05010179 CITY OF CUPERTINO z^rrw$s. yw3s «L.A''a7'a;aavatt+� '^`€
BUILDING DIVISION PERMIT CONT.RCTORINFO
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BUILDING ADDRESS: WESTSHORE ROOFING CO PERMrr Nl15010179
OWNER'S NAME: PERMIT ISSUE DATE
ONE: SANITARY NO, CONTROL NO.
(408) 629-2100
ARCHITECVENGINEER: BUILDING PERMIT INFO
BLDGELE(T PLUMB MECH
BGo LICENSED CONTRACTOR'S DECLARATION O
1 hereby affmn that I am licensed under provisions of Chapter 9(cmnmencing Job Description
1�5tl with Section 7M)aDiAsim,3oftha Bud.and Profcuims Cade.and my It..Is
?_ comes arteandTfftt ,� ZZ 1 REROOF W/DECRCRA STqM
]� Lkenml�Clw 1-_ 3 Lc.g
L Dam 1 2`hlnC - Con ON
ARCHrrECr
DECLARATION
I mcconxnd my plan M91 be wed as public records
Xut; Licensed Professmul FFR lS- 2005
505 OWNER.BUILDER DECLARATION
.� I 1 touchy amine that I em exempt from the Canoacter's License law for the
E:00 following reamer.(Section 703 1.3,Business and Rofesdum Code:Any city or county
vj$� which requites a permit m commuter,alter,imponi demolish,or repair my structure scow
in
Prior m ice issuance.als.requires Luappliemi forswh permit m file a algidw.cut
t�< Out he idicensed purmantm the provision of the Conmmmr's Uounm law(Chapter 9 Sq. Ft. Floor Area a luation
$ (commencing with Section 7000)of Division 3 ofthe Buslnmand Profession Cede)or
Out he b emmpt M mfmm and the bub for the alleged exemption My violation of
Section 7031.5 by arty applicant the a permit ubjects the applicant in a civil penalty of
net more Nan Ow hundred dollars(M). el0 O Occupancy Type
❑l,uownerafOut:pe",wmyempteycowlthwguuOukmlecompenudon,
will do the work,and Me mucture it not Intended orOBend foruLe(Sec.7044,Busiwu
and Protradau Cade:The Conmattahcendna License law ml apply in an owner Of Required Inspections
m .
propy who builds car im proves Mercer,and who does such work himself or through his
ownemployeu,provided that such improwmenu ase not intended aroRered formle.if,
however,the building or improwmant Is mid within an Sear o(mmpletiom.the owner.
Wilder will haw W burden of preying that M did nm build or(mprow far purpose of
oto.).
❑1.as Owner of the property am in clmvely contracting wish licensed conummrs in
construct Me project(Sec.7044,Business and Profeaslam Cex:)The Canusumr's I3-
come law does not apply in an owner of property who builds or improve Manson,and
who contacts for such projects with a contractor(s)licensed pursuant to the Communities
Lleone law.
❑Iamucmptunsc Sic .Ba PCfwthis un
Owner Date
WORKERS COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of Me following declaration:
I have and will maintain aCen ficai Consent 0alf-intim forWorke6 Campen.
titian,as provided for by Section 3700 of the labor Cade,for the performance of Me
work for which shin permit is iaaud.
haw and will maintain Worker's Compensation Insurance,u required by Section
700 of Me labor Cade.for The performance of Me wart fu which this permit is issued.
My Workets CamPewiian Inn aria and Polity nYm mart: L
Carrier Paltry Noi
CERTIFlCATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(7hbseerlon need notacompleud HOW,permit is foronchundrtd defian($HXB
Or ksa)
1 unify that In the performance of the work for which this permit is issued,l shat)cot
emPlryany peuon in any mammrjg�usbecome object to the Workers'Compensation
Laws of C 1fmu I-Ta,Oo4�lla�1 s�t5
Applicant
NOTICE i bl APPLICANT:If,atom making this visi ncaof of E suer o d you Mould
become momp m the Wohero Compensation or this
pmvbM i of Ou last Code.. mum -
rJ 0 forthwith comply with such provisions car Nb permit Mail a ticemW rewked.
r y CONSTRUCTION LENDING AGENCY
[.r I hereby affirm that Mere Is a construction Lending agency,for the Performance of
Pei it the work for which this permit b issued(Sec,3097,Civ.C.)
D.)Q Urider'm Name
2 1<Mets Address
U O 1 minify that 1 haw read this application and mm that Me above information is
comm 1 aims as comply with all city and county ordinances and mute laws relating to
building construction,and hereby moborim representatives of this city in enter upon the
save-mentioned Propcny Im Inspection Purpwes /JC
LL
(We)age M cost.indemnifyexpenses
and hecP harmless the City of Cupertino against `�� OJ
carZ Ibbllian(medg Of due
and Ofpemumit. mryinanywry aceuo against old City /
Uz A PLICA T of UNDERSTANDS
ing of this permit.
" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Dale
SOURCE REGULATIONS,
Re-roofs
Slynuum of AppliceHAZA HAZARDOUS
Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant Orfuuuc Wilding muPam more oehmdk huudow material
u dented by the Cupemno Municipal Cade.Chapter 9.12.and Me Health and Safety
cox.S Nen 2ss32(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yu
will Me applicant or Tatum building occupant um equipment or xrices which - If a roof is installed without first obtaining an inspection,I agree to remove
.colt hayardnaa air cmuminmu is,defined by the Bay Area Air Quality Management all new materials for ins ection.
Ulrmin? /
❑Yes 'PN.
I haveread the hays, atcnals requiremenu under Chapter 595 Mine Califon
rub HealNa SdetyCOde,Sections 25505.25533 and 25534.I understood Mu ifthe building
d s n0(cu ently m a M 4 that It is my mapanihillty m mM'y Me occupant of the
I con whit tib 4normismanccofaCcnifkamofo upanry, Signa ofAppli ant Dae
-��7, All roof coverings to be Class"B"or better
0 n mMorimd cm Dao
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
OUPERTINO
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: L.LC- •t C �"1
Job Site Address: I Jb 1
Roofing Company Name: W
A phcan1' Signature: Date: OS
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
Community Development
10300 Torre Avenue
aClOF
Cupertino CA 95014
Telephone(408)777-3228
Fac(408)777-3333
�UPERTINO
B.uilding Department
JOB ADDRESS: W1 61 �lrtbroo C-r. PERMTT#�S� /�/�
OWNER'S NAME: ILtt PHONE # 6S-OIL
GENERAL CONTRACTOR: FAX # A" Zl 3 •Z3`l"1
lam not using any subcontractors: 6 Z OS
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 Wt tSho/t Ro•� t vet
Septic Tank
Sheet Metal
Sheet Rock
Tile
0
Owner/ ntractor Signature bate
CITY OF CUPERTINO
REROOF d S-b / d l Z
CUPEkTINO PERMIT APPLICATION FORM
NM' APN# 3 / / o f 0 6 Date:11
Building Address:
11161 Ptr.*_bros�
Owner's Name: G Phone#:
L2e Chr. yog $6$ —0123
Contractor: Phone#: License#:
W e.Yk s\\o re. ?_ee'I\ n 1„c.. 461 V 3 -Y 1 S 0 MU- 1
Contact: Phone#: Cupertino Business License#:
Go.1jr�Ll 1�eVho�v� LOS 2-15-3150
Type of Roof Covering:
Existing: Proposed: .
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify) DeCIfoa SILC
Number of existing coverings 1 ❑ Provide LC.B.O.Report#
To be Removed ❑ Provide Mfgr. Installation Specs.
Ani I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: gAv__^vt l �e �t� S 1�L awe t �stwl\ Ue Lf 0, Si ewe Cowit.l
coo ff- s -s-t-L►w c, mss A .
Residential X Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project: Type of Construction: Occupancy group:
1-7/600 Ke*-Oo+ FR.
Qty. if
Applicable 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
OF