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CITY OF CUPERTINO
I1V1?ORMATION
IIIIILDINC•DIVISION PERMIT
CONTRACTQR
BUILDING ADDRESS:
ALLIANCE ROOFING
P"MRN006060143
19330 STEVENS CREEK BLVD
OWNER'S NAME:
PERMIT ISSUE DATE
HELEN PASTORINO
1250 CAMPBELL AVE
06/16/2006
NE:
SANITARY NO. CONTROL NO.
(408)261 -2595
ARCHITECT /ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0
LICENSED CONTRACTOR'S DECLARATION
Job De$CT1pIlOn
I hereby affirm Nat 1 am licensed under provisions of Chapter 9 (commencing
ith Scion 7") of Division 3 of cBusinm and Profedom Cc&",ad my license is
In full Come and er
OVERLAY EXISTING CAPSHEE ROOF WITH A FIRESTONE
'tense el coo , n� -S
Date coo
SINGLE PLY 60 MIL TPO CLASS A
ARCHTIECTSDECLARATION
DIECr
1 ndcnland my plans mall he used u public records
Licensed Pmfessianal
OWNER-111.111-DER DECLARATION
I hcreny affirm Nat I am exempt from the Contractor's License Law for the
fallowing mmon. (Section 7(D1.5, Business and Profmions Cook: Any city or county
which requires a Permit to commo,r, alter, improve, demolish, at repair any structure
prior to its issuance. also requires the applicant for such pcamil m fait a signal sn msern
Contracters License Law (Chapter 9
Sq. Ft. Floor Area
Valu i*5000
that he is licensed pursuant to the provision of the
(commencing with Section 7 000) of Division 3 of NC Business and Prorm ons Cock) or
that ne is eumpt Inmcfrom and Ik bnsu for the alleged essmption Any violation of
ApN N�Ir�l] ber
Occupancy Type
Section 7031.5 by airy applicant for a permit subjects the applicant to a civil penally of
Oat more Than rave hundred dollars (SSW).
3M 5 0 2 0 0
1, m co rut of the property, err my tmployce with wage ns their sole compensation.
Required Inspections
awowmimols 7U 4q Bnsinm
at
will daufasso
sCcddat
and Profession Code rn Cantlactora License Taw doe not apps lf rt owner
License Law apply
q P
is
progeny who bailee or ice proves thereon, one who ants such work Mmulr or through his
awn employers, pmva Thal such improvements arc not intended aroRerW forule If.
or i fee
however. the building orimprovemml,
oimproeefartheowncr-
atwithinmuyrsr
builder will have the buNela of proving Nat he did not bald or improve (or puryase of
Ron
sale.).
❑ I, as owner of the pmpeny. am exclusively contracting with licensed ronlnaors to
'
It(
cOnlmel the at (gee. Business and :) Gnrherm..
bui
■���-
es o. ray, h builds or rm theaon, nd
tersefew nonrotchapply loan ownero(paPeny whoeadporunt
to do es
who. for such pmjecu with a ernlrxmrtt) licenses pursuant to the Convenor's
Lace
LkInse law.
❑lam tempt undo Sec .BBPCfar Nis reason
— 1006
Owner Date
BUILDING
WORKER'S COMPENSATION DECLARATION
1 hereby aaiam under penally of pcajury me of Ilse following hdaadons:
1 have and will maintain a Cetificste of Consent w self -insum for Worker's Compen-
ration, ns pmvi4d for by Section 37W of the labor Code, for the peafomunce of the
work for which this permit is ismad.
have and will maintain Workers Compensation Intersect, u required by Section
7 of the Labor Code. for the perfancrmee Of the work for which this permit u issued.
'
Worker's Compensation MSurance 'm and Policy number sae:
Cartier. PORCYNa. :f()Cy3Q/7 %S('
�TE
/
OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(Thu semlrn need notbecompleted RIrk peraft is fororc hummoldollars ($I W)
less.)
1 certify drat in the performance or the work for which this Permit is issued, l mail am
employ any percent in my manner' as to become subject to the Worketa'Compenudon
Laws of California. Dmc
Applirsnt
NOTICE TO APPLICANT: If, after making this Cenificau of Exemption, you should
became Subject to the Worker'i Compensation pmvidans of the labor COMIC, you mum
'
forthwith comply with such previsions or Nu permit shall be deemed metes.
i CONSTRUCTION LENDING AGENCY
1 Acroby.tram thm there u a catharses. kndog agency far the performer c of
' to work fur which this Permit is issued (Sec. 3097, Ch, C.)
Lender's Name
Lender's Address
j 1 ceni(y Nat 1 have mad this application and must that the above inrormadun is
' carter. ) agrce in comply with all City and county carifi rafts and state laws relating to
building convection, and hereby authorize mprescmaliva of this city ED enter upon the
ahuve-mcnu
(We) agree to save, indemnify and keep harmless do City of Cupeniao again,
ex;,a er
judgments. usfo d
j which may in my way eccmc ageints4id City
inconsequence fthecosuantl of this pawhich
inconsequence Of the granting of permit
' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
A
Issued by: Date
SOURCE ffEQULA jyJS,
/ "'w!/ s-�Ja/
O
��� �(bl
Re -roofs
Type of Roof
Signal a A C 1 nor a�
Dure MATERIALS DISCLOSURE
Will thee !Muni Wilding
Cupertino C.occupantroseorand HeaNOUSmaterial
M defined by the Cuptnino Municipal Code, Chapter 9.13. and Ina Health and Safety
Cook. Se 5533(x)?
❑y.
All roofs shall be inspected prior to any roofing material being installed.
1
Will the applicmt or future building oceupmt tau equipment or devices which
If a roof is installed without first obtaining n inspection, I agree to remove
g P g
emit harardnuv sir conumi mum a dcrircd by the Bay Area Air Quality Management
all new materials for inspection.
DlmlrlC,7
❑Yrs No
I have mac the ha shich snomm -la mquimmenu under Chapter 6.95 of the Cdifor.
nix Health ds SafctyCIAC. Steven 25505,25533 and 25534. I uaW:rstaM the ifulc Wilding
doe not cure I nme a tenant. that it R my ponialily b notify ale occupml er the
requimmc Chmn pact. nraCeniOrstearacv
Signature of Applicant Date
All roof coverings to be Class "B" or better
Owner ,nm a ea
,te
m 1 of 1
0
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 37502021.00
DATE ISSUED.
RECEIPT # ...
REFERENCE ID
SITE ADDRESS
SUBDIVISION
CITY .......
IMPACT AREA
......: 06/16/2006
34890
# ... : 06060143
: 19330 STEVENS CREEK BLVD
......: CUPERTINO
OWNER ............: HELEN PASTORINO
ADDRESS ..........:
CITY /STATE /ZIP ...: ,
OPERATOR: amyw
COPY # : 1
RECEIVED FROM ....: RAYMOND GONZALES
CONTRACTOR .......: MILLER, ROD LIC # 20791
COMPANY ..........: ALLIANCE ROOFING
ADDRESS ..........: 1250 CAMPBELL AVE
CITY /STATE /ZIP ...: SAN JOSE, CA 95126
TELEPHONE ........: (408)261 -2595
;170162 °n
BU R DING
1U3UO TORRE AVE
CUPERTINO. CA 95019
9087773282
Sale
IO: J50N6219275
06,16, 06 l0: l L 28
Bahh 0: 026387
?MEH
HHHHHH01'0I026
bpr Code: 511516 1 "i9ti; li�iji'r;`:
total: 506.25
Cu5toi"er Coos
THANK YOU
FEE ID UNIT
---- - - - - -- ------- - - - - --
QUANTITY
---- - - - - --
AMOUNT
- ---
PD -TO -DT THIS REC
NEW BAL
BPERMFEE VALUATION
45,000.00
- - - - -- ----
496.80
-- - - -- -- -- - - - - -- ----
0.00 496.80
- -- - --
0.00
BSEISMICOM VALUATION
45,000.00
9.45
0.00 9.45
0.00
TOTAL PERMIT
---- - - - - -- ----
506.25
- - - - -- ---- - - - --- ----
0.00 506.25
- - - - --
0.00
METHOD OF PAYMENT
---
AMOUNT
NUMBER
-------- - -- - -- ------
OTHER
- - - ---
506.25
---------------
AMEX
- --
TOTAL RECEIPT
506.25
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
iq.
4
CITY Of
WUPEkTINO
•
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777 -3228
Fax(408)777 -3333
Building Department
JOB ADDRESS:
PERMIT #
/v
OWNER'S NAME: a
PHONE# Od 6 /'aSYS
GENERAL CONTRACTOR S
FAX # e � 7
I am not using any subcontractors:
i tore ate
Please check applicable subcontractors d o ete the following information-
hd
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
•
•
0IYof
CUPQiINO
CITY OF CUPERTINO
REROOF
PERMIT APPLICATION FORM
oi6TIM
APN # 3-
BPERMFEE
Date:
J
U-1 UdOLIL-
Building g Address:
BUILDING
BSEISMICRE
Owner's Name:
BUILDING
Phone #:
BSEISMICOM
Seismic Commercial
BUILDING
Contractor:
BPLANCHK
License #:
Vvi ..
702_
C ntact:
BUILDING
Cupertino Business License #:
M
20 -79
Type of Roof Covering:
Existing:
Proposed:
Built -Up Roof
❑ Built -Up roof
• Asphalt Shingles
❑ Asphalt Shingles
• Wood Shakes
❑ Wood Shakes
• Wood Shingles
• Other (Specify)
❑ Wood Shingles Po
� Other (Specify) si i 1'
Number of existing coverings
❑ Provide I.C.B.O. Report #
❑ To be Removed
❑ Provide Mfgr. Installation Specs.
1 Have Read, Understand and Will Comply With Cu
ertino's Tear Off Policy:
Job Description:
Residential Commercial
Cr �.reiyt
�t
Fire Zone: Yes ❑ No ❑
Confirmed with Planning D I. If
there are an restrictions:
Cost of Project: o Type o onsttvction: Occupancy group:
Qty. if
Applicable
Fee ID
F'ea t>nerri nfinn
BPERMFEE
Bldg Permit Fees
BUILDING
BENERGY
Energy
BUILDING
BSEISMICRE
Seismic Fee Res
BUILDING
BSEISMICOM
Seismic Commercial
BUILDING
BPLANCHK
Plan Check Fee
BUILDING
BUSLIC
Business License
BUILDING