05090120 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CON! A,0RANFORMATION `
g.2&
BUILDING ADDRESS: WESTSHORE ROOFING CO PERMIT NO.05090120
7545 DUMAS DR
OWNER'S NAME: PERMIT ISSUE DATE
JAN STEIN 102 OLD ORCHARD DRIVE 09/16/2005
NE:
SANITARY NO. CONTROL NO.
(408) 213-3750
ARCHMC BINGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
uo0 LICENSED CONTRACTOR'S DECLARATION
C 1 henhy affirm that I am licensed under provisions of Chapter 9(commencing Job Description
U with SectionTIM)of Division 3 of NC Business and Professions Code,and my license is
imm�fnm and if REROOF-T/O COMP. , INSTALL COMP. y
s�= L e Lw.» 1tS222 � N.1ALE
r Dame Contruwr 1.�4EL
EARCHITECTS DECLARATION
1 undcrxunJ my plans shall tic useJ u puhlic ecnrds o /�� _
�roD `L/ 2005g
0G Licensed Pmfcssional
3 Bad I am exempt fmm the RATION
1 hereby alum that 11. exempt from the Contrecmod License Law for the
O o followin axreson.(Seniors]In L4 Business and Prufecsbn Cock:An cit or cavil N
following y y y I rl th �'
<m which its ism a permit I.ro uiresrthe alters improve,h Perlia Fi repair any awment fl 5 i7 0;0.0
yai pdormis issuance,also requinsthe applicant for such Permit file asigncJ statement ✓ u uL
< that he is licensed purauardwdeprovLpiom the c mmcwrsLies.Law(Charter9 Sq. Ft.Floor Area Valuation
`Uf
yF� (commencing with Section 7")of Division 3 of NC Business and Professions Codc)or
y that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit aubjecu the applicant w a civil penalty of 3APRMARruOccupancy Type
not mom than Ew hundred dollars(5500).
1,ss owner of the progeny,or my employees with wages as their sale compensation,
will do the work.and the structure is notinunded oroffered foralc(Sec.7014,Busiruss
and Professions Code:The Conputora Licertu Law aces apt apply to an owner of Required Inspections
property who builds orimprnves themon,and whodM3 such work himself or through his
own employees,provided that such improwmener are not intended proffered forage.If.
huweva,the building or improvement is sold within one year of completion,the owner.
builder will haw the burden of proving that he did not build or improve for purpose of
❑1,as owner of the progeny,am exclusively contracting with licensed conmmora to
construct the project(Sec.9,344,Business and Profeal Code:)The Contax<wi s Li.
corse Law does not apply w an owner of property who builds or impanel demon,and
who contracts Ws such projects with a eontmapr(s)licensed pursuant no the Conuactora
License Law.
❑ 1 am exempt under Sec. B&P C for this won
Owner Dau
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury none of the following declarations: '
I have and will maintain a Cenifrcam of Consent w self-insure for Worker's Compen-
sation,as provided for by Section 3]00 of de I:hor Code,for the p diem unce of the
work for which this permit is issued.
1 have and will maintain Worker's Compensation Insurance,u required by Section
37110 of de labor Code,for the perfomunee of the work for which this permit is issued.
My WmksC�'ytC�ompmuasion Ircun .or and Polity n'u(-}mW sm
Carrier, l'4;p/x�9- \�V
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This.stip.iced notbceompleudifdo permit is Route hundred dollars(SIM)
or less.)
1 certify It in the perfuamanee or the work for which this permit Is issued.l dull not
employ any person in any manner m as to become subject o Be,WorkersCompensation
Laws of California.Dow
Applicant
NOTICE TO APPLICANT:If,after making this Ccnificau of Exemption,you should
become subject to the Worker'a Compensation provisions of de Labor Code,you must
.J O forthwith comply with such previsions or this permit shall be deemed revoked.
Z CONS RUCTION LENDING AGENCY
I hereby alBrm tat then is a construction lending agency lot he perfrrmawe of
!Y. the work For which But;permit is issued(Sec.MD.Ci,C.)
D] Lender's Name
D
Lenders Addw
U Q 1 certify that 1 Mw read this application and sate dm the above information is
�-r Correa I agree w comply with all city and county ordinances and sus laws elating w
0U building construction.and hereby mourim mpesenutiws of this city to enter upon he
r W ahoye-mentioned prolixity for inspection purposes.
(We)agree to save.indemnify and keep harmless Be City of Cupertino against
F' ra/I liabiliucsJudgmenu,cesu and expenses which may in any way accrue against said City
t..1z inconsequence ADER "'
og of his permit.
A PPU A T U ND WILL COMPLY WITH ALL NON-P999FFFNNNT Issued by:3 Date
SOUR GU y/
Si nate N J Re-roofs
g pplw HAZARDOUS MATERIALS DISCLOSURE Dau Type of Roof
Will the applicant ur fusun building occupanumre or lundle hnardous material
a Mined by the Cottonton Municipal Code,Chapter 9.11,and tae Health and Safety
ode. Sy.lss3x(a)? yJJNo All roofs shall be inspected prior to any roofing material being installed.
Will the applicant rrV fu,ue Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it hazardous air contaminants ss defined by the Bay Arca Air Quality Management all new materials for inspection.
District? I ///
❑Yes ,�7Nu
I have rcitl the hursrddtnus materials rcc.i.menu under Chapter 6.95 of the Califer.
iia HeWH
alth&Safety Code,Sccuass 25505.25533 and 25534.1 undcrsund that it the Wilding
donten thata is my responibllity w notify art..P.,of thp
nquiW tpnorwismance.facerdhcau f«epp /p.� Signature of Applicant Date
T �Do All roof coverings to be Class "B"or better
m �t Dam
PTY
-^= Community Development
10300 Torre Avenue
HJ Cupertino CA 95014
Telephone(408)777-3228
F Fax(408)777-3333
�UPERTINO
Building De artment
JOB ADDRESS: PERMIT #
15H5 NyAas EY, v ,!�C-U o/26
OWNER'S NAME: D-Y� . PHONE # LA06 V 3-3 S
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors: `1 6 -
ignature Date
Please check applicable subcontractors and co m Tete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
S 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
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
U P E f�Tl N® 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:
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: ky\
lob Site Address:
Roofing Company Nam SV\Ye,, v t' ��"" 1 V\ C
Applicant's Signature: Date: 1 d[�
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINO
San RE ROOFCITY
CUPEI�TINO PERMIT APPLICATION FORM
APN # �S LZL� b`�C� Date:
Building Address:
Owner's Nam es PhonegDg 9 73
Contractor: Phone #• License #:
� S CS�de VO(A , U 3 1575 .
Contact6-c-,Vvi-\�1 p J nye 0#9 ),i 3 3, S Cupertino Business License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
Asphalt ShinglesAsphalt Shingles
/110M
❑ Wood Shakes /❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
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: v,�vC. Coif G-`^()- t n5 \v \t Co nn ro P\n V"o 0
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project: O T e ofnst�uction: Occu ancy group:
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