04110010 CITYBUIODING DPERTNNO PERMIT CONTRACTOR INFORMAU ,
nUILDINGADDRESs: WESTSHORE ROOFING CO PERMITNO04 110 0 10
10845 E ESTATES
OWNER'S NAME: PERMIT ISSURDA'fE
LIN TU 5869 WINFIELD B 4
ONE: SANITARY NO. CONTROL NO.
(408) 629-2100
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
B ELECT PLUMB MECH
0
uo0 LICENSED CONTRACTOR'S DECLARATION Job Descripti
m I hem).y affirm that 1 am licensed under provisions of Chapter 9(commencing
with Section 7").f Division 30f the Busimssand Profusions Code,and my liccnm u
'c„ Inmllforenandc r.2 t REROOF W/ SHINGLES
Z�? License C us Lic.R NOV4
, Date Ll^ a9 Conlraclor WV(SllaL r ���o0t
ARCHITECTS DECLARATION
4i z 1 undcrsund my plans shall M used as public mer rda Ingt O��B
JU U�k1���u C3
is.0 Licensed Professional
aS Oat NEmexemtfo DECLARATION
y I Mrcby affirm that 1 I. exempt from tM COnins License low for the
o O whicfollowing ions a Perm(Secit t ltDlA Business and w,de Professions h,or Code:Any an or mousy
which myuircs a pcmrit m mnswey,also,impmw,demolish,or mpir any swnum
Fzi Prionnis issunmc.also sequifn the applicant for such pewiva Ble asignetl summem
a < NmMiscingwJparstion7 h)ofDiviounfoftheBvinessandPorflaw(Chaper9 Sq. FL Floor Area Valuation
r=--� (commencing with Section 7")of Division3nftM Business and Profusions Core)or
WOar M is exempt themfsum and the basis for the alleged exemp0on.Any violation of
Section 7031.5 by any applicant for a permit subjects On applicant to a civil penalty of (g 0 Occupancy Type
not mom than five hundrtd dollars($500).
I,uownerof theprrpenyi oris employeeswith emdfu theirsale core.Bus ms
will d9 Professions
andthe o,Curt isnots stem de Law dos Out apply
704x,Bulinus
and .ywh bis Code:The Conuacmis ndwhe taw don tort apply to an mugh is Required Inspections
Own enywho b,provirid Out uch improvements
who sum
hwork himself 9r frrugh his
ownemployeWilding
iprovidedthatouchimprowmcnuarcnot Intended or lerrcd for owner.
however.Ne bve thgor mumproprovin issolddidnot yamofmpnowfrthrower-
builder will have the burden of proving Net M tlitl not Wild or improve for purpose of -
sl
I,as owner of she pmpenX am exclusively contracting with licensed contractors M
consumer the prrjem(Sec.7044,Business and Professions Cade:)The Contractor's Li.
mnm law does not apply m an owner of furriery who builds or improve thereon,and
who contracts for such pmjecs with a conumcmgs)licensed pursuant to the Contractor's
License law.
❑1 am nem t nder/Sec. .B&P C for olds mumu
Own" 2A e6 4 Dme 'C
WORK CSENSIMNDSCLARATION
1 hereby¢(firm under penalty of perjury ane of Ne following dulanyi0ns:
1 haw and will maimafn a Cenifint,of Continuo self-insum for Work esComp,n-
satinn,as provided for by Section 3900 of the lalam Code,for Ne peffarmanm of Ne
work for which this permit is issued.
❑1 haw and will maintain Worker's Compensation Insurance,as mate iced by Section
37W of the Labor Code,for We performance of the work for which this permit is issued.
My Workret'ss Compensation Insurance carrier and Policy number am:
Cartier:J n1E Aum D Polity No.: OLV A 919
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Cron amtirn need not M completed if IM permit is foronc hundred dollars($100)
(ir los.) -
I ceniry that in the performance of to work for which this permit is issued.I shall not
employ any Peron in any manner w as in become subject m the Workers'Compensation
Laws of Cabfnmia Date
APPlicam
NOTICE TO APPLICANT:If.after making this Ccnifcam of Exemption,you On.)I
become subject m the Works s Comperwtion Provisions of the labor Code.you a=
.JO forthwith comply with such provisions or this permit shall M deemed revoked.
Z '� CONSTRUCTION LENDING AGENCY
F I Mmby affirm that there is a Construction lending agency for the performance of
a the.,it for which this permit is issued(Sec.3(97,Civ.C.)
!s]0Under's Name
= Z Lender's Address
U O 1 Cenlfy Nal 1 haw mad this application arta sexm that On show informldun is
PCereCL 1 agree to Comply with all city and county onfinances and suds,laws muting to
U building construction,and hereby avthorve mpresenutives of this city to enter upon On
W aMve-mentioned property for inspection purposes
F gr. (We)agree to saw,indemnify and keep harmless the City of Cottonton against
rA liabiliyies,judgments,casts and expenses which may in any way accrue against mid City
U Z in consequence of Ne granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Signawrc of ApplicaDDam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant ser future Wilding mcupanumre m honour harudous material
m defined by the Cupertino Municipal Code.Chapter 9.12,and the Hcalth and Safety
Code,OYonsn 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
AZI Will Ne applicant or future building occupnl use equipment or devices which If a roof is installed without firs[obtaining an inspection,I agree to remove
mit hbr dour air contaminants as dcfmcd by do Bay Arra Air Quality Management all new materials for inspection. '
70W
iauicO .,,.t
❑Ycs ,may Nu
Ihawmvl thee,Socuos,25505.25533and mmc is 5534.1under dconand.95ofthe Wilding / /
us nith&Safety hawatonumra2sw5,ssymulasss3nyin nmana thmathe beudin SAS/ L//�C/�/6//SGL//
on not currently haw a¢nano that it u my mspomiM1ility b notify the occupant of Ne �
gaim m �im uatM apoc¢rissn mnrac"tihcamnrampmmy. SignaCureofApplicant Date r
n"oram nricaa nny ` Date All roof coverings to be Class"B" or better
r Community Development
10300 Torre Avenue
§L Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPERTINO
Building Department
JOB A RESS: PERMIT # D
s EIsT R l
OWNER'S NAME: kv\ PHONE # `l08 ' l3"g 82.E
GENERAL CONTRACTOR: 411 ,L,//� FAX #
I am not using any subcontractors: 'A' ;! //� &— , 1/�
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
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/dbntraor Signature ate
Community Development Department
Building Division
Ir
City of Cupertino
1A10300 Torre Avenue
CITY OF Telephone: (408)777-3228
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.
e3) 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 the above stated policy on re-roofing.
Homeowner's Name: p��ty\ T),T -
Job Site Address: MAS` \st Fto4e S .1 l
Roofing Company Nam
A plicant's Signature: Date:
1 Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
SID REROOF
CUPEkTINO PERMIT APPLICATION FORM
APN# Z Z Date: i 1 I21
oZa l
Building Address:
Owner's Name: ` �v Phone#:
Contractor: .r� Pone #: License #:
Welts re 1 00{� � OAS 2,13 31SD
Contact:/� n hone#: Cupertino Business License #:
Vol` Y l-C- 1 0V\--CkV,, qOg 2,13-31S'O
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt ShinglesAsphalt Shingles
ElWood Shakes ❑ Wood Shakes -
Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings Z ❑ Provide I.C.B.O. Report#
5;�, To be Removed ❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
lei Job Description: Q,t ®„� ��� IU rs v a d st\u�Q J %O s-lall 30 ✓alar C-"^-P
aver I e” 6 .5 . 3 Sl ee t ^ -
Residential ni' Commercial7l
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Det. if
�\ there are any restrictions: LJ
Cost of roject: 1 Type f ns c 'on: Occupancy group:
�a UOQ on,:
S�� •
Qty ' .
Ap rc 0 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
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