03070188 CITY OF CUPERTINO et+i' v+. r'`
BUILDING DIVISION PERMIT C,ONTRACT®RINFORMATION,z¢
BUILDING ADDRESS: WESTSHORE ROOFING,Teti INL. """'03070188
OWNER'S NAME: 5869 WINFIELD BLV PeRMrrlaue DATE
ONE: SANITARY N0. CONTROL NO.
(408) 629-2100
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
y0o LICENSED CONTRACTOR'S DECLARATION IOC Description
hereby affirm that I am licensed under previsions of Chapter 9(commencing
n� with Section 70skBof DiAsmn Softhc Bu'n rand Professions Cnde,andmylicensels
Ell Liccnhn sot cffec�r A �f�—I�•L I REROOF
=p Date 1 Cumru .i I��nn A p
FF7W7W AR NITECr URATION
tl I understand my phos¢hell he u public rccnrJa C ']
Licensed Professional AUG 5 2003
i0 OWNER-BUILDER DECLARATION
a�e 7 1 hereby affirm that 1 am exempt from she Contractor's License Law for she
O O following reason.(Section 7131.5,Business and Professions Code:Any city or county
X$� which requires a permit to construct,Nur,impri demolish,at mpair my strucsom I 4 A gA
'st�'n prior m its issuance.also requires applicant rot men permit to rile satiated statement
�£�'<
that he is licensed pursuant n
aanttotheprovisinn¢nheContracto;wrnreLaw(Chapter9 Sq. Ft. Floor Area Valuation
C $ (commencing with Section7W0)of Division 3 of the Business and Professions Coda)or
3
that he is exempt therefrom and the basis for the alleged a¢mpllon.Any viohtlon of
36227009 . 00
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
nos more Wes five hundred dollars($5007.
❑1,as owner of the pmpeny,or my employees with wages as their salt compensation,
will do the work,and the suuctum is not Intended or offered(or&sit sec.7044,Business 305 _ FRAME
and Pmfessiom Code:The Contraam's License law doer not apply to an owner of Re aired Inspections
property who builds or improves thereon,and who does such work himselfor brought his 307 - INSULATION
own cmplryces,provided that such improvements are not intended or offered for is.If. 601 — ROOF TEAR OFF"
howeveq be building or improvement is sold within one year of completion,be owner-
haildcr .will have the burden of proving Cn he did not build or improve for purpose of 602 - ROOF PLYWOOD NAIL
`"I`') 603 - ROOF BATTENS
❑1,as owner of the pec.704 .Business exclusively contrasting wide licensed cnnvaoors so
construct doesjmpplytoo44,wneoandrtywhonsds or i The Contractor's present,Li- 604 — ROOF IN-PROGRESS
come law docs not apply to ts owner of property who builds or improve Centro,and
whocontractsLace for such projects with o contrenor(q licensed pursuant to the CamncmM1
Licence Law.
1 am exempt under Sec. ,B&P C for this reason
Owner Dau ,
WORKER'S COMPENSATION DECLARATION
r I hereby affirm under penalty of perjury ane of be fallowing declarations:
1 bac and will maintain a CeAficne of Conant to ulFlnsum for Wmkeri Compete
Milan,m provided for by Section 3700 of the labor Code.for the performance or the
work for which this permit is issued.
1 have and will maintain Worker's Compensation Insurance,as mquimd by Section
3700 of the labor Code,rot the performmcc of the work for which this permit is issued,
My is Cnmppnsninn 1.nsunnec artier and Policy nutniMr�
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE ,
(This stain.need not comrpleed ifrbe permit is farm¢hundred dollars(SIM) j
orlt".)
I cenify mut in the performance of the work for which this permit is issued,1001 not
employ any person in any manners as m become subject to the Workers'Crmpensatlon
Laws of Calimrah.Data
Applicant
NUIGCE TO APPLICANT:If,after making this Ccniries¢of Escmption,you should
become subject to she Worker's Compensation provision.arms,lobo Code,you must
,z forthwith comply with such provisions or this Permit shall W deemed revoked.
Z'O CONSTRUCTION LENDING AGENCY
I hereby affirm that here is it construction lending agency for be performance or
!Y be work for which this permit is issued(Sec.3097,Civ.C.)
W Lender's Name
jz Lender's Address
U 0 1 certify that I have read this applicuion and suite the the shove informuiun is
W F correct.)agree to cum ply with all city and county ordinances and state laws reining to
pU building construction,and hereby authorim representatives of this to enter upon the
r U move-mentioned property for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
FN liabilities,judgmenu,costs end ezpenur which may in any way attrue against said City
C.),z, in consequence of th Framing of this permit.
'-' APPLICANT UN RSTANDS A WILL COMPLY WITH ALL NON-POINT Issued by: Date
SgUge uT TIO
X /14 'BIZ 0-4 Re-roofs
stirmurc A IiwnUC est ctof{, Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or
rum"' ilJing oeeupant stere or handle ha�ous material
As distinct by the Cupaninn Muni psi Code,Chrpter 9.11,and the Health and Safety '
Coda,Sectio.25572(a)1 Yes All roofs shall be inspected prior to any roofing material being installed.
Will the applicant OrVidahoad
ildingoccupant ora cipi pineal or devices which If a roof is installed without first obtaining an inspection,I agree to remove
If havardnus air rnnuiminby Ce Bay Arca Air Quality Mamgcmrnt all new materials for Inspection.
District?
❑Yes /JJ
IhavercadbehmardalsmquimmenuunderChapur6.95ofthe Celifor- / / /I
m HUN,A Safety ndc,Seem.05505,25533 and 25534.1 undcrsund thatifmc building J/ �IZI''' D3•
Jtcs not rA
urren I a I that it is my ,reaponsihility m notify be rccupam of be /�L T
rcyuircmnuiwh' m nnissuanaofaCcrtih aa:of can y. Signature Applicant '� Date
0 All roof coverings to be Class "B" or better
woes ,,,.d agent Dam
Community Development Department
smam.
Building Division
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
RUPEkTINO 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: W kN a t k I NCs) S WKN
Job Site Address: 7(o Z3 SQLLMEv.)0Q0 y2/ i / LU ounrz /ilk qS0<fI
Roofing Company Name: STSHORE 1460NG INC.
5869Winfield4,yB,,11
wd,,.,.
San Jose,CA 95123
A phcant's Signature: " �. a Date:
CALCFOR FREE ESTIMATE r„
408.629 2100,. �iv�
Greg teel
J Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO3 J � _
OREROOF
CUPERTING PERMIT APPLICATION FORM
APN # � � Date:
Building Address:
*76 Z3 SezUtizzwccD WAY, PE 1K)D/ i�A 9Sm
Owner's Name: WA-W(SI I A4IW61 SH7t1J , Phone#: 996 3663
Contractor.,' _- Phone#: License#:
WESTSHORE ROOFIN6IN * 7 8 7ZZ�
<` 5869 Winfield Blvd.
Contact: . .__;San Jose,—CA 95123 Phone#: Cupertino Business License#:
CALL FOR FREE ESTIMATE.
406-629:2100 Type of Roof Covering:
Existing: Proposed:
Built-Up Roof C3 Built-Up roof
❑ .Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) NaO Other(Specify) 16 3 i11�e roo h-el
Number of existing coverings Li Provide I.C.B.O.Report# 4E L SLP0 U
❑ To be Removed Provide Mfgr.Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: dye e4c45, etl rMf 0,44A 1" Ig�
(LL�WLI�,WU2�
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning De
there are any restrictions:
Cost of Projec Type of Construction: pOccupancy group:
Qty. if
A li ab e Fee ID Fee Description Fee Group
BPERMFEE Bld Permit Fees BUILDING
BENERGY Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC I Business License BUILDING
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