03070187 CITY OF CUPERTINO ''"th3 "' f
BUILDING DIVISION PERMIT C 0NTRAC"'TQR NFOIRMATION S
BUILDINGADDRESS: WESTSHORE ROOFINCIfNG f """'030701870
WNER'S NAME: 5869 WINFIELD BLV nRiNUTMUEDATE
124/2002
ONE: SANITARY 0.
(408) 629-2100 CONTROL NO.
BUILDING PERMIT INFO
ARCHITTiCfIENGINE6R: BLDG ELECT PLUMB MECH
0 0 0 0
y0o LICENSED CONTRACTOR'S DECLARATION Job Description
eL mF 1 herchy affirm that 1 am licensed under prnviamors of Chnpmr 9(ct arrome ng
<ce with Section191)n(Divirtm Sof Ne Busipgasand profession,Code,md mylicenm is
in in full lnm effect. ./vf
5qz Lianmcla4s Lm.x 78� 2 RE—ROOF OVER EXISTING ®
Dam eon �. �Ifi� p
ARCHITECT'S ATION WOOD SHAKE ROOF. ^LE®
�i un erstand my pians shall be used ss public records
LL G Licensed Profeasihn.I 5 E P 2 5 2003
^03
OWNER-BUILDER DECLARATION
d i f I hereby affirm that I am exempt from the Cauractor's License Law for the BUILDING i pe 0 following moon (Section 71131.5,Business and Pmfecsions Code:Any city or county ala[ tl�®',Y.\�
u 9 E which rere+a permmm
it to shoulder,alma improve,deolish, repair any uructure
prior to its issuance,also requires the applicant for such Permit to file a signed statement
£��< that he is licensed pursuant in she provisimu M the Commoner's Liam,Law(Chapter 9 Sq. Ft. Floor Area Valu
y�$ (commencing with Section?(XM)of Division 3 of the Business and Prafessinna Coyic8t30A200
)or 413
that be is exempt Ihcmfmm and the basis for the alleged exemption.Any violation of �-A,�7s��-�v�.,v{�
Section 7031.5 by any applicant for a permitaubjecu the applicmt to a civil penalty of 3JV VAlYi`e9CrQQ Occupancy Type
not mom Nan five hundred dollen(g5B0). J V i"9
❑I,as owner of the pmperty,or my employees with wages as their sole e3mpenco0on,
will dm the work and thntmcmm is not intended or offered for sale 7044,Business Required Inspections
and Profeaslmns Code:The Contractors License Law does not apply m e ns an owner of q P
property who builds or Whom thereon,and who time uch work himself or through his 305 — FRAME
own employee,,provided that such improvements m net pleaded or brand for ole.If. 307 — INSULATION
however.Ne building or imm
prmsent u is within ox yeof completion,see.,.
builder will have the burden of proving that he did not build or improve for purpose of 601 — ROOF TEAR OFF
cote.).
[D 1.as owner of Ne property,am exclusively contracting with licensed eonlnctmm to 602 — ROOF PLYWOOD NAIL
construct the project(Sec.7M,Business and Professions Code:)Tire Contractor's Li. 603 — ROOF BATTENS.
come law does not apply to an owner of property who builds or improve,thereon.ane,' 604 — ROOF IN—PROGRESS
who contracts for such pmjeeu with acontnnoKpursuant Ne
+)licensed pursuano Contorcue's ,
License Law.
❑1 am exempt under See. .B h P C for this own
Owner Dam
WORKER'S COMPENSATION DECLARATION
1 hereby aff rte under peralty of perjury one of the following declinations:
I have and will maintain a Certificate of Consent m sel40uum for Worker's Compen.
tion,ess Provided for by Section 37M of Ne labor Code.!or the performance of she
work for which this permit is issued.
❑1 ban and will maintain Worker's Compensation Imen.a e.as mquimd by Section
7700 of the labor Code,for the perfmrmmee of the kfnr which his permit is issued.
My Worker's Compen+uimn lnsunna ami n icy num her are:
Cs lis,No.: cZ
r CERTIFICATE OF EKEM ON FROM WORKERS'
COMPENSATION INSURANCE
(TMs recthm need not be eomplued if the Permit is foronc hundred Collars(SIM)
threat.)
I certify that in the performance M the work for which Nis permit is;owed.1 shall nut
employ any Person in any manner so as to become subject in the Workers'Compemation
Laws of C.lif.rrl..Data
Applicant '
NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should
become subject to the Worker's Compensation Provisions of the Labor Code,you must
.J O forthwith comply with such provisions or this Permit hall be deemed revoked.
ZCONSTRUCTION LENDING AGENCY
=
(•' I hereby affirm that there is a construction lending agency lot he Performance of
CC 7 the work for which this permit is issued(Sec.7097,Ci,C.)
W Q lender's Name
P.
z Lender's Address
U
V Q 1 certify that 1 have read 11 city lit county
and sure the,and
above infrnmuiun is
0. (~ cormcL l groe to comply with sll city seri ceires oNinanttf and cote lens reining to
p abovengconstruction,tioneand for by impaction
rpoesenutivxs of this city in corer upon the
6UWi above-mentioned are Progeny for inspection k.,ha
(We)agree m cove,indemnify end keep harmless the City hi Cupensts ageinsl
.F.,z incoitlqucncofihcgmnlindexpmuuwhichmay in any wymane,gal^n sold City
V z re APPLICANT of cgnTANDfthis permit.
APPLICANT U STANDS AND WILL C PLY WITH ALL NONPOINT Issued by: Dat
SOURCF,tEqAAT
e �7 �w03 Re-roofs
> ser f pplica C`ontracov Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Nc"Plicrm no rulum building occupant nmrc or handle barardoos material
ss defined by the Cupertino Municipa de.Chapter 9.12.and the Health and Safety
cmdc,stion 25532(.)+ All roofs shall be inspected prior to any roofing material being installed.
Eyes
Will the applicant or room building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it havudow air comamimnts as do d by the Bay Area Air Quality Management all new materials for inspection.
vrict7
❑Yet;
I haus mad the hazardous melcrialtmyviremenu under ChaPmr AYS of the Orin.
^it.Hcmlb&Salcty Gds,Sections 25515,25533 and 25534.1 undcfamnd Nat ifdm building w
Jens not currently h Ilan al io u my rca)ansiM1ilioy ore nndly the oacupmt of the
req. me hi mu role mmee0.0cruramnraeu er. Signatur Applicant Date
wner ur th prod agent 7 p m 0 All roof coverings to be Class "B"or better
t
Community Development Department
Building Division
(ItL City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
OUPEkTINO 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: I Cui i d
Job Site Address: �O-1 $1 (_1✓1d.CL Ui5fzt . T>r. Cum 2/DJtb
Roofing Company Name:
A pllcant's Signature: +.WESTSHORERQOFING INC:- Date: 7 Z t®s
(TOW�^ 5869 Wirifr' Blvd.
San Jose,EE ES 23
j_CALL FOR FREE ESTIMATE
Greg teel 408-629-2100 '
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF
CUPERTINO PERMIT APPLICATION FORM
�J,30�0/87
APN# O r Date: -7I OS
Building Address:
(0"1% _1 UN0A VISTA- Dy— G.1PE)2, IIQ0, CA 9501
Owner's Name: Cif- tIMIC1 DA-V,() Phone #:
Std l8 1.9
Contractor: ' _ PhoAe#: License#: 7g7 2�
t WESTSHORE ROOFING INC:
5869 Winfield Blvd.
Contact: --San Jose,CA 95123__ Phone #: Cupertino Business License#:
-CAL-L:FOR:ERLE'ESTIMATE
621`2W • S
408-629.2100 ` 'Type.of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
Wood Shakes ❑ Wood Shakes
❑ Wood Shingles O Wood Shingles
❑ Other(Specify) ❑ Other(Specify) ,o_t-ard s ca( I 1�e
Number of existing coverings ❑ Provide I.C.B.O.Report# E1Z•
❑ To be Removed Provide Mfgr.Installation Specs.
1, I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: PE-RcexF 6"dtmzyksnWOW SWAye eaZ5�P- 1K)57tZ
7U
Ru_ OkC1C 1K) to "l 20O
Residential Commercial ❑
Fire Zone: Yes ❑ No Confirmed with Planning Deft. i
there are any restrictions: LJ
Cost of Project: Type of Constructi n: Occupancy group: —
�3, moo. ,
Qty. .
Applihable 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
10