04110130CITY OF CUPERTINO T.�YT?i "'i
*x'a��r+ •i '`�' «+ '"°'"'
BUILDING DIVISION PL'1�1Y11T
BUILDDIGADDRMS: -
WESTSHORE ROOFING CO
VERMTTNL04110130' -'- - -
10517 SAN FELIPE RD
OWNER'S NAME:
PERMIT ISSUE DATE
MARK EVANS
5869 WINFIELD 13LV
11/19/2004
ONE: -'
SANITARY NO. CONTROL NO.
(408)629-2100
ARCHITEC (ENGINEER: -
BUILDING PERMITINFO
EO PLUMB MECH
D O O
LICENSED CONTRACTOR'S DECLARATION
Job Description -
o
1 hereby eM m that I am licused under provisions of Chaplcr 9 (mmmencing
Mth Section 7") of Division 3 of NC Business and Professions Code. and my license is
-
infull tome end eBe. r 72Z I
License Class 7� 7 Lm.
REROOF W/ SHINGLES
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Date /l-ry -Uv.l GVmretlor -dr STSHrrj
ARCHITECTS DECLARATION
I dd y pl a M public record
/�� J -
!!!
Lice d Pref oral RDEC
OWNERBUI LARATION
I herchy affirm that I am exempt from the Contncctars Lico.se Law for the
following reason. (Secdon IID 1.5, Business and Pm@ssion Cede: Any city or county
L
0� -
which qulres a permitm construct. altar, improve, demolish, m ¢parr any nmcmm
m
$10000
Sq. Ft. Floor Area
Valuation'
prioo its issuance, also requires the applicant for such Permit o Ole a signed summers
rt
that he is licensed punmanttn the pmvisinuof the Contractor's License Law (Chapter 9
(commencing with section 7WK)) of Division 3 of the Business Prefessi... Cole) ser
that W is exempt therefrom and the buts for ate alleged exemption. Any violation of
¢
Occupancy Type '
Section 7031.5 by arty applicant for a Permit subjects the applicant in a civil penalty of
not mart Nan five hundred dollars (M).
❑ I,uowtmr of me pmpmy, or my employm with waguu Neo sole compensation,
Required Inspections
will do the wolf, and the svucture Imre intended m offered image (Sec. 7014, Business
and Profeaamas Code: The conn mes Umnto sew does net "Ply m an owner or
a'
property who builds ter impro ms Weser, and who doossuch work himml f or tiuough his
own employees, provided that such impmamenes seen, intended creamed for sale. If.
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however, the Wilding or Improvement is "Id within one year of completion, the owner.
builder will have the burden of proving that he did not Wild or improve for purpose of
sale.).
❑ 1, as owner of line property, am exclusively contracting with licensed com4actom W
.. -
construct the project (Sec. 7004, Business and Profession Code:) The Contracmrs U.
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mean law dors not pply in an owner of property who Wilds or improve thereon, and .
who contracts for such projects with a conuacmr(s) licensed pursuant to has Contractors
License law.
❑ lannuemptuncier Sec. .B&PCmrmisrcxxm
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following decimations:
I hers and will maintain. CertlOcam or Consent 1. self-imure for Workers Compere
sation, an provided for by Seetion 3700 of the IsWr Code. for the performance of the
_ ... .. -
.A for which this permit is issued.
❑ 1 have and will maintain Workers Compensation Insurance, as required by Secure
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3700 of NC Labor Code, for the Performance of the work for which this permit is issued.
My Workers CCo�m-penrsation carrier and Policy numbirr em:
,
�inns�urance
Carrier. tel/ It s`UN(n') Policy No.: o01670 -20U
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This unites need not W completed if the Permit Is forone hundred dollars ($1010
less.)
1 certify Out in the performance of the work for which this Penni, is issued, l shall not
employ any person in any manner an as in become subject to man Worlums Compensation
Laws or Califerma. Date
Applicant
NOTICE TO APPLICANT: If. after making this Certificate of Exemption, you should
become subject to me Worker's Component.. previsions of Ne Labor Coca, you most
forthwith comply with such prnvisiou or this Permit shall W deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby affirm that more is a construction lending agency I'or me performance of
the work for which this permit is issued (Sec. 3047. Civ. C.)
Lenders Nam.
Lenders Address
1 certify that I have read this application and suite that me a Wse information is
correct. 1 agree in comply with all city arld c.Unly ordlMnes and sum laws raising in
Wilding construction. and hereby authorize nurammatives of this city to enter upon the
ahovc-mentioned for inspection
property purposes
(We) agree m save, indemnify and keep harmless Ne City of Cupmum againstliabilities,judgments,
17(
costs and upoeses which may in any way&come against said Cityin
conuyuencc of No gra ming of this Permit._APPLICANT
DE TANGS N IL COMPLY WITH ALL NONPOINT
Issued by: ' DateSOURCERE
LA Nf• -- -
—�
_
Re -roofs
Type of Roof
C
Signature 0 Applican onuum' Data
HAZARDOUS MATERIALS CLOSURE
Will the appiiant or fuium building nmp l moremha.dle hvaAous material
as del nod by the Cupertino Municipal Code. Chapter 9. 12, and the Health and Safety
cede, sc❑N.n 25532(a)7 ``�`�� - -- - .,._
Yes pfnu
-•All roofs shall be inspected prior to any roofing material being installed.. -. ,...
r
'.gmpment.r whish
If a roof is installed without first obtaining an inspection, I agree to remove ... _. .
Will me app cant car co/m\m budding o meant u dcvm.a
colt heuNous air commitmen s as defined by lite Bay Area Air Quality Management
all new materials for inspection.
District?
❑Yes �Nu
I hanimad dcharardllusmucrialsmquim=nuunder Chapter G95of Ne Califer
nu Heal N& SafmyCom, Section 35505,25533 and 25534. IunlkrstaM dlatifthe Wilding
dors nor extrul,y vea tenana t i14. y. ponihility m sou fy thc aceuput of the
mqu.mu hi must me 'ter w't!u .fa nm of Occas pncy.
P
-a
Signature of Applicant Date
All roof cov rags to be Class "B" or better
0
Community Development
10300 Torre Avenue
It a1111-4aCupertino CA 95014
Telephone(408)777-3228
CITY OF Fax (408) 777-3333
UPEkTINO
Building Department
JOB ADDRESS:
10 / 2 SS U
/PC
PERMIT #
OWNER'S NAME: Plark
iEva hS -
PHONE # yd r ?71-E3.3
GENERAL CONTRACTOR:
4)(5 F5ty,-e /lam=f "
lvic.
FAX # ifu $ ?-13-Z3 7
I am not using any subcontractors: - I l I \ `\, o
Signa a Date
Please check applicable subcontractors and complete the followine information:
Owner/ Contractor Signature Date
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
j J2s jSGw.t �+o �i /y, c .
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/ Contractor Signature Date
CITY OF
CUP1:QTINO
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408) 777-3228.
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.
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"si'gn off from the City'.the following steps are
...,.required:'
1) Pre mspection and/or tear off approval.
_2) In -progress inspection approval. `
3) Final inspection approval.
a) Spark arrester installation.
r 5; ' . If plywoodis installed, a plywood' nail inspection,is required._
• 6.:
-Any roofing,which is appliedwithoutfirst obtaining an•inspection,
will require the removal of all new material down -to the sheathing,
so'a properCity mspection can be'performed
NOTE:`If yon`call for a plyivood'nail inapection-and'the lob"is not ready, ,
_you will be "chazged a re-inspectibnfee: of $17618: ;,The re yinspection fee must '? .
beyaid before another inspection can be scheduled i
IMPORTANT:
1. Flat roofs must have a mmiinum 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.
'
Homeowners Name:. Mol—V Gt v1 S
_ _.. y -
Job Site Address: ITF/�ellPt
Roofing Company Name: W2 S-71 S h C 4 1 Zo.o-T iVVA K C-
Applicant's Signature: Date:' y
Greg Casteel
Building Official .
.' Revised 11/2/04
orhtwd on Recycled Paper ,
,..
CRY OF
CUPEkTINO
CITY OF CUPERTINO
REROOF
PERMIT APPLICATION FORM
APN # � r l � � � Z
Bldg Permit Fees
Date:
Building Address: ,
17 F`Gk
Energy
IaS Sar I t
BSEISMICRE
Owner's Name:jo r
� k C.l�hs.
BUILDING
Phone #:
00 Fl91-833b
Contractor: Phone #:
Wests4.�fe �Zc>o-E� 4aX 2�1S-3�S°
License #:
7k�2-7—
Contact: Phone #:
Plan Check Fee
Cupertino Business License #:
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)
- Nugiber of existing coverings �_ .
LlProvide I.C.B.O. Report #
Tbe Removed
❑ Provide Mfg. Installation Specs.
I Have Read, Understand andWill Comply With Cu
ertino's Tear Off Policy:
Job. Description:- �&w.owu -t I06Tf• tnedd a,,k
i�s�c 11 Uo. btHr ca—T,, vvtr O,S.3• sH.atti'
2-79-U
Residential .: Commercial❑+c+,ir�a.
Fire Zone: Yes ❑ No ❑
Confirmed with Planning D ..if
there are any restrictions:
Cost of Proje t:Type of Cons c
Occupancy group:
c
S
�t)OOO�,X —rzoe f
f
QtY
Apppcabl
Fee ID
r
Fee Description
Fee Group
BPERMFEE
Bldg Permit Fees
BUILDING
_ 13ENERGY
Energy
BUILDING
BSEISMICRE
Seismic Fee Res
BUILDING
BSEISMICOM
Seismic Commercial
BUILDING.
BPLANCHK
Plan Check Fee
BUILDING
BUSLIC
Business License
BUILDING