05100043 CITY OF CUPERTINOBUILDING DIVISION PERMIT aCONTRACTORINFORMATION a
BUILDING ADDRESS: WESTSHORE ROOFING CO PERMIT"°'05100043
848 KIM ST
OWNER'S NAME: PERMIT ISSUE DATE
KUANG WEN WU 102 OLD ORCHARD
JNE: SANITARY NO. CONTROL NO.
(408) 213-3750
ARCHITECT/ENGINEM BUILDING PERMIT INFO
BLDG ELF,CT PLUMB MECH
la
�O o LICENSED CONTRACTOR'S DECLARATION
U C I hemby affirm Ihas I am licensed under provisions of Chapter 9(commencing lob Description
b withllto=TO(IU)ofoivixion]of NC Buainus and Profccsicmcodc. mylicclss is �Q .�, {I�tt �®
n d Tomo omeander&n. Z, REROOF-ISNTALL STONE COATE a1,tytlt L
X12? License Clua Lic.I
ZFO Da¢ GnnUficbf
ARCHITECTS DECLA IOW
a5 al I TECT
1 understand my plans shall he used u public records
;0� Licensed Professional
OCT -?5z 2005
g OWNER-BUILDER DECLARATION
<I 1 hereby affirm that 1 am exempt firm the Contractor's License Law for the t�-'�B, a �5x
O o following mason.(Section 7131.5,Business and Professions Codde:Any city Or county Will {? f �a :+1' 2
which quire a p mil to ennromcl,alcor.impmm,demolish,or motor y someone - y1,{ 1%526 21
._IQpoor m its issuance,also mquims the applicant for such permit m file a signed summons �.�
that he is licensed pursuant to the previsions of the Contractor's Lic.nue Law(Chapter 9 Sq.F[. Floor Area Valuation'
YFo (commencing with Section 7000)of Division 3 of she Businos and Professions Code)or
'a Nos k u exempt Nemfsom and do buil far the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3AP149H&F 00 Occupancy Type
not more Nan five hundred dollars(5500).
❑I,as owner of Ne property,or an,employees with wages as their to compensation,
will do the wink•and Neswctum u nos intended or offered for mic(sec.Tota,Business Required Inspections
and Professions Code:The Contncto's License Taw dors nm apply m an owner of q P
property who buildsm improves thereon,andwho doessuch work himself or Nmugh his
Own employees,provided that such improvements am not intended oroRemd formic.If.
however.the building or improvement is wild within one year of completion,the owner-
builder will have she burden of proving that he did not Wild or improve for purpose of
sale.).
❑1,a Owner of the pompon,am exclusively contracting with licensed contractors an
Construct the project(Sec.70dW,Business and Professions Code:)no Contractor's Li-
cease law does riot apply to an Owner of pmpeny.who Wilds or improves Nemon.and
who cum ices for such pmjeem wit a cpnmactm(s)licensed pursuanuo use Contractor's
License law.
❑1 am exempt under See. B Ar P C for this tcuon
Owner Dam
WORKER'S COMPENSATION DECLARATION
1 hemby affirm under penalty of perjury one of the following doelarauons:
I ham and will maintain accnifieate of Consent m se f-insure for Worker's Compcn-
7301W
ion,a provided for by Section 3700 of the Labor Code,for Ne peoormancc of um
rk for which this permit is issued.
I baron and will maintain Worker's Compensation Insunna,as m ruined by Section
of the Labor Code.for to performance of the work for which this permit is issued.
y Worker's Co 'mruno Immiartt airierand Policy number alb/Vzra.LJ
rtier: Policy No.:.0/J���L
CERT�MON FROM WORKERS'
COMPENSATION INSURANCE
(This section need nm becomplacd if the permit is for one hundred dollars(SIM)
of less.)
1 certify that in the performance or 1M work for which this permit is issued.I shall not
employ any person in any ma locr so as m become subject o the WorkersCompensation
Laws or California.Date
Applicant
NOTICE TO APPLICANT:If.after making this Ccnificatc of Exemption,you should
become subject he the Worker's Compensation provisions of the Labor Code,you must
.JO forthwith comply with such provisions or this permit shall W de.med mvoked.
Z " CONSTRUCTION LENDING AGENCY
P:� I Mreby alarm that dere isaco ormetion lending agmKy fordm perfurmanauf
15use work for which this Permit is Wood(see 3097.Civ.C.)
U] Lendcts Name
fR, Lroder's Add.
IU 0 1 comfy,that 1 have mad this application and sum that the chow information is
F' cortect.I agree to comply with all city and county on inances and sum laws selning to
0U Wilding Construction.and hereby butiooxe representatives or this city in enter upon de
r 4i1 above-mentioned property for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupcoino against
F" Tai
liabilities.judgments,costs and expenses which may in any way eats,against said City
U in consequence of the gmnung of this permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NO -POINT Issued by: Date
SOU CE LAT S. Q
01 6 Re-roofs
Signau of p ¢an VCO for Drift
—
VCO ROODS MATERIALS DISCLOSURE Type Of ROOF
Will the applican or future Wilding occupant room or handle hazardous material
M d.fincd by the Cupertino Municipal Codc.Chapter 9.12 and the Health and Safety
cod.,Season 35532(.)? All roofs shall be inspected prior to any roofing material being installed.
,or
Nu
Will the applicant or rumor building occupant use equipment or devices winch If a roof is installed without first obtaining an inspection,I agree to remove
mit hazardous air contaminants a defined by the Bay Area Air Gaudily Management all new materials for inspection.
Distrito?
❑Yes Nu
1 ban mad the haxarNms mamrialsmquimmena under Chapmr6.95 orthe Califon
nia RutN&Sdciy Codc S.cdo 25505.M533wd25534.lun&m=dNuiftho Wilding
docs not currently have a teran Nal it is my mepouibllity w nuuly the oc upmt of the
requirements which 51 Ipnor toi a «ofa catihcam of Occupancy. Signature of Applicant Date
f D B All roof coverings to be Class"B"or better
Own rauth rix. agent Da¢
Community Development
0300 9
upertino CA
venue
C95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPEKTINO
Building Department
JOB ADDRESS: _ PERMIT#
�yg K`m � 6r1000 C-( 3
OWNER'S NAME: -
W HONE # 11,0 Zp -i(0 7 Z
GENERAL CONTRACT �{ n FAX # 13-L
I am not using any subcontractors: kl&e /Oleo/05--
Signature
Oleo/05--
Signature Date
Please check applicable subcontractors and complete the following information:
66 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/Contractor Signature Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
�
CITY OF Telephone: (408)7717-3333
77-3228 UPEI�TINO Fax (408)
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 Y4- per foot slope and demonstrate
that there is no ponding.
2. An LC.B.O.report is required to be on the job site at the time on inspection.
I understand and will comply with the aboove, stated policy on re-roofing.
Homeowner's Name:
v •` ' "� "
Job Site Address:
Roofing Company Name Vv Q S ` ^ss e 1`Jw� `v�L-
A pIi t' Signature: —� Date:
Greg eel
Building Official
Revised 1/30/03
?rimed on Recycled Paper
-� CITY OF CUPERTINO
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN # Date:
l6 03 is-� -
Building Address '
esf
r � J rY1
Owner's Name: Phone#:
P✓1 Wk 01-76-,-1& 72-
Contractor, Phone#: License#:
a rte 7-6--13756 7
Contact: Phone#: Cupertino Business License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
GO�Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) p" Other(Specify) IV F
Number of existing coverings El 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 Descript'
1 �l� �e r5v�/ J�JD►1e e -e k//
Residential Commercial ❑ ,-4' %
�l
Fire Zone: Yes ❑ No Confirmed with Planning D�t. if
there are any restrictions:
Cost of Project: Type of Construe ion: Occupancy group:
1 Z L-
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 BLZLDING
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Z3s � 6