04090199 CITY OF CUPERTINO
BUILDING DIVISION PERMIT 1,€CONTRACTORANT O MATION
Bu1LDINGADDRESS: WESTSHORE ROOFING CO PERMIT NO.
04090199
OW NER'S NAME: PERMIT ISSUE DATE
GEORGE HILL INTLIPTRIM 2117 MA
ONE:
SANITARY O. OL NO.
12
ARCHITECT/ENCINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
nota LICENSED CONTRACTOR'S DECLARATION
w I Mmny !firm tWt 1 am IienxO under provision of Chapter 9(commencing lob Des tion
with See 7 )of Division 3 of Jte Buss ofession Cole.and my license is ®tl®tl@@
ca
in run fortex eRut39 X22 t REROOF W�COMP . ���
Dya? Liccnu Cl L Lk.N���}
new Dam —/7—yy G.... 41,11 /.RHOI?
< ARCHITECTS ONION
I c`o J Pla xGWIn uxdas records SEP 2004
_>D 30
Saw Licensed Professional
g
OWNERZOILDER DECLARATION ii®aa
1 hereby affirm diet 1 em nempt from the Convanots Liccnx law for the ■
00 following moon.(Section 7W L5,Business and Professions Code:Any city or county yR
K 2 e which mgoires a pnmtit tit consumer,alter.improve,demolish,nr rtpait any structure
m—'v' prior u+its issuance.alao require Ne applicant for such permit to file a signed statement -
F?GthatheislicensedpurxanttotheprovisionnfNeConnecsor's license Law(Chapter 9 Sq.Ft. Floor Area auat
6�S (commencing with Section 7000)M Division 3 of the Business and Professions Code)or
Nat he is exempt themfmm and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects me applicant m a civil penalty of 3GVV21uM*M0 Occupancy Type
not more man Rw hualmd dollar(1500).
I,as owner of the property,or my employees with wage u their sole compensation.
wilt do the work and the swctum is not intended or offered forgone(Sec.7014.Business
and Professions Code:The Conuxmts License Law don not apply to an owner of Required Inspections
property who builds or improve thea m on,and who does such work himself or through his
own employee.provided that such improvements are not intended or offered foraale.If.
however,We building or improvement is sold within one year of completion,the owner.
builder will have the Wrden of proving mat he did out Wild a improve for purpose of
ale.).
❑1.as owner of the properly,am exclusively contracting with licensed Contractors to
construct We project(Sea 7W.Business and Professions Cade:)no Contractor's Li.
more law does not appy or in owner of proper y who Wilds or improves Women.and
who currants for such projects with acral rselor(s)licensed pursoam to die Comvaclo's
License law.
1 am exempt under Sec. .B Al P C for this mason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of We following declarations:
1 have and will monsoon aCerufinm of Co..,to self-intim far WorkersCompen-
737W
hen,as provided far by Section 3700 of the labor Code,for On perfmmana of dm
rk for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,n required by Section
o(We labor Code,for me perfo arounnof the work for which this permit is issued.
y Worke�r'ss CCompensation Insamrtce carrier and Policy number art:J// Fi �sstd�[�nPolicy No.:-T I��� z 00
ERTIFCI ATE OF EXEMPTION FRDMWORKERS'
COMPENSATION INSURANd notWcompinNif the permit is Can hundred dollars(SIIXn
or less)
1 tinnily mat in We performance of the work for which this Permit is issued,1 shall not
employ any person in any manner sr,u to become subject o the Workers Compenauon
Laws of California.Dal
Applicant
NOTICE TO APPLICANT.IC after making this Certificate of Exemption,you should -
become subject m the Worker's Compensation provisions of the laMr Chose,you all
.J.Z forthwith comply with such provisions or this permit shall on,deemed revoked.
z
CONSTRUCTION LENDING AGENCY /
ifor by which
diatthem isaconstruction(97,Clending agency lot the performance of
!Y
On work for whim this permit is issued(Sec.3097.Civ.C.)
W z Leromrs Name
6. Lender'-s Addm.<
U O 1 certify mat 1 have mad this application and sole div the above information is -
W P correct.l agree to comply with all city and county militiamen and state laws relating to
0U building construction,and hereby audition reprexnutives of this city in enter upon We
rW show-mentitioed proper far inspection purposes
gy (We)agree to save,indemnify and keep harmless We City of Cupertino against _
F h ts.
liabilities,judgmeneoso accrue and expenses which may in any way acee against said City
U Z APPLICANTnsuccusimeUNDERSTANDS Aof On loading oftND WILL COMPLY WITH ALL NON-POINT Issued by:
50 CER U TIQNS
Re-roofs
Signuu f many ntraet /J Date
HAZARDOUS MATERIA ISCLOSUg)✓ Type of Roof
Will On applicant or future building occupant store or handle haramous material
as defined by the Cupen"' Mu icipal Code,Chapter 9.12,and the Health and Safety
ade.Section 25532m)? All roofs shall be inspected prior to any roofing material being installed.
❑Y
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit haramous air contaminants as defined by the Bay Arta Air Quality Management all new materials for inspection.
District?
❑Yes W
I have mail the havamous materials requirements under Chapter 6.95 of the Cali(or- T • -/
nix Health&Safety Code,Secumu 25505.25533 and 25534,1 tordersond count(the Wilding V
does not currently haw a tenant that it is my naponlbility w entry We occupant of We
mquimmen hi r Wmetprio anccoa ruricamtiroccu corp. Signature of Appli aI Date
trcrnranmtiora g t Dam All roof coverings to be Class "B"or better
r
y Community Development
�4 10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPE(�TINO
Building De artment
JOB AD ESS: WRMIT #
�� .��.✓ S r Gi O
O 'SN H NE # 2 - o
GENERAL C CTOR - s a t ✓ #
I am not using any subcontractors: �„�,�1 G
�A �— -
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 L8J
Septic Tank
Sheet Metal
Sheet Rock
Tile
ontractor Si e Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
PEI�TINO Fax: (408)777-3333
3
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: Cpw -r�P,
Job Site Address: ` S (�_ S r 1 L�
Roofing Company Name: V�S� V\��e oo-�\v\ 1 �C
A "'t's Signature: Date:
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
Fir
CITY OF CUPERTINO c,
R. REROOF
CUPEkTINO PERMIT APPLICATION FORM
APN # 3 / / o Date: � ll ,1 �� , n
Building Address: Ct '
Owner's Name: Phone #
Contractor: License#:
0- 5: 04
�oY2, �pt� \v,c , �87ZZ.1
Contact: Cupertino Business License #:
STN r�rt •4. � IzU Mum .
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles id Asphalt Shingles
Wood Shakes ❑ Wood Shakes
❑ Wood Shingles' 13 Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report#
❑ To be Removed W Provide Mfgr. Installation Specs. - So vtea•r_
-� I Have Read, Understand and Will Comply WiL
"C�1u ertino's Tear Off Policy:
Job Description: w c �e k<a�er w..O IS kQ cl c( t-,3-i PNI\ Sc, L3QtiT Cov,•t f-
Residential Commercial E] 1
Fire Zone: Yes ❑ No ❑ Confirmed with Planning De I. i
there are an restriction i .
Cost of Project: Type of Constructi : Occupancy group:
700 RC— Rad+ S
icab 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