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CITY OF CUPERTINO
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NaCONTRAC�T'OR INFORMA TLQN
BUILDING DIVISION PERMIT
BUILDING ADDRESS:
WESTSHORE ROOFING CO
PERMIT N005090119
19707 ALDERBROOK WY
OWNER'S NAME:
PERMIT L45UE DATE
JEANIE CHANG
102 OLD ORCHARD DRIVE
09/16/2005
ONE:
SANITARY NO. CONTROL NO.
(408)213 -3750
ARCHITECT /ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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LICENSED CO mRAC10R'SDEC ON
Iicen.d CWpm 9
Job Description tlon
1 affim Net l am under prmacif r (rnmmen
with Section 7 NO of Diviaio3of m BUSrccsand Processions Code. and my license is
in full fbme and If t. 7r7-1 Z
License 1 / � Lie. M
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REROOF -T /O SHAKE, I NSTA'LL��),STONE'COATED STEEL
n Bid `eb V l4l(wm g'�ey IS.s��
Dale Contractor Ind - �3'{si ✓`!i! L
,
HI
ARCTECTS DECLARATION
1 understand my plans shall he used as public records
/ J /�_ '1 �(5 nC
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Licensed Professional
OWNER - BUILDER DECLARATION
m
I hereby m'rifm that I am exempt from tiro Comaxcmo License
ereby t Law for the
he Codnm
ry _ [;�� �.-t
are/
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following (Secti on Business and Code: Any city m county
which requires a permit m construct, alter, improve, demolish, or repair any structure
,(,(?l(
�lq�(j l �u( s ryU \,Y�/'l•
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prior its issuance, also n tuires the applicant for such permit to rile a signed statement
that he is licensed pmwanun the provisimoof the Ccmmcmfi Lien. Law(Chapmn 9
Sq. Ft. Floor Area
Valuation
(commencing with Section ]0)0) of Division 3 of the Business and Professions Code) or
that M is exempt therefrom and the basis for the alleged exemption. Any violation of
'
Section 7031.5 by any applicant for a permit subjects the applicanuo a civil penalty of
3 0
ere
Occupancy Type
not in= than five hundred dollars ($500).
0 I. M owner of the propeny, or my employes with wages u their role compensation,
will do Ne work, and the structure is not intended or offered for sale (Sec. 7044, Business
Inspections
and Professions Code: The Commcmt's License Law does not apply In an owner of
,Required
pmpeny who builds orimprnws thereon. and who does such wmkhimselfor through his
own employees, provided that such improvements arc not intended rroffered for sale. If,
however. the building or improvement is sold within one year of compl.um. the owner -
builder will haw the burden of proving that M did not Wad or improve for purpose of
aide.).
El I, as owner of the propeny, am exclusively contnning with licensed contractors to
construct the project (Sec. 7044, Business and Professions Cm1eU The Comeactors Li.
cense law does not apply in an owner of propeny who Wilds or improves thereon, and
who contracts for such projects with a contravor(s) licensed pursuant or the Contractor's
License law.
I am exempt under Sec. ,B &PC for this reason
Owner Dam
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
1 have and will maintain a Ceniricate of Consent o Self - insure for Workv'S Compeer -
cation, we provided for by Section 3700 of the Labor Code, for the pertormance of the
work for which Nis permit is issued.
(] 1 have and will maintain Worker's Compenx ion Ire ... as wired by Section
3700 of Ne labor Code, for the perho man w of the work fm which this permit is issued.
My Worker's Compensation nsu`n�n,¢f, canner and Policy number am:
Cannot: 4.��}ii ' V ` • Policy No.: I b I ()� /i`+ D f-
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu scnim real not uncompleted if On permit is Rotation hundred dollars ($10()
err less.)
I ecnifv that in the perform... of 00 work for which this Permit u issued, I shall not
employ any person in any mamnerro as or become subject o the Workers' Compensation
Laws ofcauforma. Date
Applicant
NOTICE TO APPLICANT: If. after making this Ccnilleam of Exemption, you should
become subject to the Worker's Compensation previsions of the Labor Code. you must
forthwith comply with such provisions or this permit ahadl W deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby affirm Our them is a construction lending agency for de perfurrom a of
the work for which this permit is issued (Sec. 3097, Co. C.)
Lender's Name
Lender's Address
1 certify Nat 1 have read this application and sme that the above information is
coned 1 agree to comply with all city and county ordinances and sum laws relating in
building consuunion, and hereby authorise represenmiven of Nis city to crime upon the
.bowde.nuoned property for i pe purposes
(We) agree to save, indemnify and keep harmless the City of Cupertino against
.n st and upcnsce which may in any way accmc sgeinsuaid City
expenses
e
liaco
acquenco c lasts
iAnP OnugAUCnc.uNthc RST m oS LAND WILL COMPLY WITH ALL NON-POINT
Issued by: Date �
LA
SO RE LAoNS.
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4 I 1 f 10
Re -roofs
Type of Roof
amgWt Appliean Mmmxor %
�""
HAZARDOUS MATERIALS DISCLOSURE Da Ic
Will the applicant tar frown Wildingaccu. more or Mmile haarmus mamnal
as delned by the Cupenino Municipal Cook, Chapter 9.13. and the Health and Safety
Wk. Section 355)3(x)?
Yes No
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to
Will the applican r future building =upon( use equipment or devices whim
remove
nit Ire ardma air contaminants 0 dermcd by the Bay Area Air Quality Management
all new materials for inspection.
District?
❑Yes u
I have mail the ha Nrwc materials requirements under Chapter 6.95 orthe Califon
nia Health & Safety Code. Sections 25515, 35533 and 25534.1 undersmnd that if Ihe Wilding
tips no a dy ho m t, Nat it' y responsibility m mnuty the occupant of the
Require s hichm nW IIncr seance of a Ccm cam fOccup cYx-
Signature of Applicant Date
b
All roof coverings to be Class "B" or better
ownnn rat reed agent t) mm •
L
CITY OF
UPEkTINO
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777 -3228
Fax(408)777 -3333
Building Department
JOB ADDRESS:
),110 _ A \4v0�oo4- LJ
PERMIT #
os-0 ?otol G
OWNER'SNAME: + ,ke. �V -
PHONE# tlb�— /'j,
GENERAL CONTRACTOR
FAX#
I am not using any subcontractors: AL 1 / \ -� I 1'6' 0 �.
Signature Date
Please check applicable subcontractors and complete the following information:
Owner/ Contractor Signature
Date
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
Owner/ Contractor Signature
Date
Community Development Department
Building Division
City of Cupertino
EEEltt 10300 Torre Avenue
Telephone: (408) 777 -3228
CITY OF Fax: (408) 777 -3333
*UPEkTINO
Building Department
Subject: Re- roofing policy for the City of Cupertino
1. Prior to permit 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: WC�Y\ It
lob Site Address:
Roofing Company
Applicant's Sign
Greg Casteel
Building Official
OCA- w
Y-&
Revised 11/2/04
Printed on Recycled Paper
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Date:U�
�.
CITY OF
CUPEkTINO
CITY OF CUPERTINO
REROOF
PERMIT APPLICATION FORM
,�) ��l 0 � 1-7
APN # Z,1
BPERMFEE
Date:
�-
Building Address:
Owner's Name: \ ^ CV-0, V-,D
BUILDING
Phone #:4D9 � 7 7 q 1 -L
Contractor: Phone #:
��s z,lY -s�sa
License #:
Y7ZZt
Contact: Phone #:
�jYt.F�� �iwtu+'�, dog 2t3 -37St7
Cupertino Business License #:
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
Other (Specify) �r�,u n C c4gc tta
Number of existing coverings
❑ Provide I.C.B.O. Report # j�6K, L4_2, ,
/2( To be Removed
El Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu
ertino's Tear Off Policy: ❑
Job Description: \2ewvvc SW 1(R �^c k Cou-tn
9_00- � V`^ .
T�F ! S S'
Residential Commercial ❑
Fire Zone: Yes ❑ No 2
Confirmed with Planning Deft. if
there are any restrictions: LJ
Cost of project: O Type of Construction: Occupancy groongroup: 0
Qty. if
ADDlicable
Fee m
Rea Tlacrrintinn
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BPERMFEE
Bldg Permit Fees
BUILDING
BENERGY
Energy
BUILDING
if
BSEISMICRE
Seismic Fee Res
BUILDING
BSEISMICOM
Seismic Commercial
BUILDING
BPLANCHK
Plan Check Fee
BUILDING
BUSLIC
Business License
BUILDING
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