04050171 CITY OF CUPERTINO @ `` • *' y'
BUILDING DIVISION PERMIT t 'o�1 �.C"I�'�1I2`Il�.'' 'IiT.Id11'' t
BDILDINGADDRESS: WESTSHORE ROOFING CO PERMIT"04050171
OWNER'S NAME: PERMIT ISSUE DATE
GE
NE: SANITARY NO. CONTROL NO.
(408) 629-21100
ARCHITECDENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
40o LICENSED CONTRACTOR'S DECLARATION
0 1 hereby affirm that I am licensed under provision.of Chapter 9(commencing Job Description
with cli 7M))of Division3of Ne Butinusand ProfessionsCo ,andmylicenwis
n in full antl cffe
zp� f.;can �legsc #'g Lie ?-F -7 f REROOF W/ PRES . TL COMP.
06
Dem S^\\1G��OY LCu�ntmECCmIr/./ULSr SMI�Lf�
Y � Ida +tsnJ my plans eltsl Muse+es DEC.
P Ik.,ends
306 Licensed Professional
OWNER-BUILDER DECLARATION
. 0 I hereby affirm Net 1 1. exempt from the Contractors License Law for the
i.pe O following meson.(Section ID3 stn Business and improve.
de imts Code:Any city or county
m whichitsissuance.
requires permit Re cores the,alk,improve,deromil t ver easir anygned tatement
�y Patin,Itsensedoleoacquiree thovisiosofcant for such Contractor mfile
enseLaw(Cha anent
< that(commencing
witPSection70th,ofDivionsMtheCo usinesaLkcnseLew(Chodmr9 SCI.FI.Floor Area ValUa
yl=-� (cat he
xem;th3creion7un0)of Divislofr the
exempton.Any vii Code)or
y�$ Nel he is exempt Nc.from and the bei.far Ne alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 21kP'N3fuiiber0 0 Occupancy e
not mo.Nan five hundred dollen(M). P Y •7 P
❑I,uownm of the property,or my cmployces with wegrs as Heir sole compenutren,
will de the work end Neawcture is not intended eroffered Crash,(See.7144,Business
and Professions Code:The Ceneecmrs License Law does or apply m an owner of - - Required Inspections
properly who builds orimprovu lhereon,andwho daessuchworkh;mselforthrough his
own employees,provided that such improvements arc not intended or offered for sale.If.
however,the building or improvement is sold within one year of completion,the owner.
builder will ban me burden of proving that he did not build or improve for purpose of
&I
❑1,an owner of the properly,am"elusively contracting with licensed contractors to
construct the project(Sec.7044.Business and Professions Code:)The Contractor's LF
corse law docs not apply to an owner of property who builds or improves themon,and
who contracts for such projects with a contnctoms)licensed purmatn in the Contractor's
License Lew.
❑1 am exempt under Sec. .B&P C far this.aaon
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
1 haw and will maintain a Certificate of Consent to self-insure for Workces Compere
cation,u proSection
provided for by 3700 of the labor Code.(m th"performance of the
work for which this Permit is issued.
❑I have and will maintain Worker's Compensation Insurance,as required by Section
3710 of NC labor Code,for the performance of the work for which this permit is issued.
My Workers Compensation Insurance carrier and Policy number am:
Co
r. ,STf1�F FVnig1 Policy No.:
\`gyp CERTIFICA— MMONFROM WORKERS'
COMPENSATION INSURANCE
(Thu section need notWcomplemd if the permit Is forone hundred dollars(SIM)
on Ice.)
I cenify that in the performance of the work for which his permit is issued.I shell not
employ any poison in any manner so an to become subject to the Worker'Compcnaa0en
Laws of California.Data
Applicant
NOTICE TO APPLICANT.If.after making this Certificate of Exemption,you should
become subject in the Worker's Compensation provisions of the Leber Cadc,you must
.,O forthwith comply with such provision.or this Permit small he deemed.wked.
Z CONSTRUCTION LENDING AGENCY
[r 1N-1 1 hereby affirm that Nem is a construction lending agency for the performance of
!Yi the work for which this permit is issued(Sec.3097.Civ.C.)
W Lender's Name
]z Lender's Address
V Q 1 certify that I have mad this application and state that the above information is
F correct.1 agroe to comply with all city and county ordinances and t4k laws mining to
pU building eonsuunion,and hereby authosin mncremadvex of Nis city to enter upon to
r Lit ahovcjudged propertycosts
for inspection purposes i.
y (We)agree ro sae,indemnify and keep harmless the City of Cupertino against
nFs Z liabilitiescnuence fthecoarsing expenses pe which may in any way accmc against said City
O z A consequence of UNDERSTANDS
of this Permit, IN
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURC¢R�GULAT ON -
/(5�/w �l �I Re-roofs
g ortme ofApplicanVCon m,
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building Occupant store or handle hmardous mamrial
as defined by the Cupenina Municipal Code.Chapter 9.12.and the Health and Safely
ode.Ogen 25532(a)?Yen No
All roofs shall be inspected prior to any roofing material being installed.
�
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it hazardous air contaminants a defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Ycs No /'�
I haw to Ne bar ousmawrialsmqui.mcntsundcr Chapmr6.95ofdte Califor- ��! /
nia Health&Safety Code," b.s25505,25533and25534.lunde.tsndthaifthebuilding \`// ^�
does not currently have a meant.that it u my.apomihility m nudity Ne oc upant of the
require., is Mcbmust mtpriortu' uanccofacemncamora,upancy. Signature of Applicant Date `
" r
own r authorind amen aJ DateAll roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
Fax(408)777-3333
OCUPEkTINO -
�4 Building D partment
j ADDRESS: PERMIT #
/00 ,2, 1 o.4 JY 1 (9�4 �� f:0 1 7-
OWNEWS NAME: t�'Aj, P14CNE # iL-3 I-K 2
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
21 ISUBCONTRACTOR 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
Septic Tank
Sheet Metal
Sheet Rock
Tile
0 r/Contractor S6nature Date
10/28/03
Community Development Department
T" Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
4UPEkTINO CITY OF 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: Q` AAO
Job Site Address: 10(A
Roofing Company Name: 54L,4 Anc
A vhcanY/s Signature: Date:
IN V
Greg C eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF o �
I�
CUPETINO PERMIT APPLICATION FORM
APN# a (v d��j • Date:
Building Address: t
I 00$9 Oakl-P.CA4 1o,ce -
Owner's Name: Phone#:
Contractor: Phone#: License#
I nc
Contact: Phone� #: . Cupertino Business License#:c �Yt�1 �Ov. t/ n• t{pa ^2c� . Z I tl d
Type of Roof Covering:
Pres l tse`*;ekek T �-
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ,)< Asphalt Shingles
Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report#
\23 To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: 4Vr,OQ4_ lVLYr t eboj Y,04 covfvl ,. o .� �SF� tiI Pres• jl . Cow P•
6vQV, .D• X . �>
Residential Conifnercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Det. if
there are an restrictions: LJ
Cost of Proje • Type of Constructio Occupancy group:
6U0 . Ife- R, SFK -
Qt .
A i �tbl 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
•