02100080 (rry OF CUPER'I'INO -
BUILDING DIVISION PERMIT yC0NTiiAC-T0A INFORMATION g
Bu1L3150x91>R€Ur AS DR WESTSHORE ROOFING CO PER drN®2100080
owNTOEI/�Af jk1I UMESH K AND PALLAVI 5869 WINFIELD BLV APPI'ICATIT"OY2002
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IONS: 4 0 8 62 9-210 0 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
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LICENSED CONTRACnOR S rproviCons of CON
1 hereby affirm Inas I am licensed under provisions of,Cudc. 9(commencing lob Description
with Sttlinn]IxxpnfDiviaion3ofthcOusincaand PrnfcssinnnCoJc.anJmylicense is REROOF
row in lull force, dcB 5
Lic.x
zo N�z Liccnsc F p Dam Oy Convector
ANCIIITIiLT'S DECLARA ON
4�< I understand my plans shall be used as public reeords /
=spaX0dV O/
Licensed Professional
at OWNER-BUILDER DECLARATION
a P 1 hereby It.that I am exempt from the Contractor's License law for the
w o o following mason.Pwition]f13IS.Business and Professions Curb:Any city or county $8700
S(v which mildrev a Permit to construes,nher.improve,demolish.or repair any asmnore
Fiy prior to its issuance.also ruptures the applicant ler such Permit o file a signed statement
Yz aO that he is licensed pursuant it)the provisions of the Cumraztor's 4�
Live me Law 9 a-1qM AFDAIG0 Valuation
al (commencing with SectionBXXp of Division 3 of the B usiness and Pndessions Crde)or
i
that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 703 L5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than fizz hundred dollars(S5fly, IS N Occupancy Type
❑ 1.as,owner of the property.or my employees with wages M their sole compensation, 307 — INSULATION
will do Ne work.and the added.is not intended or offered for sake(Sce.]Wa,Buri. �f�r �p
and Professions Code:no Contractors License Law elks not apply to an owner of 602 - ROOF P S rV IJ n RAFfitn5
property who builds or improves thereon,and who does such work himself or through his
own employecs,pmv;ded that such improvements are not intended or offered for sale.If. 603 — ROOF BATTENS
however,the building or improvement is sold within one year of completion,Ne manner-
builder will have the burden of poeving that he did not bui ld or improve for purpose Of 604 — ROOF IN—PROGRESS
are.).
1,as owner of the property,am exclusively contracting with licensed contractors to
cnnswcl the project(Sec.7IH4,Business and Professions Codo)The Co rraemr's Li-
cense law does not appy to an owner or property who wilds or improves IFsreon,and. .
who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's
License Law.
1 am exempt under See. B&P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penally of perjury one of Ne following declarations:
I have and will maintain a Certificate of Consent to.self-insum for Worker's Compen-
sation,as provided for by Section 3700 of the Iawr Code,for Ne performance of the
work for which this permit is issued.
1 have and will maintain Worker's Compensation Insurance,as required by Section
.11x1 of Ne labor Code,for the performance of Ne work for which this Permit is issued.
My Wohera.Cyp�m-�Ppcnsau/o�n lnsuren�¢carticr and Polity num rare'
Ceretec�Sb/R{✓ CI!2 / Policy No.: S'UV
CF.RTIFICAnE EXEMPTIONFROMWORKERS'
COMPENSATION INSURANCE
(Thea acainn need not be completed if the perm;l is formic humhod dellaR(SIBB)
or less.)
1 certify that in the performance of the work for which this permit is issued.1 shall not
employ any person in any manner so em become subject o the Workers Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:11:alter making this Cent Beate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Crile,you must
OO forthwith comply with such provisions Or this perm it shall be deemed meowd.
'Z�'� CONSTRUCTION LENDING AGENCY
[� I hereby amrmthat were is a vonstmction lending agency lot he performance of
ai the work for which this Permit is issued(Sec 30)7,Civ.C.)
W� 0 Lender's Name
,a z Lenders Address
V C 1 certify that 1 have read this application and state that the above information is
H. F' correct 1 agree to comply with all city and county ordinances and such,laws relating to
DU building construction.and hereby authodrs representatives of this city to enter upon the
above mc judgm papery forinspection forripwhich ma.
H 0. (we)agree to save,indemnify and keep harmless the City of Cupertino against
h inconstabore of
and eapmtscsarit. may in any way att'mc against said City /1
U z in nmscyuentt of the graining of this permit (f
�^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON POINT Issued by: Date
SOURCE REGULATIONS.
'dz Re-roofs
Signature cal AppbcunVConttaelor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will we applicant of future building occupant store of handle ImAndous material
as defined by the Cupenimr Municipal Code,Chapter 9.13,and the Health and Safety
,doilf7tole,Scc❑timYesn 3550
31a)] All roofs shall be inspected prior to any roofing material being installed.
N
Will the apphm
eaulf buildinguccold(usccyuipmemordeviceswhich If a roof is installed without first obtaining an inspection, I agree to remove
mit haeardnus air contaminates
nants as defined by the Bay Arca Air Quality Management all new materials for inspection.
District!
❑Yes CflW�
1 base read the haeardnus materials requimmcnts under Chapter fi 95 of the Califor-
doesnox I tcurrenfctyawuSenant.hatns iti,3myre33 siJ35534.1 unikmanJe occuort of he �vr +'o
does not &Safety
haw,lection,that it is 55 rcand25534.1 alfily Ir rawly Cheat if me t nl'tha I
requirement wh' metformin esu cofa Cenlfies. foccuens,
Signature of Applicant Date
Owner or au hnrimd age Date All roof coverings to be Class "B"or better
Building Division
10300 Tom Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
CUPERTiNO
Building Department
Subj ect: Reroofing policy for the City of Cupertino.
1. Prior to permit issuance,you must agree to comply with 1997 UBC Standards
and manufactures specifications on reroofing.
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 reroofing 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) Preinspection 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 that the
proper City inspection can be performed.
IMPORTANT:
1. Flat roofs must have a minimum of V"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 of inspection.
We understand the above policy on reroofing and will comply with this policy.
Homeowners Name: 1, —1'irllil �
Address:
Reroofing Company Name:
Applicants Signature: Date:
Joe Antonucci
(Chief Building Official)
6/25/01