03060157 • CITY OF CUPERTINO ' °�'a4 40 4' '"
BUILDING DIVISION PERMITCONTRACTOR=INFbRMATIOIV
aq
oUILDING ADDRESS: WESTSHORE ROOFING CO PERMIT NO 03060157
• OWNER'S NAME: 5869 WINFIELD BLV PeRMrr kssue DAra
NE: (408) 629-2100 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0
jog LICENSED CONTRACTOR'S DECLARATIONLED
J
Ozu I hereby affirm that I am Itcenscd under provisions of Chapter 9(commencing Job Description �1e res
n< with Seetion 70111)of Division 3 or Ne Busimmord Professinrs Code,and my license is - �/
< infall fonxendeffeQ-1- Z� I REROOF
Lieenm 1,+, LIC.X AL 0 2 2003
'g Det. - Contreez B V46FIN"
5 ARCHITECTS DECLARATION
I understand my plans shall be used at public records
5 BUILDING
s ] Licensed Professional
n OWNER-BUILDER DECLARATION
Io y I masa affirm 1 a.1. exempt from the CsourotCo :Any law for Ibo
-00 followwhichingmasna(Secuun 7031.5,Business duoamprve,dOuns Code:Any city or county
$� which requires a pem10 m construct,tltea improve,demoluA,or repair any swctum
Mpoor In its issuance,also requires the applicant forsuch permit file a signed statement
�O that be is licensed pursuanl to the pmvisimm.f the Contractor.,License law(Chapter 9 Sq. Ft.Floor Area Valuation
g2� (commencing with Section 7000)of Division 3 of the Business and Professions Cede)or
i that he is exempt themfrom and Ila buns for the alleged exemption.Any violation or 32611092 . 00
Section 7031.5 by any applientfar a permit subjects the appltanuo a civil goodly of APN Number Occupancy Type
nal more than five hundred dollars($5001
❑1.u owner of the property or my employee with wage as their Ole compensation,
will do the work,and t1u.mmtem I...t intended or offered for sale(Sec.7De/,Business Jub - Re lilted Inspections
Rod Profession.Code:The Caavactor's License Law docs not apply i an owner of 307 - INSULATION p
property who buildsor improves thereon,and who does wohim
such mark selforthrough his
own employees,provided that such improvements arc not intended or offered forule.If. 601 - ROOF TEAR OFF
however.Ne Wilding or improvement is Old within one ye+r of completion,the owner-
balae will haw the Wraen of proving that be did not Wild or improve for purpose or 602 - ROOF PLYWOOD NAIL
"In.). 603 - ROOF BATTENS
1.as owner of the property,am exclusively commuting with licensed convectors in 604 - ROOF IN-PROGRESS
construct the pMject(Sec.7014,Business and Professions Code:)The Contractors Li-
cense law done not apply m an owner of property who Wilda or improves Ibemun,and,
who contracts for such pmkeu with a contnemrW licensed pursuant to the ConmactoM1
License law,
I am exempt under See. B h P C for this mason
' Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby alfttm under penalty of perjury,aro of the following declarations:
1 have and will harmala•C.mFC.m of Consent to self-insum for Workei.Compcn-
Orion,u provided for by Section 37W of da IJbor Code,for the po rarmeone of the
wart for which this Permit is issued.
❑I hove Rod will maintain Worker's Compensation InsurOe,u Required by Section
3700 of the labor Code.for the Performance of the vat h fm which this permit is issued.
My Wori a/r's Contpeaatlon I...carrier end Policy number am:
Cartier.lflYTI FUND PolicyNo.: LS"I o$
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
This section need not bovemplead if the permit is fm one hundred dollars(SIM)
or less)
1 certify that in the performance of the work for which this permit is issued.l shall not
employ any penin in toy manner O a in become subject O the Workma Comperellumn
Laws of California.Dale
Applicant
NOTICE TO APPLICANT:IL after making this Ceniricale of Exemption,you should
become Object to the Workeh Compensation provisions of the Iahm CON&,you must
.J 0 forthwith comply with such provisto s or this Permit hall he decmcd mvnked.
Zy CONSTRUCTION LENDING AGENCY
I-i I hereby affirm met there is a construction lending agency fes the performam:c of
ai ? tho work for which this permit 0 issued(Sec.3097,Civ.C.) ,
W Q Lender's Name
= z Lender's Addrcs+
V Q 1 enify that I have read this application dnd One Na Ne above information 1,
W P correct.I agree 10 comply with aft City and county ordinances and state laws relating to
0U thave- construction.and Wtente euthonmrepresenmivss of this City taenia uiXm the /T
W ahovnmentianree ropertyto
for demnify an keeph. / X/3
a (We)agree to taw,indemnify expenses
keep harmless the City of against against
hue4 inChides.Judgmc the granting es penesmitchmayinany way eccnw Salon aid City
O F77 in cnnseyucnce of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOyy��REppULAT NB.�7
An_ �.� Cnf) �-75.03 Re-roofs
um
Sign Of ApplicO on tar Daa
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant at future Wilding Occupant nom or handle hvaudous mmum)
as defined by the Cupertino Municipal,Code.Chapter 9.12,and Im Health and Safety
Code.Section 25532(07 All roofs shall be inspected prior to any roofing material being installed.
OYau
Will the applicant a,comm WOdingoccapaat we.quipmemardevices which If a roof is installed without first obtaining an inspection,I agree to remove
It be dons air conand...or as dclumd by the Bay Arca Air Quality M...gcmern all new materials for in ec[ion.
Id.n.te..
/❑Yu HNo
I have mel Ne huurdnus materials requirements under Chapter 6.95 of the Califor-NcoiNA Safely Coda Sections25N)5,23533end25534.1understandthatifthe Wilding lyha on Ol.the It is my r.+ponsihility m nattily IM cecupant of Neui 0. ohm 1Wor 'o,Otssuanccof.Ccniric�nfocccupncy.� Signature of Applicant Date
Owner tar ontorived&S'em 4 Dow All roof coverings to be Class ��B�� or better
Community Development Department
f" Building Division
f City of Cupertino
dui 10300 Torre Avenue
4CITY�F Telephone: (408)777-3228
UPEkTINO Fax: (408)777-3333
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: �7
1) Pre-inspection and/or tear off approval. 0 0 IJ M
2) In-progress inspection approval.
3) Final inspection approval. JUN,2 5
a) Spark arrester installation. ti
5. If plywood is installed,a plywood nail inspection is requir d.
6. Any roofing which is applied without first obtaining an ' pe tion,
will require the removal of all new material down to the he thing,
so a proper City inspection can be performed.
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:
Job Site Address: 10161 ��X�2✓ A U
Roofing Company Name: liter Y-f Oz 41 vi
A plicant's Signature: 1-t) Date:�l O 3
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINOW
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN# 11 Date:
Building Address:
U1 ey-
Owner's Name: �\ I I ,a Ybq 7
Contractor: Vv VVPho #: ��" `� Lie nse#:
Contact: i Phone#• Cupertino Business License#:
QL,t,)-I F6w(,e r N rL5. ZIUU
Type of Roof Covering: Vakes
77Existing: Proposed: 1❑ Built-Up Roof ❑ Built-U❑ Asphalt Shingles ❑ Asphalt❑ Wood Shakes ❑ Wood S❑ Wood Shingles ❑ Wood S _❑ Other(Specify) ❑ Other( _Number of existing coverings ❑ Provide❑ To be Removed ❑ Providepecs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑
Job Description: kcMavc fset S-ttr, rhe* cow-)" C-10CA Sb4vjd �vtst.( l 6-.)3.r-
G-ra..d 5-11,O, J eA L°t-.P) O"q y 1V;z.//
Residential N;r\ Commercial ❑
V
Fire Zone: Yeses ❑ No ❑ Confirmed with Plannin De t. if
there are any restric ' ns:
Cost of Projec 0U Type of Cons t n Occupancy grou .
Qty. if
A li le Fee ID Fee Description Fee Group
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