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03010022 CITY OF CUPEW11NOW - - ," '- BUILDINGDIVISION PERMIT � IN tCONTRACTORFORM, TION , BUILDING ADDRESS: WESTSHORE ROOFING CO PERMIT NO. 829 LONNA LA OWNER'S NAME: 5869 WINFIELD BLV APPLICATION SUB DATE LIU TUNG-CHIEN M AND HSIU-FE 01/06/2003 lotZONE: (408) 629-2100 SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: FINAL BUILDING PERMIT INFO BLDG ELECT PLUMB MEC11 �00 LICENSED CONTRACTOR'S DECLARATION FEB o2003O O O O Job Description F I he by arum that I am Licensed ander Provisions of chapter v(commencing `,� wiihsectin 000)nf Division 3 of Ne Business and Professions Codc,and my license is zoD,o in rase It, and feet. �1 ��.� �Z REROOF R��y,,�^/),N�y� z Licen L Lie. tCGS INSTALL OSB 40 YR. ONFo Date- - TS N �✓4TY Vie - /0 WOOD / naanTfscrs Drc ATION TAMKO COMP. SHINGLES � � \.UpUCmaad my plans shall be card a. ¢records pwaU ti// LLorLicensed Pmfcssiunal j3 OWNER-BUILDER DECLARATION yy02 1 naso affirm that I am exempt from the Contractor's License Law for the my - dXC0 followhich re requires Permit ](Lisr Businessandwe.dmolih,us or Any city or county K$ which requires a pemrit re construct.alley,improve,demolish,or repair any structure prio�3< that hnslimmodpurlsoritto the thovisio s(i for such Pcrmil toiense Law(Cha mem p that purstion70hc of Division (if the Contractor's LicenseLawCode)Or Sq. R. Floor Area V81Ua1100 (cot he is exem with Section and the basis r the alleghe ed Business prion,Professions Cofc)or that he is exempt therefrom and Ne bazis for the alleged exemption Any violation of Section 7031.5 by any applicant for a Fermi t subjects the applicant to a civil Penalty of APN NumberC Type not mme Nan five hundred dollars(SSW). Y YP I,azowner of thepropeny,or my employees with wagesaz their sole compensation, will do Ne work,and the structure is not intended or offered for sale(Sm.704,1.Business and Professions Code:The Contractors License Law does not apply to an owner of RegUlred IDSPCCll0U5 property who builds or improves thereon,and who doeasuch work himself or through his own employees,provided that such improvements are not intended or offered for sale.If, 3055 - FRAME htnvever.the building or improvement is sold within one year of completion,the owner- builder will have the burden of moving that he did not build or improve for purpose of 307 - INSULATION 'wto) 601 - ROOF TEAR OFF 1,as owner of the progeny,am exclusively contracting with licensed contractors to 602 ROOF PLYWOOD NAIL construct the project(Sec.]INA,Business and Profusions Code:)The Commences Li- come Law does not apply to an owner of property who Wilds or improves themon,and 603 — ROOF BATTENS who continues for such pojects with a commctnrfn)licensed pursuant to the Conformer LimLaw. 604 - ROOF IN-PROGRESS ❑ 1 am exempt under Sec. .B&P C for this reason , Owner Data WORKER'S COMPENSATION DECLARATION I hereby aRrm under penalty,of perjury one of the fallowing declarations: 1 have and will maintain a Cenificam of Conenun self-insure for Worker's Comprn- aminn,as provided for by Section 3700 of the Labour Code,for the Performance of the work for which this permit is issued. 1 have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Labor Code,for the porf nommen of the work for which this Permit is issued. My C rtWorkera1Comp'nseinn Ins Wca�n etl cy Noil ry numi] a �m / ii CERTIFICATE OF EXEEIM\�PTIO WORKERS' Jam( COMPENSATION INSURANCE (This section need not be completed Bra,Permit is forma hundred dollars($]00) toss.) 1 comfy that in the Pormotance of the work for which this permit is issued.I shall not employ any person in any manner aro az In become subject to the Workers Compensation Laws of California.Dam Applicant NOTICE TO APPLICANT:If,after making this Cenilicate of Exemption,you should became subject to the Worker's Compensation provisions of the Labor Code,you most O O forthwith comply with such Provismns or this permit shall bo formed revoked 'Z CONSTRUCTION LENDING AG ENCY (-i I hereby affirm that there is a commiction Rodi ng agency for the performance of 1 CC the work for which this permil is issued(Sec.31N7,Ci,C.) W� Q Lenders Name r7 Z Lctdcrs Address U O 1 certify that 1 have read this application and state that the above information is IT. F correct.1 agree o comply with all city and county ordinances and state laws relating to �U building construction,and hereby authorize representatives of this city in enter upon the rW shove-mentioned property for inspection purposes. G (We)agree to save,indemnify and keep harmless the City of Cupertino against FF-t fA Iiabilitiu.judgments,costs end expenses which may in any way accrue against acid City U Z in consequence of the grafting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY W HALL N$IN-POINT Issued by: Date SSO�URR REGUI.ATIONS. /,-6 -05 ygBmmre of Apml'am/ rD0 SMATERIAI.S DISCLOSURE Data Type of Roof Will the applicant ser future buil ' g nocupant wore or handle W.Flims material as defined by the CupcnimfMunic' Code.ChaPbr 9.12,and the 11ea11h and Safety Code.Section 255320a07 ' All roofs shall be inspected prior to an roofing material being Installed. ❑Yes No P P Y g g Will the applicant of future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove ]iarir'! mit haeaNnus air cnmaminants eud ed by the Bay Arca Air Quality Management all new materials for inspection. 1 byes - SaI have mad the Wart)us mamrialsrtyuiremenuunder Chapmrh 95ofthr Califon- r ia Bealth 5 fety C,nk.Sccdo®25505,25533 and 25534.1 unfrrmnd that if the Willing does notcurmmly have a minor,that it is my resrymslbility m naff the saeuPant of @c re circ swhichmun Mom onoismance rCmiiicimm Cy. Ba(UIe OfA FII ( ({{ Gwfermimtheri dug I Dam �� All roof coverings to be Class "B"or'better BullftDivision ' ! &C, 10300 Tone Avenue Caperdno,CA 95014-3255 Telephone: (408)777-3228 CUPERTINO Fax (406)777-3333 Building Depaent Subject: Reroofing policy for the City of Cupertino. 1. Prior to permit issuance,you must agree to comply with 1997 UBC Standards and manufactures specifications on reroofing. I ,New roof coverings shall not be applied without first obtaining all inspection Wand written approval from the building inspector.A final inspection and approval shall be obtained from the building inspector when the reroofing 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) Preinspection 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 that the proper City inspection can be performed. IMPORTANT: 1. Flat roofs must have a minimum of V"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 of inspection. We understand the above policy on reroofing and will comply with this policy. �� N� " M t • Homeowners Name: C Q �C� �� Address: nZ�'I a� 'U"o'l- ifJ Zieroofmg Company Name: -"0' Z4jet 1ST11aJ5 Applicants Signature: Date: J9. oe Antonucci (Chief Building Official) 6/25/01