05030009 CITY OF CUPERTINO ' asRx�� .�'�=�a�+ �d� s�'-'
BUILDING DIVISION PERMIT CO�VTRACTORW. INFORMATION A.
BUI LDING ADDRESS: WESTSHORE ROOFING CO PERMIT N005030009
OW NER'S NAME: PERMIT ISSUE DATE
ONE: SANITARY 2 CONTROL NO.
408 629-210
ARCHITECTIENGINEEN, BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
°00 LICENSED CONTRACTOR'S DECLARATION JobDescri tion
�til 1 hemby.nem Nal I am IiavN under provisions of Chapter 9(commencing P
i� with Sation]00E.fDivision Sof the Business and Pmfessires Code.and my he.is
n<n in full forte and en L
5'p? Lken Cys Lte.g 7�f7�22 g REROOF W/STONE COATED STEEL SHAKE
ry ARCHITECTS DECLARATION
? 4np72y I>f,ads 4hal}fused ac puMie rammir
uG Licensed Pmfesnonal
�p3 OW R-BUILDER DECLARATION
I I Wmhy aIimi tat I am exempt form Nc Crnlmaofs License law far the
00 following mason.(Section 7031.5,Business and Psoassiom Cale:Any city or county
291. which ntquirea a permit m crouton,alter,improve,demoliab,ar mpoir any avuetum lonnn
Fotoprior to its issuance,also requires the applicant for such permit to file a signed statement
that he ishmnsod pursuant o the pmvisiom of the Conuacmr's Uceme Law(Chapter 9 Sq.Ft. Floor Area Valuation
s�a (commencing with Section 7000)of Division 3 of the Business and Profeuiam Cade)or
Nat M is exempt 0crtmm and the hasis far dr alleged earmpdon.Any violation of
Section 7033.5 by any applicant for.permit subjects the applicant to a civil Penalty or 3 81��I8Vh�erO 0 Occupancy Type
not more Nan five hundred dollars(S50R. P Y yP
❑1,as owner of the property,or my employes wit wages as their sole compensation,
will do tits wark,.nd the seuctua is net intended ororfered forsate(Scc.7044,Bosons Required Inspections
and Pmfeuiom Code:The Contractors Liame taw does Mt apply te an owner of q P
peopenywit builds orimprova thereon,and who doessuclt work himself or through his
n employees,provided tat such improvements ane not intended or offered for We.IL
however,the building or imp nvement is sold witin one year of completion.to owner-
builder will bare to burden or proving tat he did not Wild or improve for purpose of
❑1,ru owner of to property ,B sine siv nd confessions with licensed eonuaemrs m
construct the project(See 7044,Business and ropy who
Code:)The Conuac dinner.
4, a
eeme taw dors not apply...owner or peopeny who Wilds or improves Centro,.nd
who contracts for such projects with acontsacwr(s)Iiamed pursuant to the CoContractor's
License
tLaw.
❑lam exam u rSee ,B&PC for tis nonan lVf .tom
Owner
WORKERSCOMP0,1SPIONDECLARATION
1 hemby affirm under penalty of perjury one of the following deelaratiom:
I hire and will maintain a Certificate of Consent m sslf-insum for /1/5�'v Worker's Camper- e
Won,as provided for by Section 3700 of the labor Code.for the performance of the
137W
rk for which this permit is issued.
1 have and will maintain Wmkc/s Compemnion Insurance,as required by Smartt
oathe
of to Labor Code,for to pesfamance of work far which tis permit is issued.
y Work eri omgp�e—myrio 1nsunnce<anicrand Polli rumMrare: n
Carrier: . -�a/J!- ; 07- Policy If!-/S 90-.G.�3�
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(ibis settlor iced not he completed if Cir permit is far..Imadmd dollars($100)
or lcsv)
1 certify tat in to Performance of the work for which this permit is issued,I shall not
employ any person in any manner so as at hrcomr subject o the Workers Compensation
Lias of California.Date
Applicant
NOTICE TO APPLICANT:If,afcr making Nis Cenifica,of Exemption,you should
become.ubjat a the Worker'.Compewtion provisions of the labor Caddo,you muss
faMwit comply wit such provisions or this Permit shall W deemed revoked.
'P'O CONSTRUCTION LENDING AGENCY
�-+� I hereby affirm tat then is a construction lending agerry for to performance of
C the walk for which this permit Is issued(Sec.3097,co,C.)
0.Q Lendels Name
z landefs Address
fJ 0 1 certify that 1 have read this application and state tat to allow information is
correct 1 agree at comply with all city and county on iriams and state laws misting to
C)U building construction,and hereby autorinmionsenutives of this city to color upon dlo
r� above mentioned property far impaction purposes.
(We)agree to save,indcmnrfy and kap h rmlesa the City of Cupertino against
Frg liabilifies,judgmcnu,case and expenses which may in any way accmc agaimtsaid city
t1z inconsGuence oftc granting of this permit.
^ APPLICANT ODERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURC E L,ATI 5.
--/—ds
Signvum off S IicanVC uactoe Data Re-roofs
HAZARDOUS MAdRIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant slam or handle havardous material
as defZcd by the Cupertino Municipal Code.Chapter 9.L2,and the Walt and Safety
Code,Se Yes 15531(x)? All roofs shall be inspected prior to an roofing material beim
❑Yea ON. P P Y g g installed.
Will tc applicant or future Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
if havardaus air contaminants as,defined by to Bay Area Air Quality Management all new materials for inspection.
Disuie?
❑Yes ❑No
1 have read to hvaNnus materials uquirrments under Chapter 6.95 of the Cilifar.
nice Halt&Safety Cade,Satiom 255D5.25533 and 25534.1 understand opotrope Wilding
doe role it hate.lenan4 tat it is my mSprmibilily m bob(,the..,.I or the �(/✓✓
ntymrtm ta ren orae eine at hxette r. rti0ote er Ocapansy. Si nature of Applicant Date
owner sartho i cd.grm Date All roofcoverings to be Class"B"or better
Community Development
10300 Torre Avenue
' Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPEI�TINO
Building Department
JOB ADDRESS: PERMIT
S kmlg,s 8 the 05010009
OWNER'S NAME: (-kv0-- PHONE # "Iv$ 2 t 3 S D
GENERAL CONTRACTOR: WestSwjk _ FAX # �-kW9 Zl3 Z'SI
I am not using any subcontractors: to V' L Z$ �S
Signah, e Date
Please check applicable subcontractors and complete the following information
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Aldh Linoleum/ Wood
IV Glass/ Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing 4LJ Sa }(0j2 PC),lr/AK t C.
Septic Tank
Sheet Metal
Sheet Rock
® Tile
2 2 -0S
Owne /Contractor Signature Date
Community Development
f4 ! 10300 TorreiAvenue
Cupertino CA 195014'`
3
Telephone(408) 777-3228
CITY OF Fax(408) 7,77-3333
UPEkTINO
Building Department
"r JOB ADDRESS: PERMIT #
OWNER'S NAME: (j-,vc,lk )uL1 PHONE # "Jol 2,1-3 - 7 S 0
GENERAL CONTRACTOR: 1Lv es-tSbw,je FAX # (4U(4 Z13
I am not using•ariy subcontractors: len/V�; ' J ``X��_ 2,1,2$ OS
Signatu e _ �. Date
PleaseI ck,applicable subcontractors and coin Tete the-following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets&Millwork
1 ,Cement Finishing
Electrical
\ Excavation
Fencing r `
/ Flooring: Carpeting
Linoleum/ Wood
Glass /'Glazing
Heating
Insulation
Landscaping
Lathing
'
'7 Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
v c tc Plastering) `r l at)
Plumbin+gN ip n
W � S �C ' •-`Roofing,,�� � � 1- i ,- _ 1 4" t _
j < cl,r, Septic Tank, .n�
Sheet Metal i
e
Sheet Rock- '``,
Tile
'2(29 oS
Owner'/Conlractor Signature' j Date
Community Development Department
Building Division
1 1 City of Cupertino
YX
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
2UPEQT1N0 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: ( \y C K UQ 'i' 1 N sr- i &0 V"
Job Site Address: S ��` `' \0 y f I
Roofing Company Name: Weslskoa
A plicant's Signature: Date:�2_,S/c,_5
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
-� CITY OF CUPERTINO C
Gey- REROOF
CUPERTINO PERMIT APPLICATION FORM
APN# Date: Z/2 P v S-
Building Address:
Lj6S KIh sb✓� Q1 .
Owner's Name: _ Phone#:
Cl�vck Vin 61�rtc� �
q0 F>
Contractor: Phone #: License#: �� ZZ
U,fS-1ClVv (Zoc arc, '02211>-31ST
Contact: Phone#: Cupertino Business License#:
(Te.brte �w . 1 -too$ 2A3 -3110
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) ,a' Other(Specify) (T<� 011S-tant _�-It2I
Number of existing coverings 'Z 1,1ir Provide I.C.B.O.Report# IJ f=lL u{1 j
J� To be Removed ❑ Provide Mfgr. Installation Specs.
I/Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: 4,,ol_o 2- 1 C•�.c c e y 151(� . p C . I n 57a t I (fc ✓cr v
5r. -� Ccrtizr{ S7ee� St hTI C,IcS5 Ya L c —
Residential Commercial
Fire Zone: Yes ❑ No 0 Confirmed with Planning Det. if
there are any restrictions:
Cost of Project: oo Type of Construction: Occupancy group:
Ia C, 0-0 ,7y
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 BUILDING
0 / 7D,