03080024 t CITY OF CUPERTINO n
BUILDING DIVISION PI RMIT CONTRACTQRINPORMATION
4 i-M%4A
BUILDING ADDRESS: WESTSHORE ROOFING CO PERMIT"03080024
' OWNER'S NAME: 5869 WINFIELD BLV . PERMIT LS9UE DATE
YANG LU 08/06/2003
"E` (408) 629-2100 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINCER: BUILDING PERMIT INFO
' BLDGELECT PLUMB MECH
0 0 0 0
.0o LICENSED CONTRACTOR'S DECLARATION
F u 1 hereby affirm Dthativision
I em licence.under Provisions Pwil ns or Chapmr 9(commando. 1®
with Sconce oil
ecDiviaidn Jofda Businnv and!Profcuinns Code end myliccnsc is �s mp1�E
s08i in full lone and effect.
;4: Lice..Claa C's L .. S7ZZI REROOF
i�O °'a AUG 1.8 2003
££ ARCHITECTS DECLARATION
f W U I understand my plana shall W used As public records
e wO Licensed Pmfcuinoid
OWNER-BUILDER DECLARATION BUILDING
i8 1 hereby affirm that 1 am exempt from the Contractors License Law for the
OO following reason.(Section 71)31.5,Business and Professions Code:Any city or county
5$� which aqui¢$a Permit to construct,alter,improve,demollah,nr repair any structure $8100
is prior to its issuance.also requires the applicant(or such Permit to File a signed statement
4QO that he is licensed pursuant to the prevision (it the Contractor's License Law(Chapter 9 Sq. Ft. Floor Area Valuation
F$ (commencing with Section 70ARo(DivisionJorlireBusincuand Professions Come)or 36911002 . 00
rt3 9 that he is exempt themfrom and Ne buil for Ne alleged exemption.Any violation of
Section 703 1.5 by arty applicant fon permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not mom ties.five hundred dollar,u5WL P Y YP
❑L u owner of the propene,m I. emntendes with wages r their Sale mmpenutlan,
will do the work.and Ne slrucwmis not intended or offered fonale(Scc.706a,Businw q�G� dins eC[IOnS
And Professions Code:The Conuacmri License Law does not apply to An owner of 307 - INSULATn r P
property who builds or improves themon,and whodoes such work himself or through his
own employers,provided that such improvements are not intended or offered for mile.If, 601 — ROOF TEAR OFF
however.the building or improvement is sold within one year orcompletion,the owner
builder will have the burden of paving that bba did not Wild or improve for purpose of 602 - ROOF PLYWOOD NAIL
.te'). 603 - ROOF BATTENS
01,a owner of the progeny,Am exclusively umnming with licensed contractors le 604 - ROOF IN-PROGRESS
consumer the project(Sec.7060.Business and Profr-asions Code:)The Contractors U
cense law due.not ayPIY to an owner of property who builds or improves Tamen,and
who contracts for such projects with a eonricter(s)licensed pursuant o the Character's
Llcenae Law.
0 1 am exempt under Sec. B k P C for this noon
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under Penalty,of perjury one of the following declarations:
1 have and will maintain a Cenificam of Consent m self-insure for Workers Camper.
u provided for by Seedmi 3700 of the IaWr Code.for the performan m of the
work Tor which Nis permit is issued.
1 have and will maintain Workers Campmwtion Insurance,u mluired by Section
J of Ne Labor Code,for the perfm ourm of the work for which this permit is issued
My Workers Compensation Insure tt artier and Policy number art:
Garner:.. re Fu P.d Policy Nd.:�6e?O-1003
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Thlssee inn n ed not he cumplumd if the permil is Jordan hundred dollars(.100)
nr leu.)
1 certify Nm in the performance of the work far which this permit is Issued,1 shall not
employ any parson in any manner so U In became subject to the Workeri Compenudon
Laws of Cal ounia.Data
Applicant
NOTICE TO APPLICANT:If,after making this Campeau,or Exemption,you should
become object m the Worker's Compensation provisions of the Ichor Code,you must
z forthwith comply with such provisions or this perm it shall be deemed mvokcd.
ti O CONSTRUCTION LENDING AGENCY
1 hereby affirm that dare is a construction lending agency for the performance of
:4the work for which this permit is issued(Sec.3m,Civ,C.)
Lender's Name
z Lcndch Address
J P 1 certify that I have read this application and sins the above ws salmon is /
S.U coiled.I agree to comply with all city ori country maordinances sor ori curt laws relating to
J U building eon6ructioaAnd hereby amhonp rposesenntias of this city to enter upon the
LTl hhove (We) no properly for inspection an micit hs.
(We)agree m ssve,indemnify and keep harmleu Be City of Cupcninoagainst
:yZ fiabilin
equnce of th,W[ning ofPeaaawhiehmay in anywayaaCNe against mud Cily �� /^O .S
J z in consequence of UNDEhe RSTANDS
of this D WILL
6 /S
APPLICANT UNDERSTANDS AND WILL OMPLY WITH AL(,NON-POINT Issued by: Date
SOURCE REGULATIONS, wo[05
1 Re-roofs
Signature of AppliceDoc
HAZARDOUS
S MATE RIALS DISCLOSURE Type of Roof
Will the eCurama(Mun building occupant nomorandth Health ad Safety u defined by the Cupeninn Municipal Curie Chapter 9.12,and the Health end Sefcly
ale,Sccde25532(a)?
Yea
YNu All roofs shall be inspected prior to any roofing material being installed.
❑
Will the...heantor metre building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
of harndnus air contaminants As defined by the Bay Ama Air Quality Management all new materials for inspection.
iatrim?
❑Yes Nu
Ihavcned C.R,S.mA am05,25quinmenuundcr Chopmrb.95iftho Wilding
units not
haws lemant, hm iti my rand255J6.l Wmods.d thnlfNe Wilding �U vet tl t. .V\➢NA��Vn\
dims nhI currently hove a tenen4 Nat it is my rcspensihility m nmily IW meups.t of Nc
mqu manta hiahmum to met prior Orissuance of.ccood, rcOcmpancy. Signature of Applicant Dat
_MMA&I- �S t"6 0 5 All roof coverings to be Class"B" or better
Owbor or sommi.d agent Dam
t
Community Development Department
Building Division
'6 City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
U P E IST I N O 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 bf 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: lC(A9 LK _
Job Site Address: X0365 t a K$O/W (e ,L,\/,Roofing Company Name: W Pis rsk0% 9.00 F l(tiC KQC f
A plicant'sSignature: Date: O ` i 3_
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
t '
��I'���►►`,,�y�.yt CITY OF CUPERTINO
�.��t REROOF v 3 � �� ��/
CITY OF
CUPERTINO PERMIT APPLICATION FORM
APN # �- l � ) ^ 09 2— Date: S[7�O _5>
Building Address: `Q? /bJ f 1,a r A/1e Q
cJ Gl l V
Owner's Name: / /-
14 Phone #:
aK L -5O ' — g�LW
r `(
Contractor: Phone#: o License#:
V4e5vskofe t� g6zq-2coo 7g7Zz(
Contact: POneg#: / ,ZIOO Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
)i(_Asphalt ShinglesAsphalt Shingles
C3Wood Shakes ` f
❑ Wood Shakes
❑ Wood Shingles Cl Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings Z ❑ Provide I.C.B.O.Report#
KTo be Removed �(e C ❑ Provide Mfgr. Installation Specs.
• I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description:
Ve H co�,t�oltl-con S f�tf So Ye P� i�a�that 6:)Hposi No
Residential &:�- Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are an restrictions: LJ
Cost of Project: g`00 Type of Construction: Occupancy group: SI Pot r-,,
J.
✓e-(oo P.
Qty. if .
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bld Permit Fees BUILDING
BENERGY Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
-2, X72/