03090029 CITY OF CUPERTINO %' '�^ '="trx«�w'�-.z s•3+: �ilnaknix a-�Nfi: ;=
BUILDINC DIVISION PERMIT ..,CONTRAC"rOR INFOR,MAT ON:
BUILDING ADDki:ss: PERMIT NO
WESTSHORE ROOFING CO 03090029
OWNER'S NAME: - PERMIT ISSUE DATE
5869 WINFIELD BLV
NE: SANITARY O. CONTROL NO.
12002
(408) 629-2100
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
+or. yesLmthatIDCONTAdunderSDEConsofCON g Job Description
wp T Wrcb fRrm that I am IianxO under Provisions of Chapter Y(commencing�iW wite.cnion 7akp f oon]of the Business and Professions Code,antlmyliccna is
in mu force and err (.
;'q? Liansc claa Lice L TEAR OFF WOOD SHAKES w�
' 'te
mac Dam cunvacwr REPLACE WITH SAME PL YAL n
•E� ARCHITECTS DECLARATION
I m 1 understand my plans shall W used as public records
G N Licensed Professional
SEP 1 12003
5 OWNER-BUILDER DECLARATION
a0 1 hereby affirm self this 1 1m exempt from the Contractor'&License Law for IW
e00 followingreason(.cation7onsfe Business andve.de.nsCnde:An,city nrcclum BUILDING
m which wyuifes a permit re cnnswm,pplic improve.demolish m e repair g any svummc
umi Chpriarm its issmnepursualso requires the
ovisim of for such Contrator'mimax Law(ned Chapter
(comm iswiit pursuant the of Division
Sof t Contractor's nd Prof Law(,Code)9 Sq.F[. Floor Area Valva
[t— Beat(commencingheeempt Section7")and the
Division]of the alleged
Business and Any vi Code)or 1"000
`C Na Section
u exempt thcmfrom and the basis far the subjects
flcd exemption.Any violation of
not mom
than03 by any reddmtfor a rs(S50rmit mbjccu the applicant macivil penalty of Occupancy Type
n.�m.rethanfin nanareaamlars(s5oo). — - - 3'A�'$I�Y.ATb@r00 - - P Y YP .._
CD I,u owner of the prepcny,or my employees with wages as their sole compensation,
will do the work,and Ne swcmm is nal intended or offered for sale(Sec.7044,Business
and Professions Cade:The Contractor's License Law doss not apply to an owner of Required Inspections
property who builds or improvu thcron,and whodocs such work himself.,dwugh his 305 - FRAME
ownemployces.provided tharsasimpromblenuue nmimmrded aafre¢d forale.If. 307 — INSULATION
however,Ne building or imprevemem is sold within one year of completion,Ne owner.
builder will have the burden of proving that he did not Wild or improve for purpose of
ale.). 601 - ROOF TEAR OFF
[1 1,as owner of the propmy,am exclusively convecting with licensed contractors to 602 - ROOF PLYWOOD NAIL
construct the project(See.7(1 Business and Profusions Code:)The Contractors Li. 603 — ROOF BATTENS.
cense law does not apply to an owner ofpraperty who Wilds or improv Nemo.and 604 - ROOF IN-PROGRESS
who contracts for such projects with the a contractor(&)licensed pursuant to Cl ntrecwra
License Law.
0 1 an,exempt under Sm. .8&P C for this reason
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
1 naw and will maintain a Cenificam of Consent o Ulf-iuum for WorkefsCompen-
satim a provided for by Section 3700 of the Tatar Code.for the parrmmus.of the
work for which this permit is issued.
0 1 ham and will maintain Wurke"s Compensation Inswana,a required by Scaion
3700 of the Lather Code.for the performance of the work for which this pemtit is iaad.
My WmkeY nm anon Insurance artier and Policy m art: g
Cartier. f Policy�.MWc�Q v
CERTIFIC NFROM WORKERS
COMPENSATION INSURANCE '
(Thu sceion aed nothecomplered fine Permit is(wane hundred dollars(5100)
loss.)
I cmify that in the performance of the work for which this Permit is issued.I shall not
employ any person in any mannerso at m Wcume subject t.the Workers'Compensation
Laws of California.Dole
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation previsions of thm LItar Code.you raw
z th"with comply with such provisions or this Permit hall W deemed revoked.
Z rjy CONSTRUCTION LENDING AGENCY
1 hereby alum that them is a construction lending agency I'or the Performance of
1a the work for which this permit is issued(Sec.3097.Co,C.)
QUnder'.Name,
Z Under'.Address
J Q 1 certify Nat 1 haw read this application end 10m tear the a Ww information is
i (•-' coecn.I agree m comply with ill city and county on inanas and state laws misting to
V building construction.and hereby authorim«prerentalima of this city to enter upon the
U ahove-memioned property for inasmuch purposes.
CL (We)agree w saw,indemnify and keep hamdess Ne City of Cupenin,against
(n liabilitieajudgroar,,costs and expenses which may in any way aceta against aid City
;)z In consequence of she granting of this permit.
APPLICANT UNDERST NDS WILL COMPLY WITH ALL NON.POINT Issued by: Date - C)
SOU C REG LATION .
R
aRe-roofs
Bnw, ofAppicam/Con mr Dam
-
HAZARDOUS MATERIAL.DISCLOSURE Type of Roof
Will the applicant or fount building hat sonhandle hazardous material
u defmcd by the Cupenin.Municipal Code.
Chapter 9.13,o,and the Health and Safety
Code,Section 35532hd?
/ ❑res All roofs shall be inspected prior to any roofing material being installed.
Wili thc a licam.r future building If a roof is installed without first obtainingan inspection,I agree to remove
PP d by the B tie ea Air Qu or devices which
is hazardous air contaminants a defined by the Bay Arca Air Quality Management all new materials for pection.
uin1 /
❑Yes u
1 have read the haezNnusmamnals mquiremems under Chapter 6.95 of Ne Califor.
nia Hcalth&safmY Ca Sections 355/15.25533oW 5X.lunMraandthmiftM Wiidiag LLC///yyy���ppprrs J
does not curre 0 cans moan t u my ponsihility m n dry tic area mu,n of the `
Icy re, uv chm st Ip wtuuvtce fa Ceruficam t enc. Sig atU Of Applicant I Dat
i t
x D �a
\. wmunorrxmdagent rL.-T All roof coverings to be Class "B"or better sa
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
OUPEkTINO
.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.
al
Homeowner's Name: ���� 1 a
Job Site Address: 1. l O-Ye e v-� t i o()LA
Roofing Company Name: -41 Co v�C
Applicant's Signature: Date:�3
SGreg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
am 1 of 1 PERMIT RECEIPT OPERATOR: nancyc
COPY # 1
Sec : Twp : Rng : Sub: Blk: Lot :
APN . . . . . . . . : 37543037 . 00
DATE ISSUED. . . . . . . : 09/03/2003
RECEIPT # . . . . . . . . . : 23012
REFERENCE ID # . . . : 03090029
SITE ADDRESS . . . . . : 19320 GREENWOOD DR
SUBDIVISION . . . . . . :
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER JOHN Z. HO
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-3454
RECEIVED FROM . . . . : WESTSHORE ROOFING
CONTRACTOR . . . . . . . : WESTSHORE ROOFING INC LIC # 21357
COMPANY . : WESTSHORE ROOFING CO
ADDRESS . . . . . . . : 5869 WINFIELD BLV
CITY/STATE/ZIP . . : SAN JOSE, CA 95123
TELEPHONE . . . . . . . . : (408) 629-2100
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- - - - - --------- ---------- ---------- ---------- ---------- --------- -
BPERMFEE VALUATION 6 , 000 . 00 117 . 00 0 . 00 117 . 00 0 . 00
BSEISMICRE VALUATION 6, 000 . 00 0 . 60 0 . 00 0 . 60 0 . 00
---------- ---------- ---------- - -------- -
TOTAL PERMIT 117 . 60 0 . 00 117 . 60 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
------ - - - ---- - - - - - ---- ------- -- ------------ -- - -
CHECK 117 . 60 14269
TOTAL RECEIPT 117 . 60
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
305 FRAME 307 INSULATION
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
603 ROOF BATTENS 604 ROOF IN-PROGRESS
CITY OF CUPERTINO W9�Do2�I
REROOF
CUPEkTINO PERMIT APPLICATION FORM
APN#
Building Address: 1 n 1
7 (SrtcN.w�or� �,
Owner's Name: 1 ` Phone#,((..
Jo"Q Z, r� 6CY) T c6"ZPZ`
Contractor: Phone License#:
W2.S�zhor� [2�bEt ` 1 62q Zt� l$�ZZ �
Contact: Phone#• Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
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:
ow, kr. ✓ -4 AtStt Woo Gavev�� ova tVt TQ, l Class $
Residential Commercial ❑ w
Fire Zone: Yes ❑ No ❑ Confirmed with Planni rf
there are an res ions:
Cost of Projec Type of Cons ct n , Occupancy up:
(oUUO .
Qty. i
A 1• ab Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Ener BUILDING
i BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING