06070068 CITIOF CUPERTINO ^ a.,sss«�s.:* e3' '> `C
BUILDING DIVISION PERMIT ...CONT UGTI I{iVFORNrIATIO,N
BUILDING ADDRESS: WESTSHORE ROOFING COMPANY PERMITNO06070068
7899 ROBINDELL WY
OWNER'S NAME: PERMIT ISSUE DATE
FERGUSON, TODY 2814 AIELLO DR 07/11 /2006
NE: C 2I O� SANITARY N0, CONTROL NO,
J L (408) 694-0060
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
n o 0 0
,op LICENSED CONTRACTOR'S DECLARATION Job Description
u1 bcreby affirm that I am limed under provisions of Chapter 9(Comc
mrmsng
ith S
t W wectionTOM)a(Division 3 offt Business and Profession Code,and my licenxu
infullfom'aneerkc 3 g 7g7LZ I REMOVE EXISTING ROOF, INSTALL PRESIDENTIAL COMP
Li..
lav C
f-p Dau �—l —O Can Lae.
ARCHITECTS DECLA ATOR N
f C< 1 understand my plans shall he used as Public meords
)yU
s o in Licensed Professional
MC WmOWNER-BUILDER DECLARATION
I 1 hy affirm that 1 am sxempt(mm NIl
e Contractors Use..Law far the
Mp O following mama.(Section 7031.5.Business and Profcc ima Code:Any city or County
a:w which mquires a permit to enmuuct,alter,impmvc,demo)"sxh,or repair any swcnm 9000
Zj, prior N its issuance.also rcquims the applicant for such permit m file a signed stammcni
< that he is licensed pursuant iNeprovisions ofthe CommcwrsLicmveLaw(Chapter 9 Sq. Ft. Floor Area Valuation
SEC
(commencing with Section 7000)o(Division 3 of NC Business and Prolusions Cods)or
y Nheat is exempt Nehlram and the basis for the alleged wmplion.Any violation of
Section 7031.5 by any applicant fm a Permit subjects the applicant N a civil penitY 3 W*Rr"eru U Occupancy Type
not mart Nan five hundred dollars($500).
Q I.asowncr of the popeny.omY ooPloyces with wagesas Ne'a sok eompewuon,
will eo Ncwores and e: swnurt is roti Li ens car caw does
not apply in an owner of Required Inspections
and Prty who Wild,Cade;The Contractor's Liana Law don not apply N an awncr of q P
own.ertywho proorf mproms NereomaM wbotlanotimemrk hhahalfothrough his
own employm.Ping ori painm m issold nts art mat ear ofcd oroffopted n.for raiser.
bowew,the Wilding or improvement is hath within ons year.(completion,the owner.
of
builder will hacih
ve te When of proving that he did not WiW or improv farse purpoof
sale.).
❑1,as owner of the property.am aelusively contracting with licensed Contractual;in
c...net the project(Sec.7044.Business and Pm(ess ms Code:)The Contactor's Li.
cense law does not apply h an owner of property who Wilds or improves Neremt.and. j
who conatus for such projems with a comm endefi)licensed pursuant an the Contractors
License I.
❑lam exempt under See .BBPCfar this,sawn
Owner Dau /
WORKER'S COMPENSATION DECLARATION ` O�
1 hereby alEno uMcr penally of perjury dote of the following declaration:
1 hsm and will maintain.CcrtificaN ofConcm an self-insua for Wtolue.Compe.-
smion,as provided for by Section 3700 of the Labor Cuba.for Ne performance of the
oh ro hick this permit is iasuM.
have and will maintion Worker:Compensation Insurance,as numbed by Section
700 of the labor Code,for dte Performance of the waste:for which this Permit is issued.
My Worse,a C�ompena/u�on�In-sura`.a cart:',and Policy number are:
Comic'. Yrs�Q rW V/\ Pollry No.:nGti7 Z(1 I f3�'
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(Thu section need not becompleted if Ne Permit is forone hundred dollars(Slip)
or less.)
1 certify Nat in the performance of the work for which this permit is issued.I shall not
employ any person in any mannerha as to become subject to Ne Workers'Compenmion
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If.a(mr making this Ceniricate of Exemption,you should
become subject m Ne Wohers Compensation pmvisorts of the Iahm Code,you mute
.J O foMwiN comply with such provision o Nu Permit shall W deemed mmkM.
P'y CONSTRUCTION LENDING AGENCY
[-+^ 1 hereby affirm Nat Nert u a conazmcuon kin ing xgemy(m the pcdarmance.1'
the work fur which Nis permit is issued tSce.3097,Civ.C.)
a Q Lender's Name
7 z Lenders Address
U O 1 certify that 1 have had this application AM sum that too
above imfotmatian is
D. Concoct-I agme m comply with all city and county ordinances and sum laws misting in
(] V Wilding conswnion,and hereby authorim mphsenutives of Nis city to enmr upon the
F yshove-men ioned property for inspccuon purpo.s.
(We)agree to save,indemnify and keep handless Ne City of Cupcnino against
50 liabilities,judgments.costs and exPe-•-s which may le any way acerae Meant said City
U Z in eonsequene of the granting.(this permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
rn
T13—
0 Re-roofs
Signazum ofAplicanVCal.r pan
HAZARDOUS
MATERIALS DISCLOSURE Type Of Roof
Will Ne applicant ior mfuture Wilding Code.
haptnoc o handle Hcallous material
C defined io Nc Cupertino Municipal Coec.Cbapkr 9.12,and the HcaIN and Safety
Cade.0Yci 35532(x)? / All roofs shall be inspected prior to any roofing material being installed.
41 [3rd If a roof is installed without first obtainingan inspection,I agree to remove
Will Nc applicant or funs¢ ding occupant u.equipmem or devises which P g
trait hanrdous air comamin a dcfncE by Ne Bay Aha Air Quality M...gement allnew materials for inspection.
District?
❑Yes ON.
IhavehM Neh,acd ma503. requimmc uun534.lundcoead.95af Ne Califng
ria HcalNhSa(my Calc,Sccuothat it, my mu8olity indcrsmnd mete Wilding
dans sot curtenuy here a tenans that it u my responihilitY u wufy tar oceupant Or
myaihmcnu wh' m Wmct priarmivaarxx tar.Cutifzem a��Necr. / Signature of Applicant Date
�pV
Owner or anmatvcd agent D,te - All roof coverings to be Class "B"or better
CITY OF CUPERTINO
I of 1 PERMIT RECEIPT OPERATOR: bethe
COPY # 4
Sec: Twp: Rng: Sub: Elk: Lot:
APN . . . . . . . . : 36219025.00
DATE ISSUED. . . . . . . : 07/13/2006
RECEIPT #. . . . . . . . . : 35227
REFERENCE ID # . . . : 06070068
SITE ADDRESS . . . . . : 7899 ROBINDELL WY
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : FERGUSON, TODY
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-5076
RECEIVED FROM . . . . : WESTSHORE ROOFING
CONTRACTOR . . . . . . . : FOWLER, PAUL LIC # 21417
COMPANY . . . . . . . . . . : WESTSHORE ROOFING COMPANY
ADDRESS . . . . . . . . . . : 2814 AIELLO DR
CITY/STATE/ZIP . . . : SAN JOSE, CA 95111
TELEPHONE . . . . . . . . : (408) 694-0060
OE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 9,000.00 158.76 0.00 158.76 0.00
BSEISMICRE VALUATION 9, 000.00 0.90 0.00 0.90 0.00
---------- ---------- ---------- ----------
TOTAL PERMIT 159.66 0.00 159.66 0.00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ -_------__---__---
CHECK 159.66 18099
TOTAL RECEIPT 159.66
•
Community Development
10300 Torre Avenue
Iryf' Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
16UPEI�TINO
Building De artment
JOB ADDRESS: PERMIT # ?00
OWNER'S NAME: ( 1$pyl PHONE # —oc,
GENERAL CONTRACTOR: kp 119 ..II FAX # ^o Gf f(
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following ' ormation:
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
Owner/Contractor Signature Date
Community Development Department
p Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY Fax: (408) 777-3333
��INO
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 Raid 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.
j6
Homeowner's Name: yyly Em�V,j�I
Job Site Address: O ! l ��` tt `L(�-/e✓
Roofing Company Name: i1V A�eSt 5� I
Applicant's Signature: Date:
• Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF
CUPEkTINO PERMIT APPLICATION FORM Dlpo 1000
APN # Date:
/ _Das -7 -1z -ob -
Building Address:
Owner's Name: j�11 1 � d� 1 I (fie Phone#
OLS j:a� 2,52-- 0732,`0
732,
ContractorPhone License#
we/s -co 60
Contact:Pa).Aj y„_ ,I Phone#: 6v—oo U[o Cupertino Bu mess License #:
�(JW( Vo,/ 7
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)
Number of existing coverings 2 ❑ 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:
rc�r- Iv�s3 ( r�tr��a� Ce)rcP z3
Residential ❑/ Commercial ❑
Fire Zone: Yes ❑ No 21 Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Pr oje t: Type of Construction: Occupant oup:
al� s
Qty. if
Applicable Fee ID Fee Description Fee Group
I 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
•