04080236 ..z oz's,::
CITY OF CUPERTINO CUI'TRACTURN'FU.�ATUI�:.
BUILDING DIVISION PERMIT , b tl•, ,:,
BUILDING ADDRESS: WESTSHORE ROOFING CO PERMITNo.04080236
10797 LI
PERMIT Issue DATE
OWNER'S NAME: nA
BILL ST. CLAIR
SANITARY N ONTROL N0.
NE:
408 629-23 QQ
PERMIT INFO
PL
ARCHITECrIENGINEER: BLDG ELECT PLUMB MECH
nal, LICENSED CONfRACT00.'S DECLARATION JO ' ALE D
U p 1 bemby affirm that 1 am licensed un pm neons of Chepmr Y(commencing ��
a� wiSeS do 7IX10)of Diviaion3ofte Burin as roroadoes Code.and my hear.is
nor t err Z REROOF W/STEEL TILE
-? License Class Lm.a �—
n r p
Data - — CanlRflaf
gg'W�y' ARCHITECTSD N SEP = 2004
�ia< A I end my plena shellkuxJupub wound
ia�
LL follm I hereby lanai BUILDING
5 OWNER-BUILDER DECLARATION
'.�0 C I hereby,affeanSect onthat IIf 1. exempt from the Canuactor's License Law for the
i O m following rutin. emit t IIB 1.5, ,,Business and improve,
de ole Code:Any city of county
v�$ which uyusu a pante(re quires the
Nma inmor such
demolish,t nr repair ed tamcrum
F�< that he its issumca also require poo apple s O for nch po due- censele a Signed statement Valuation
(comm islicensedpursuant m Nc of Division
ofdue oftheB snows Littre Lew(s Code)9 Sq.Ft.Floor Area
�$ that he
angwiSeSemion711nd0Division]ofrheegedexempton.and Any
not -
Sear io usump(therefrom and me Per for be alleged cunpnt sh Any violation of
nSectionot..7031.5 five
any red d.n(for a Permit subjects Ne applicant o a civil penalty of 3 �' M��O O Occupancy Type
not mom Nan few hundmd dollars(5500).
❑I,u owner of the properly,structure
ctinumde with wage u Neirsce.compensation, ~
will do am pwroadons ands: he Comw rte$Li cense Law
do fora t apply to
an Owner of Required Inspections
and enfusions Cade:The Conheron,License law doss not apply ro an owner is q P
..ettploy..Provided
that
sch improvements
am not intended
ortflrad farad his O
owneer,tha building
pr wehimpnwmwtarcnot es,ofooroeered the moil.
wild,rq Ne building bu Improvement is mid within one year of improv farn.theowner-
builder will neve the burden of proving Net he did not klid ar improve for Purpose of •
Calc.). w�
❑1,a owner of rhe property,am exclusively Profosi ng with licensed contractors m ��0
construct the project(sec.70 n Business and Profusions Code:)The ConOawer.Lid
cense law does not apply je an owner of property who builds or Improves Nemon,and
who contracts for such projects with acommunist licensed pursuant tote Convenors p�
1don u
Law. ♦_
lam empt under Sea .B&P C for this
0 reason ��
Owner Data
WORKERS COMPENSATION DECLARATION
I hereby M.under penalty of perjury one of Ne following dedaorthms:
0 1 haw and will mainnin aCen riicemof Canal to self-insum for Work esCompen-
sation,as provided for by Section 3700 or Ne labor Code.for the porformence of the
work for which this permit is issued.
0 1 have and will maintain Warker's Compensation Insurance,as required by Section
37M of the labor Cron.for Ne performance of Ne work for which this permit is Issued.
My Workers Compensation bunnce carrier and Policy number tie:
Cartier. Policy Na.: $COCIy
CERTIFICATE OFEXEMPr10N FROM RKER5
COMPENSATION INSURA
(This section heti not k completed lfre M farm.hundred dollars(SIM)
or less.)
1 certify that in the performance of the,work for which this permit is issued.I shall am
employ any person in any manner so W at become subject in NC Warkers'Campenasdon
Laws of Califanis.Data
Applicant
NOTICE TO APPLICANT:If.otter making this Cedificate or Bacmptian,you should
become subject to the Worker's Compensation previsions of the Later Cade,you must
.�,Z, forthwith comply with such provisions or this permit shall k deemed mvoked.
zO CONSTRUCTION LENDING AGENCY
P: Ibo.byeflirm that Mo.ie a couw
ninn lending agency far N .
e perr. ..f
g•1 the work fur which thas permit is issued(Sce.3097.Cih,C.)
W Q
Le dcr'a Nanc
,1. z Lender's Address
V 0 I certify that I have mad this application and sixth that the above information is
W F torten.I agree to comply with all city and county ordinances and state laws mlal ng to
0 V building cansVuction,and hereby authorize nepresenntlws of Nis City to enter upon Ne
W shove-(We)
grased!Property saw,for inspecindemnify
purposes /
0. (Wc)agree to saw,indemnify and keep harmless to City of Cupertino agaist
V) nCf—y,'(VJ
liabilities, coati rae and expenses which may in any way aceagainst said City
C) in his onth.
APPLICANT aUNDERSTANDS of tho Spending of(AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
s qzziza
SOURCEUTATIONS. "'�6—d
Re-roofs
ou.of Apple anUCona motor Dem
HAZARDOUS MA RIALS DISCLOSU RE Type of Roof
Will the applicant or future building occupant stare or handle havallous materiel
u defined by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
Code,second 25532(1)7 All roofs shall be inspected prior to any roofing material being installed.
D Yes ,19.r+a
Will Nc applicant or Tamm building occupant use cyuipment or devices which If a roof is installed without first obtaining an inspection,I agree[o remove
emit havardous air contaminants as Jcfincd by the Bay Area Air Quality Management all new materials for inspection.
District? ! a
❑Yes
I have read the hazardous malerialsrequircmenls under Chapterb.95 aide Califon e n
nia Health&SafetyCode,Sectiou2 M5,25533andZ53a.1undcm=dNatifNe Wilding 6 V/.y
does not currently how a moot,Na(it is my responsibility o notify the MCupan(Of Ne
regai.m uwhich unk e(prioroissu 'e of a Cenincate of Occupancy. S' gn urs of Applie nt ��_�Date
6b All roof c erings to be Class"B"o better
Owner or (bodudagco( Dam
Community Development
10300 Torre Avenue
". Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
�UPEkTINO
Building Department
JOB ADDRESS: . PERMIT# !� �Or-0 Z 3
4 t ]0 T
OWNER'S NAME: gj&c 3T. PHONE #(4-y r,2g
GENERAL CONTRACTOR: Kn O:F_V401e4 &6A FAX #
I am not using any subcontractors: -2 6-0 y
Signature Date
Please check applicable subcontractors and complete the following information:
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 �}(D
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contract Signature Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
IWPEkTINO
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: B t`` &t C((A'\r
job Site Address: t D-10''�II r'
Roofing Company Name:�-1N
A plicant
re, Signature:__L_ '/, Date: "t
�—
Geel
Building Official
Revised 1/30/03
Printed on Recycled Paper
y �; CITY OF CUPERTINO REROOF O a O Z36
CUPERTINO PERMIT APPLICATION FORM
APN# D 7 v t Date: 9(2-510 Ll
Building Address:
l07017 1.vl..au V.z-ta Dr.
Owner's Name: Phone#:
IDS' bqr 2uw2
Contractor: 1-� License#:
roles-� S�Ye Foo'tt lv�c. 79722. 1
Contact: b y7 Cupertino Business License #:
Y l A I 1`o r�c..^ .
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes U Wood Shakes
Wood Shingles ❑ Wood Shingles
U Other(Specify) AT Other(Specify) Cr'eP4lC' T, 1e
Number of existing coverings Al" Provide I.C.B.O.Report# tU-R V 3 .
❑ To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: -F,
w�✓e I //(,Idc.✓ ��o ' �� [Nr !q[I [m�a�o( Stare Cw,Je-4
,4-0-e-r / ,14 Katt r S1'2 nn
Residentia Commercial E3
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dot. if
there are any restrictions: IJ
Cost of Project: Ty a of Construction: Occupancy group:
j 9 oo o e - ROOD SR
Qty 'f"
A ca T 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