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03100155 CITY OF CUPERTINO BUILDING DIVISION PERMIT v CO NTRAC�T,(IRINPORMATLON BUILDINGADDRESS; WESTSHORE ROOFING CO PERMIT No03100155 OW NER'S NAME: 5869 WINFIELD BLV PERMIT ISSUE DATE 10/21/2003 NE: (4 08) 629-2100 SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH io0 LICENSED CONTRACTOR'S DECLARATION U F I Mmby affirm Nall am licensed under provisions of Chapter 9(commencing Job Descri tion i=6 with Section 7")or Division 3 of Ne Business,and Prufcssions Code.and my license is in full fame and effect. )t2K Li....CEO, C Lie., 87 REROOF ��© f u Data Cmdoxxt r ARCHITECTS DECLARATION NOV 1, O Ooo� F w V i understand J nd my Plans shall W used as public records L o G Liccnxd Professional �/)ar�d�f1 ppI'1n1I A� OWNER-BUILDER DECLARATION Ilrl/aYirIL®�Y Vo''4 i a y I hereby alirm that 1 am exempt from the Contractor's License Law for the _ YL llL�'jJ 00 following mason.(Sectiun 7131.5.Business and Profcssium Cale:Any ayor county <m which requires a permit to cdm true,alter.motion.demolish.or repair any structure8 2 O O prionnils isamnre.also requires the applicant for such permit to Glc a signed Statement :Tao that he is liccngd pursuant 10 the provisions of the Contractor's License Law(Chapter 9 Sq. Ft. Floor Area Valuation k t—$ (commencing with Section 7000)of Division 3 of the Business and Professions Coifc)ur _ Net he is exempt doomfmm and the basis for Ne alleged exemption.Any violation of 32641075 . 00 Section 7031.5 by any applicant for a permit subjecu the applicant to a civil penalty of APNNumber Occupancy Type not more than RK hundred dollars($530). Pane Y YP 1,as owner of the property,or my employees with wages as their sole compensation. will do Ne work,and Me..Cie.is not intended of offered for sale(Scc.Tried,Business and Predications Code:The Conbacmr's License law docs not apply to an owner of Required Inspections progeny who build,or improves Moment.and whodoes such work himself or through his own employees,pmvided that such improvements are not intended or offered for sale.IL however,the building or improvement is sold within one year of completion,the owner- builder will bars the burden of proving Nat he did not Wild or improve for purpose of sale.). ❑1,as owner of Ne property,am exclusively contracting with licensed contractors to construct the project(Sec.7064,Business and Professions Code:)The Contractor's Li- ecnse Law does not apply to an owner of property who Wilds or improves themon,and who contracts for such protects with a comi-scmr(s)licensed pursuant o the Contractor's License taw. EJ I am exempt moselri asp Lr Site ;7 .B&PC for is rtason Owner IA1.eS}5 PaODf WC.� InDate (017d.0-P` WORKER'S COMPENSA DECLARATION I hereby Blinn under Penalty of Perjury one of the following declarations: 1 bare and will maintain a Certificate of Coment to self-imum for Worker's Compen- sation,as provided for by Section 3700 of Me,Lear,Code,for the penoonanec of Ne work for which Nis permit is issued. r'7 1 hats and will maintain Worker's Compensation Imuradec,as myuired by Section 3100 of Ne tabor Code,for Ne performance of Ne work for which Nis permit is issued. My Worker'//s Cffn��mptte,�nsalin�n Insura/pees[artier and Policy number art: Cartier. Policy N. �� IDS Z1�3 CERTIFICATE OF EXEMPTION MOM WORKERS' COMPENSATION INSURANCE (Thu section need not tecompleted dIW permit Is trona hundred dollaR(SIBB) or 14x1) 1 epnify that in the performance of Ne work for which Nis Permit is i,aued.I shall not employ any scrmn in any manner sex as to become subject to Workeri Compensation Laws of Csiifomia.Done Applicant NOTICE TO APPLICANT:If.after making this Cenibcax of Exemption,you should become subject to the Worker a Compensation previsions of the labor Code,you most r2 forthwith comply with such provisions or this permit shall W deemed revoked. z'O CONSTRUCTION LENDING AGENCY 1 hereby affirm that Nem is a construction lending agency for Me performance of Y. the work for which this permit is issued(Scc.3W7,Civ.C.) t7 Q Lender's Name 2 Lender's Address 1 certify that 1 have read this city and c un and dinta Nat and a eal information is - y F correct.1 once m comply with all city and county nNinanmf and dux laws relating to e �f) ahon-lg<oitoodon.and hembysouthern reprexnuti.rs of Niscity to enter upon the above-me e)agree to trysave for inspection keep hs. N y (s ju agme to save,indemnify and kith harmless the City of Cupcnino against h Liabilities coatsand eapemumit. may inany way accrue againSt saidCity ;� z A APPLICANT or Negmalng ofNDS this permit. APPLICANT UN RSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: . Date SOURCE REG 10 Signature o/A I'caH HAZARDOUS MATERIALS DISCLOSURE OneTypeType of Roof Will Ne applicant or future building Occupant store or handle hesxim e,material as defined by the Cupeninn Municipal Code,Craftier 9,12,and the Health and Safety We.section 25532(a)7 Yen `^ All roofs shall be inspected prior to any roofing material being installed. ❑ Will the applicant or future building occupant use equipment Of devices which If a roof is installed without first obtaining an inspection,I agree to remove it fomenter air contaminants as defined by the Bay Area Air Quality Management D'grin7 all new materials for inspection. Yea 1 have real Ne haasNnusmaxrials myuircmsntsunder Chapxr695 of the Califor- niaHcalth&SafetyCa .Sellom25505,25533and25534.1undemaod Nuif Ne building docs not currently hast a x L.Nat it is my res,somihility to no the..,.l of Ne !/ nequircmcnu which mug at ivuW fa CauGnx of?co'cidey. S i g n atEyd'oT Applicant Date Owner car antheria abern lD 3,te All roof coverings to be Class "B" or better Community Development Department Building Division City of Cupertino 10300 Torre Avenue Telephone: (408)777-3228 CITY OF Fax: (408)777-3333 qUPEkTINO 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. 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 theabove stated policy on re-roofing. Homeowner's Name: bcrmf4 J6¢, L41a' Job Site Address 0�0_L l 5�lwt KV.e , C AI i4,0 9SOl L( Roofing Company Name: we 6j_* b S -C&E-1 f (KC, A plicant's Signature: tDate: _LaL21 X03 • Greg teel Building Official - • Revised 1/30/03 Printed on Recycled Paper CITY OF CUPERTINO REROOF CUPERTINO PERMIT APPLICATION FORM APN # 7� r Date: Building Address: 10�0Z, Cf�uSlt.ol.u. #�v� Ga-Pe.Sh� C-A �5o1Lf, Owner's Name: JoQ Phone#_ l{O 888 — 135 { Contractor: Phone#: License#: Wts+?� "re— R-00( tmc . 4,0,6 607- ztoo . 787ZZ Contact: Phone#: Cupertino Business License #: Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles ❑ Asphalt Shingles �ood Shakes ❑ Wood Shakes ood Shingles ❑ Wood Shingles e r n ' ❑ Other(Specify) -Cr Other(Specify) Alii BULL. 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:TnS u _rDdSjtk` fkSf i�oy,TI/L�tbejlc�, C"osC dk, Residential Commercial ❑ Fire Zone: s ❑ NoJ❑ Confirmed with Planni t. if there are any restri tons: Cost of P oject: 02�� Type o Cons n: Occupancy group , Qty. if ApplicaFee 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