05060072 CITY OF CUPERTINO +^':•+s a:€ 3
BUILDING DIVISION PERMIT 'XONTRAC_TQR INFORMATIgN,
I BUILDINGADDRESS: WESTSHORE ROOFING CO PERMITNG05060072
10750 S BLANEY AV
� OWNER'S NAME: PERMIT LCSUE DATE
KEVIN TILL 102 OLD ORCHARD DRIVE 06/10/2005
ONE: SANITARY NO. CONTROL NO.
(408) 213-3750
ARCHITECrfENGINEER: - BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
yKZ0 0 (� 0
Op LICENSED CONTRACTOR'S DECLARATION
w❑ I Wrtby air,,.mai I am licensed inner provisiorm of Chapter 9 commencing Job Duesepripuon pA��
Zw with Section 7000)nf Division 3 o the 0usincs and Profcssinm Code,and my license is
=a❑ (iorccLic.N REROOF= ir_7v"^yiyW SHINGLES
Data J911 161,0,5- Connote 1t
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I
S� ARCHITECTS DECLARATION •r�(AI
y¢i I understand my plans shall W used as public meet&
Dau Ud
o h Licensed Professional
` g OWNER-BUILDER
exempt
DECLARATION
Contractor's
E<2 I hereby.(Seco cont 1 am.Bumps from the Contrwmr's License Law forme
O O (allowing maw n.(Section]1131.5.Business and Rafcsdmm Code:Any city or county (a/. ;
E
_ which requires a reams re eamwce alcor,nt rrove,demolish,at repair any vroeturc \\Axl 12 0 0 0
r1onPH.,Wiucensed inffiortquirt,race applicant roasuch Cimuscmiuo flu asigned sutcmcnt
mat prinisimciff in. Sq.FL Floor Area Valuation
x F G Chat M is ing exempt
Section J0ndfar Division 3 o ShcCgC Business and on.Any vi Gndnj or
y 3$ mat he u exempt therefrom and the bull for the allegW exemption.Any violation of
Section 7031.5 by any applicant for a permit wbjecu the applicant to.civil penalty of er Occupancy Type
no,mart man Rte bandied dalhrs(35001.
❑1.rat owner of the prapcny,or my employees with wages ss this,Sole compensaJon,
will do the work,and the Swmue is me,intended or offered rorage(Sec.7044.Budniss Required Inspections
and Pmfcssions Code:The Contractor, w,License ladoes M,apply to e ns an owner of 9 P
property who Wild,or improves thveon,and who doessi ch won himself or through his '
own employe¢,pmvided that such improvements are not intended or offered foraale.If.
however,the building or improvement is Sold within one year of completion,the owner
builder will have the burden of proving mat at did not Wild or impairs,for purpose of
sato.).
❑I,as owner of the property,am exclusively contacting with licensed contractors to
com nict the project(Sec.7041,Business and Profsmons Cade:)The Contractor's Li.
came law does nos apply to an owner of property who Wilds or improves thereon,and
who contracts for such projects with a conuacmr(s)licensed pursuant to the Contractors
License Law.
I am exempt under Sea .B 6 P C far this msson
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby alarm under penalty of perjury one of the following Gclantionk
1 h,m and will maintain a CerthiaConsent sel
re of Conseno f-insure for WorkeriCompcn-
ation,as provided for by Section 37M of the,IOW,Code.far the performance of the
/- orrkk for which this permit is issued.
( rT I have and will maintain Worker's Compensation Issuance,as refused by Section
700 of the labor Code,for the performance of the won for which this permit is issued.
My WorISa Compema Into tt cant:"and Policy numbger art:
Canicc J I& )7X Polity No.: 1b 1 b•LO d MI
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu section head not W completed if rhe permit is furore hundred dallus($100)
or kss.)
I unify that in the orinn c of c q(o�µfo h Nis permit is faster,I shall nut
Lny'perwnin anyt �t rr td M.m subjcctt tl¢�'rkysOn
Lawsawsco'of California.Detc A/ 1p I
Applicant
NOTICE
CETO APPLICANT:IL atom making this previsions
o Of Exemption.you should
.J zW"wi subject to the Worker',Compensation Or Has provisions of the modLabor Code,you must
foMwith comply with such pmvininm a,mice Permit shall W damcd revalued.
zCONSTRUCTION LENDING AGENCY
te+ I hereby affirm that them is a construction lending agency far me performance or
:4 the work for which this permit is issued(Sec.3(141,Civ.C.) ,
0.Q Imdur,Name
Z Lender's Address
U O 1 Certify that 1 have read this application and sum this the Sparc information is
a, fr cosec.I agree to comply with all city and county ordinances and sure laws relaung to
0U building construction.and hereby authodm mpesenutivcs of Lou city in enter area the
} W abow-mentioned prepeny fm inspection purposes.
F gy (We)agree to save,indemnify and keep harmless the City of Cupertino against
,,7 liabilities,judgments.eosts end expenses which may in any way accrue agaimt said City
U in eortsequcnce of the granting of this permit. 1
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date ScP c�
SOURCE REGULATIONS.
6•1d-s-
Signature
HAZARDOUS
Signature of ApplicaData
HAZARDOUS MATFRIALSDISCLOSURE Type of Roof
Will the applicant or future building occupant store or andthandle Health and
as de0netl by the Cupertino Municipal Code,Chapter 9.12,and the Health end Safety
gW,aAgjjWodc.
Ycs ���''' All roofs shall be inspected prior to any roofing material being installed.
� Qrvo
Will the applicantorrffuture building Occupant use equipment or devices which If a roof is installed without firs[obtaining an inspection,I agree to remove
it havardous air contaminants as defined by the Bay Area Air Qualify Management all new materials for inspection.
District?
❑Yes IN.
1 have man the hvvdnusmaterials ie aimemenu under Chapter 6.950(the Califor.
nia Health&Safety Cale.Seetiau M%5.35533 aa125534.1 understand thatlithe Wilding Ice OS .
does rmt eumcnif ha.c tenon mat it u my responsibility w notify tic occupant n(the
require hinmu�prmtp rwiad...r.ceruRcoof p tgueofApplican[ Date
dr L � 1"(INT - All roof coverings to be Class "B" or better
Ow trona orivcJ agent Date
r Community Development
p 1
10300
Cupertino
rtinoCA 95014
~ Telephone(408) 777-3228
CITY OF Fax(408)777-3333
�UPEkTINO
Building De artment
JOB ADDRESS: Jol So S . g Ian�y q„c, PERMIT#
aso 6 oo-7 2
OWNER'S NAME: PHONE #
GENERAL CONTRACTOR: �• FAX #
I am not using any subcontractors: — N Yom/
Signature Date
Please check applicable subcontractors and complete the following information:
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 9-604 \,%c S-117,
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OFFax: (408) 777-3333
CUPEkTINO
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 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: I A
S D�°�nt� Avt
Job Site Address: 10-7SU '
Roofing Company Name S't5�no✓e ��{I (��'
Applicant's Signature: Date: �J
Greg Casteel
Building Official
Revised 11/2/04
P mw)nn Pacvcled Paper
CITY OF CUPERTINO
n ° �� 2l (l
CUPERTINO PERMIT APPLICATION FORM
APN# 3 1 2,30510 Date: 6 t
Building Address: 1 -ls O S.
.p D � ut,•
Owner's Name: k1 � Phone #: Yeg,
L�1t�
Contractor: Phone#: License #:
W01- 5wro- lzoatl lv.c. 4438 42-i3.3-7yo 7872 z I
Contact: Phone #: Cupertino Business License#:
GabYt�l iZo,�t.�>` t{aB 2,o -3150
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles Asphalt Shingles
g Wood Shakes — ❑ Wood Shakes
�❑ Wood Shingles - - ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings t ❑ 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:
Residential _ _ _ Commercial-_❑__
Fire Zone: Yes ❑ No Confirmed with Planning Dept. if
there are any restrictions: i5
Cost of Project: Type of Construction: Occupancy group:
S Fiz- .
Qty. if
Applicable 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