04080243 CITY OF CUPEMNOI
BUILDING DIVISION PERMIT C�NTRACT6R INFORMATION
B ILDINGADDRESS: WESTSHORE ROOFING CO PERMIT N004080243
11565 EVENING SPRING rT
OW HER'S NAME: PERMff I SUE DATE
WAYNE KOO 5869 WINFIELD RIM .08/27/2 004
ONE:
SATARY NE CONTROL NO.
(408) 629-2100 NI
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Lop LICENSED CONTRACTOR'S DECLARATION Job Description
y ❑ I Wmhy affirm Nat I am licemand umk�rProviaions of Chapter Y(commencing
<iW with SOEijpn]q)Il)af Divi¢ion]ofU¢Busircafmd Prafcssium Cndc.and mylimnxis
Zi« inmB mdef ✓ ZZt REROOF W/ COMP.
j 2 Date les a� Can yyy
Dao: Used As u
—� ARCHITECTS DECLA
I understand my Placa shall W used u public rtcnrN
�ayU
; y Licensed PNIC¢¢Innal
O
` 3 Oat lam exempt
DECLARATION
1 W mhy af0rm that 11. ,Business
from d r Canvas C s :Any C Lew for,M
3:o o following recon.(Section]1131.5,Busimas and Professions Code:Any city m county
K m fo which requires a permit m mnstmcL slur,improve,demolish.m mP,ir any svumure10000
y prior in its issuance,also require the applicant for such permit to file a signed stvument
��'< d�tW is littnxJ Purwanuo the pmvisioe of du Convacmrl Lkcnx hw(Chap¢r9 Sq. Ft. Floor Area Valuation
�?G (commencing with Section 7")of Division 3 of tW Business and Profoainm Code)or
or
$ that he u exempt dm¢(mm and IAC bare for one alleged exemption.Any violation of c�n��n
Section 7031.5 by my applicant for a North subjects the Applicant a civil penalty of U,q�ssulyerOO �, Occupancy Type
not more Nan five hundred dollars(5500). _ -
❑1,as owner of the property,or my employees with wages As their sole compcnudon,
will do Ne work and the stroaum is motimmoded or offered tarsale(Sec.7044,Business
And Pro(emm's Cade:The Convectors License Law does not apply to an owner of Required Inspections
Property who builds orimproves thereon.and whodoessuch work himself orthrough his
awn employees,provided that such improvements art mmimmaided or o@red forule.If,
however.the building or improvement is sold within one year of eampletion,the mwner-
builder will have the burden of pmving thin he did not build or improve for purpose of
sale.).
❑1,as Comer of the property,am a I.Owly counting with licensed conlocmrs m
construct the pmjca(Sea.7044,Business and Professions Code:)The Conmumr's Li.
cense Law docs not apply to in owner of property who Wilda or improves thereon,Ind.
who contracts for such projects with a contractor(s)licensed pursuant N the Contractors
License Law.
❑1 am exempt under Sec. ,B&P C for this mann
1371)(s)
wner Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the fallowing declarations:
I have and will maintain a Conificam of Consent self insure for Workers CumpCo-
tim.a provided for by Section 37M of the LOW,Code,for the performance of the
ork for which this permit is issued.
1 have and will maintain Workers Compeaation Insurance,a required by Section
of the Labor Code,for Ne performance of the work far which Nis permit is issued.
rkers Compensation Insurance amicr and Poliiccyy�nulrm�ber ass::G Fufib Polity�Y��'��Z—T�y
CERTIFICATE OF E?(E IPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section moil notbeeompleted if I W permit is fmmic hundred dollars(SIU])
or less.)
I certify Not in the performance of one work for which Nis Permit is issued.I shall nut
employ any person in my manner an As to become subject o LW Workers Compcnsstion
Isws of California.Data
Applicant
NOTICE TO APPLICANT:IL after making this Cenifieale of Exemption,you should
become subject to the Workers Compewtion provisions of Ne I.AWr Code.you muss
.J Z faMwith Comply with such provisions or this Immiitshall W deemed revoked.
ZO CONSTRUCTION LENDING AGENCY
Ptzi Ihereby affirm that Nem is a mmlroainn lending agency for the Performance of
CL > the work for which this Permit is issued(Sm.3M.Civ.C.)
0 Lenders Name
,z lenders Address
U 0 1 cenify Nat 1 have read this application and sum that the above informimun is
Is. P comet.I agree to comply with all city and county ordinances and sum laws renting to
0U building commuctiun,and hereby authorim mprexmiies of this city to eamr upon this
r shove mentioned property for inspemim Irdpmes.
gy WC)agree to save,indemnify and keep humleas the City of Cupertino against
In eiabilitiea,judgments,casts and expenses which may in any way acc=against said City
U Z in consequence of the granting of this permit. ,
.. APPLICANT UNDERSTANDS N WILL COMPLY WITH ALL NON-POINT' Issued by: Date
50 RCERyGyT.ATION .
A— ' u- y Z 3 y Re-roofs
Signi orApplicanslCommacuar Ir Dale
HAZARDOUS MATEFEIALS DISCLOSURE Type of Roof
Will the applicant of future building occupant store or handle hanudous mammal
As defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
ode.Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yalu
Will the applicant or Nlum building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit hazardous air contaminants As defined by the Bay Area Air Quality Management all new materials for inspection.
Dialriee? / \a
Cl Ycs
I have mad the hmardoes materials mquimmenu under Cooper 6.95 of Ne Califor. P
nia Health'C&Safety Cade.Sec6u s25505.25533amd25534.lundcamdNatiflhe Wilding
dos not'4�y Jy hove a mnana that i,is my responsibility m tify the eeeupmt of tho
requineU,whi st met o ssua a aCe fcau fOccupaney.
r'I; �`� _ZIgnature ofApplicant T� Date
4 Gov ncr tar authmnmd agent D,m All roof coverings to be Class"B" or better
Community Development
r e 10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408) 777-3333
�UPEkTINO
Building De artment
JOB ADDRESS: PERMIT #
S- Al P t O1 �!
OWNER'S NAME: efoU PHONE # Z ( j SU
GENERAL CONTRACTOR: g4C FAX #
I am not using any subcontractors:
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 �L
Septic Tank
Sheet Metal
Sheet Rock
Tile -'j - ,!
�-2 30-�
Owner/Contractors' afore Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
PEI�TINO 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.
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: Wkj1)R- Foo
Job Site Address: II 6S i ^`1 5_rr)*V a C--.
Roofing Company Name: WW S-t S t2° v4 " / t
A pllcant's Signature: Date:
eel
Greg t
Building Official
Revised 1/30/03
Printed on Recycled Paper
%or" CITY OF CUPERTINO
REROOF
CUPQfINO PERMIT APPL CATION FORM Z2
f1
APN # ,1,7 ^�
4 0
Building Address:
0S(nS
Owner's Name: Phone#:
�a r.a- koo LlotS �ZI -9k87,
Contractor: License #:
WAS'tS�ort �oa� Iv �hc Z'Z l
Contact: Cupertino Business License #:
VuY,rl2,1 �w,•r,.r.
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ,,Cr Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O. Report 4
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
1 Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: LeA o Q `o �� , o o
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning De I. if
there are any restrictions:
Cost of Project: Type of Construction: Occupancy group:
1�— ?00 Sp
Qty
A c le Fee ID Fee Descri tion 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