06060021 CITY OF CUPERTINO a "es«a*s "
BUILDING DIVISION PERMIT XONTRACTnRINFORMATIQN ''
..3,1r, ire 3�sc�5Ri-'m`5s. "--r
BUILDING ADDRESS: WESTSHORE ROOFING COMPANY PERMIT NG.06060021
7889 ROBINDELI. WY
OWNER'S NAME: 4 PERMIT ISSUE DATE
Alkk PATRICIA EASTMAN 5869 WINFI
NE:
SANITARY NO. CONTROL NO.
(408) 629-2100
ARCHRECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
it p LICENSED CONTRACTOR'S DECLARATION
wC I hereby affirm that 1 am Iimnsed under provisions of Chapter 9(commencing Job D Ot�
�iW with Section 70110)of Division 3 ofthe Business and Professional Coin.ved my license is
"N in bull rmcc Ince _� REMOVE EXISTING ONE . LA OtV 'TALL 40 Y
r nn Liccnu Ire Lic.N (/
Daa�_CantDECLARATION . COMP
es HRECCa DECLARATION
i < I undessmnd my plans mall be used.public smirch J I y 2 Z ZOOL`
idu tl
C G Licensed Professional
3
OWNER-BUILDER DECLARATION p gy�aar� y
I hereby aRrm Nm
at I am empl frouam
tim the Conmr's L iconse Law for the rF�\71:11ttJ]i f[G%iI IL$pltl}f/ry�/ILIr117I
O O following¢ on.(Section]U3 L5,Business and Professions Code:Any city or county
%$ which requires a permit h construct,alter,improve,kitchen.nr repar any avuetum
!i< prior us its issuance.also requital the applicant for such permit or file a signed sutemem QIb0000
that be is licensed pursuant to the provisions of the Cmmtrwtorb Umvc law(Chapter 9 Sq.Ft. Floor Area VaIU$
2 (commencing with Section 70W)of Division 3 of too Business and Professions Cade)or
$ that M is exempt Nemfmm and de basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the optimal to a civil penalty of MN Number Occupancy Type
not mow man five hundred dollars(1500). 3 6 219023 . 00
❑I,in manse,of to propwry.or my employers with wagn as mel are compensator,
will do the work and Ne..mute isnot handed or ofremd for see(Sm.7044,Bud .`
and Professions Code:The Contractors Llceve Law does ant apply m an owner of Required Inspections
propenywh0 builds caimprowsthnrmnand wMdaesauclh ,it himaelfor through his
own emplcym,provided tlatsuch impmaements tee not inwded wo0cred for soh.If.
however.We building or improvement is mid within one year of completion.the owner-
builder will have the burden of proving that he did ma build w improve for purports of
sat.).
❑1.as owner of the property am exclusively contracting with licensed contractional to
conmmci the project(Be..]Oat,Business and Pmfesdmns Code:)The Comtncmr's Li.
cave raw dines nm appy to an owns of property who builds or improves thereon.and,
who contracts for such projects with a comraclmr(s)limmed pursuant in the Contractor's
License Law.
❑Ism eacmpl under See ,B&PC for this maven
owMr Date,
WORKER'S COMPENSATION DECLARATION
1 bemby affirm under pcvlty of Kdwy one of the following declarations:
1 have and will maintain a cmtificam of commnt m self-ivum fa Worker's ComNn-
suion,as provided for by Section 3700 of me labor Code.for the performawe of the
wools for which this'crnit is issued.
1 have and will maintain Woftes Compensation Insunnm,as required by Section
3700 of de labor Cock.for Ne pmfemloom of the vert for which this permit u issued.
MY Worker's coomperuauon We.mnier and Policynumber am:
Cartier. all^ FV/?-A Policy No.; 60 D/b If 0_
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(rho semien need not be completed Bthe Permit is formic hinded dnllan(1100)
or less)
I roily,mal in use performance of thc work for which this permit I.issued,l shall nor
employ any person in any mannerm as to become subject in me Wmrken'Compensation
Laws mf California.Date
Appii.
NOTICE TO APPLICANT:If,afar making mu Certificate of Exemption,you should
became subject in the Wm &S Compensation provisions of dor Labor Code,you an=
0 O forthwith comply with such provisions or this Permit mall be doomed Invented.
"' CONSTRUCTION LENDING AGENCY
(--h s�-h I hereby ulErm that there I,.c...fir.lending ageney for the performance of
a> the avrk for whim this Permit u meed(Sc,3097,Civ.C)
t[1 Q lender's Name
z Lender's Address
U Q I modify that 1 have wad this application and slow that the above information Is
correct 1 agree to comply with all city and county m ismanm and sea laws misting to
0 U building construction,and hereby authmire representatives of this city to enter upon the
[t] filmic-mentioned propc costs
for
and Is c.purpose:.
(We)agree m save,indemnify and lamp harmless the City of Cupertino against
F Z I.miuccium mcnu,rosuand ex'is u nit. ay in any way acme ,I.,old City
(„)z A eomaquence of me granting of this permit.
APPLICA LAND STAN AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOUR E(U ON ./�v Re-roofs.
Bigamist of ApplimnUControaom 41 Date
HAZARDOUS I ATERIAISDISCLOSURE Type of Roof
Will the applicant or furore building mcupantstore or handle haurdmv material
az de0ncd by the Cupertino Municipal Code.Chapter 9.12.and dor Health and Safety
Code.SeNon 8532(x)?
gyro /Nb All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future Wilding amupant ala equipment of doviw which If a roof is installed without first obtaining an inspection,I agree to remove
.mit harardov air contaminants u defined by the Bay Arm Air Quality Management all new materials for inspection.
District?
❑Yin D Nhh
I have wad the hvarmaumacdals mquirements under Chapmr6.95 ofthe Collins. w
ria Health g:SectyCodc.Smums 25505.25533 ond25534.1 undersand Waif the Wilding
docs nm eorantly haw•wnan4 mal It is my ma unuhiUly as hour,tic occupant of the p�
rcgmmmm un met ' r iss m raceru0caamfommpaney' SlgnatureofApplicantDate
or alimmtired agent Date. . All roof co ening.to be Class "B"or better
CITY OF CUPERTINO
om 3 of 3 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 36219023 . 00
DATE ISSUED. . . . . . . : 06/02/2006
RECEIPT # . . . . . . . . . 34672
REFERENCE ID # . . . : 06060021
SITE ADDRESS . . . . . : 7889 ROBINDELL WY
SUBDIVISION . . . . . . :
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : PATRICIA EASTMAN
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : WESTSHORE ROOFING
CONTRACTOR . . . . . . . : FOWLER, PAUL LIC # 21417
COMPANY . . . . . . . . . . : WESTSHORE ROOFING COMPANY
ADDRESS . . . . . . . . . . : 5869 WINFIELD BLV
CITY/STATE/ZIP . . . : SAN JOSE, CA 95123
TELEPHONE . . . . . . . . : (408) 629-2100
�EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 10, 000 . 00 169 . 56 0 . 00 169 . 56 0 . 00
BSEISMICRE VALUATION 10, 000 . 00 1 . 00 0 . 00 1 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 170 . 56 0 . 00 170 . 56 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 780 . 18 17814
TOTAL RECEIPT 780 . 18
•
Community Development Department
Building Division
/�• . City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
CUPEkTINO
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.
7. NOTE: If you call for a plywood nail inspection and the job is not ready,
you will be charged a re-inspection fee of$176.18. The re-inspection fee must
be paid before another inspection can be scheduled.
IMPORTANT:
1. Flat roofs must have a minimum of 1/4 " per foot slope.and demonstrate
that there is no ponding.,
2. An I.C.B.O. report is required to be on the job site at the time on inspection.
I understand and will comply with the�above stated policy on re-roofing.
Homeowner's Name: �tirtgY �ipV`r^ I—u1—lw.wv�
Job Site Address: I% V 1
Roofing Company Name:
M�
Applicant's Signature: �GJ\ v Date: 6 7- O(o
•
Greg Casteel
Building Official
Revised 11/2/04
adnred on Pecvded Paper
Community Development
10300 Torre Avenue
1' Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
IJUPEI�TINO
Building Department
JOB ADDRESS: 1$� 1 �b;y�0.lZ �-"�• PERMIT #
OWNER'S NAME: 1 �q �,, PHONE # tjo (6*j -00(o'-
GENERAL CONTRACTOR: 'iTtiorc FAX # o$ 60n
I am not using any subcontractors:-INQ �- T2 0 Jp
ignature 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
Septic Tank
Sheet Metal
Sheet Rock
Tile
• b�2�ob
Owner Contractor Signature Date
CITY OF CUPERTINO 000(000LO
G d�
REROOF
�CUPEkTINO PERMIT APPLICATION FORM
APN # 2W— �� on Date:
7J6�Z-I�fD
Building Address:^' p
1 0 901 o Lj V, 1
Owner's Name: Phone#:
qa)?- 25 lit 6 c>
Contractor, QAO�� 1�`•Phone %- oo60 License#:
``NN Y� `tO�• 6°IK• zz,\
Contact: Phone#:Yob 6 -OoCupertino Business License#:
62
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
Asphalt Shingles ,W Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report#
To be Removed ❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description:
VA i11 ow t• a w.f avkcl iii c 1 q0 qr Cow.
Residential ommercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Det. if
there are any restrictions: Ll
Cost of Project: 2!a Type of Construction: Occupancy group:
/0 0-0 d. Re.--• 9_6 of'
Qty. if
A licable Fee ID Fee Description Fee Group
PERMFEE Bldg Permit Fees BUILDING
RBESEISMICOM
ENERGY Ener BUILDING
SEISMICRE Seismic Fee Res BUILDING
G Seismic Commercial BUILDING
PLANCHK Plan Check Fee BUILDING
USLIC Business License BUILDING
•