid 25514.1 understand doxifthc WiIJ does no,estrntly haw a tenant,bar it is my mxporssihilily a Only ek ceeupanl lir Kquircon use mctpnarmissuana 'ficateofDecorate,Y �D�a�t �pplican[ Date rasa vcdaganl - Dar All roof coverings to be Class "B"or better CITY OF CUPERTINO IEem 2 of 2 PERMIT RECEIPT OPERATOR: suem COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 37518030.00 DATE ISSUED. . . . . . . : 09/03/2003 RECEIPT #. . . . . . . . . : 23007 REFERENCE ID # . . . : 03090028 SITE ADDRESS . . . . . : 10271 JOHNSON AVE. SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : JOHN LA PLANTE ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 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 5, 000.00 107.00 0.00 107.00 0.00 BSEISMICRE VALUATION 4,800.00 0.50 0.00 0.50 0.00 __________ __________ __________ ---------- TOTAL PERMIT 107.50 0.00 107.50 0.00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ _-__---_----____-- OTHER 275.60 MASTERCARD TOTAL RECEIPT 275.60 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 �D�$ REROOF • CUPERTINO PERMIT APPLICATION FORM APN# -3 -76— � © Date: 9de3 Building Address: r Owner's Name: Phone#: t 't°` Z Contractor: Phone#: License#: ,-L 00 at--9 71- 9 Contact: Phone#: Cupertino Business License#: zmn X08ele-n Type of Roof Covering: Existing: Proposed: aL Built-Up Roof OV Built-Up roof �j Asphalt Shingles ❑ 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. - I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: Job Description: I Residential [2 Commercial ❑ Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if there are nnu restrictions: LJ Cost of Project: Type of Construction: Occupancy group: Qty. if A licable Fee ID Fee Description Fee Group BPERMFEE Bldg Pen-nit Fees BUILDING BENERGY Enemy BUILDING BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING