06090082 CITY OF CUPERTINO + F§ '"�" `* °� '�`'' "
BUILDING DIYTSION PERMIT CONTRA.CTQRIN•FORMATIO
BUILDING ADDRESS: WESTSHORE ROOFING COMPANY PERMR N0.06O9OO82
10750 STEVENS CANYON
OWNER'S NAME: PERMIT ESSUE DATE
Ank STALLCOP JAMES 2814 AIELLO DR 09/12/2006
NE:
SANITARY NO. CONTROL NO.
(408) 694-0060
ARCHITECTAINGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
ion LICENSED CONTRACTOR'S DECLARATION O O O
u P I Wmby affirm that 1 am licensed under provisions of Chapter 9(commencing Job Description
:Zw with Section7M)of Divisic.Wth,Business and Profevsims Code.aha my license is
�„ in fell force and art., REROOF- REMOVE WOOD SHAKE, INSTALL OSB FELT, 30
t la z Licenu Class
�o Dam - - Conlranor COMP CLASS A, 52 SQUARES
qq
< ARCHRECI'SDECLA ATION Mv,,5
i 2 1 undersand my plain shall W uwd u public records J
Ot; Licensed Pmressional
10 3 OWNER-exempt RDECLARATION
C I hereby.firm that I I.S.exempt from the Contractors Licenu Law for tW
:OO followwhich
mann.section h IIintrBusiness and Pwfcsinm h..1 My can or county
Mo.
m which roquiru a permit w cnnstnu:L alto,improve.dcmplish,nr repair any awmure
.Z6 prior m its issuance,also requires the applicant for such permit to rile a signed stam
teent
Nal he is licensed purwant to the provisions of the Conmcwime
r's tLaw(Chapter 9 Sq.Ft.Floor Area > Valu$fb®BOO
1FG (commencing with Section]Op0)M Division 3 of NC Business and Profmsipm Code)of
9 that he Is exempt therefrom and the basis for the alleged eumpdon.My votedon of
Section]031.5 by any,applicant for a Permit wbjecu she applicant to a civil penally of APN Numberane u Type
not more than lva hundred do0.,(5500). 35603044 . 00 P y yP
I,u owrcr mf dte properly,army employees wish wagon u sheiz sale compewtion,
will do the work,and ma awcmm isnot intended or offered forsake(See.7(3o.Business
and Professional Cada:The COmeracrar's Lt..L]w d.MI apply us an owner of Required Inspections
Property who builcumimpmves theronn,andwho doessocnwurlehimscif or through his
awn employ=,provided that such improvements are not intended oraffered rte sale.If,
however.the building or improvement is sold within ane year of completion.the owner-
be irrer will luxe the burden of proving Nal W did not Wild or improve for purpose of
sale.).
1,as owner of do property,am exclusively conuacung with licensed mntrxmrs to
construct the project(Sec.7(44.Business and Profusions Code)The Contractor's Li.
,cine Law docs not apply us an owner of progeny,who Wilds or improves Norton,and.
who contracts for such pmjcm with a conenctm(s)licensed purwant in the Cannoneer,
Li,,.law.
El amuemplunder See .Bikpcforthismaun
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury,one of the following declaralious:
I ham am will maintain a Certificate of Coastal to self-mare for Workers Compce-
si timn,.provided for by Secuan 37M of the labor Cade,for the performance of the
work for which this permit is issued.
❑I have and will maintain Worker's Compe eadon Insurance,as mitered by Section
3700 of ma labor Code,for to performance ofthe work for which this permit u issued. '
My Workers Cwn,auon maInwrsnce artnumber
earlier and Policy art:
Cartier. Sfia—bE and PolicyNo.:1610 `2006
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Tns section wed not W completed if the Wall is forow hundred dollam($100)
or less.)
1 certify That in me performance of lie work for which this Permit is issued.)shell not
eon ploy any person in any mannerw u in become subject to the Workers Compemadon
Laws of Califomia Date
APIA 1 metal
NOTICE TO APPLICANT:If,after making this Certificate of Esemption,you should
become subject to the Workers Compensation provisions of that Labor Code,you man
.J O forth comply with such Provisions or this permit shall W deemed revoked.
?4CONSTRUCTION LENDING AGENCY
[—a I hereby&lEsm that there is a com action lending agency for lie performance of
C
the work for which this permit is issued(Sec.3O9'I,Civ.C.)
tg1 Undoes Name
.7 z Lender's Address '
V O 1 certify Net 1 haw mad this application and sum mal the above infmmuion is
LL correct.I agree to comply with all city and county ordinances and stoic laws relating to
O V building construction.and hereby authotim repmnmatives or this city to enter upon not,
r W ahownormi.wdprogeny for inspection purpmsex.
(~ C (We)agree to save,indemnify and keep harmless me City of Cupertino against
Iq
liabilidw.judgmenos,costs and cxKmes;which may in any way sternic against mid City
of the granting of
s Permit.
VZ
in APPLICANT CUNDERSTANDS ArND WILL COMPLY WITH ALL NON-POINT Issued by: Date 7�
SOURCE REG LAnONS.
Z Re-roofs
Signature of ApplianUCo trwwr Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will IW applicant or future Wilding occupwtstem or handle hatum ore material
as;dc0wd by N,Cupertino Municipal Code,Chapter 9.I2,and the Health and Safely
,retic,Section 25532(a)]
41 ❑Yin 'PlIe All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection,I
Will the applicant of forum building..again tau equipment of devices which g agree to remove P
emit hamrdnus air contaminants as derined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes
1 have mail the havardous materials requirements under Chopu:rb.95 aria,Califor-
me Heal"Sandy Cade.Secbom 25505,25533 sad25534.1 understand Wtirtw Wilding
dare ram curood,have a tenant that it is my responsibility to notify the mcupus of the
requirements which must W met In w' of.Ccrufteam or txaparacy. Signature Of Applicant Date
as,
wr err ammartxedapat �D,Z a All roof coverings to be Class"B"or better
Sep 12 08 02.14p Wer3Shore Roofing (408)2132397 p.3
Communiry 0evclopmmnl
10300 Torre.Avenue
j Cupertino CA 95014
Telephone(408) 777.3 228
CITY OF Fax(408)777-3333
CUPEkTINO
Building Department
JOB ADDRESS: l0'2t 5 05}evQ�c� CQ,n yon �a Y'ERMTT#
60 Faoe/
OWNER'S NAME: J i 0A -,yfojjC0p I PHONE#7 q J$ (.Z`1-Z 100
GENERAL CONTRACTOR: IFAX # 0$-6 H - Oo
I am not using any subcontractors: Lxn, k7-0ro
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
Septic Tank
Sheet Metal
Sheet Rock
Tile
i
9`- (Z -C7C'�
• Owner/Contractor Signature Date
10!28/03
CITY OF CUPERTINO
eem 2 of 2 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 35603044 . 00
DATE ISSUED. . . . . . . : 09/12/2006
RECEIPT # . . . . . . . . . : 36012
REFERENCE ID # . . . : 06090082
SITE ADDRESS . . . . . : 10750 STEVENS CANYON RD
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : STALLCOP JAMES
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
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
*FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
- - - - -- - - - - ------------ - ---------- - - -------- ---------- - -- ------- ---- ------
BPERMFEE VALUATION 20, 000 . 00 277 . 56 0 . 00 277 . 56 0 . 00
BSEISMICRE VALUATION 20, 000 . 00 2 . 00 0 . 00 2 . 00 0 . 00
------- --- ---------- ---------- ------- ---
TOTAL PERMIT 279 . 56 0 . 00 279 . 56 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----- -------- - --- ----------- - -------- - -- -- -----
CHECK 515 . 52 1228
TOTAL RECEIPT 515 . 52
•
Sep 12.08 07-15p wodShore Roofirg (408)2132387 p.4
CITY OF CUPERTINO �y U
ugoo �
' REROOF l.U�
• CUPEII;TINO PERMIT APPLICATION FORM
APN# �r, _—. " '� Date: p` 1z
-0(.
Building Address:
tU o -eA
Owner's Name: Phone 9:
7,%M 5icdtZ,- ,306)
Contractor: Phone#: 0 License#:
V. ec2t5► 0 - `Z�zn r1- oo B ZZ\
Contact: Phone#: Cupertino Business License H:
u,WPf 01—Z10o
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Buih-Up roof
a Asphalt Shingles Asphalts
�, Wood Shalms Wood Shakes
❑ Wood Shingles O Wood Shingles
❑ Other(Specify) ❑ p8ur(S'peeify)
Number of existing coverings O Provide I.C.B.O.Report#
❑ To be Removed ❑ Provide Mfgr.Installation specs.
I Have Read, Understand and Will Comply With rtino's Tear off policy: 13rJ 2
Job Description: /�
tnn&O i5k' Woad a g a>� 10 d K Lom, l0. A
Residential Cy Commercial
Fixe Zone: Yes D No Confirmed witil PIanning D�pk if
there are mi restrictions• U
Cost of Project: Typo of Construction: Occupancy gmo Lp:
Q —Prm l7tAJ S F (Z 3
Qty. if
Applicable Fee ID Fee Desai tion Fee Gro
BPER VEFEE Bldg Permit Fees BUILDING
BENERGY Energy BUILDING
BSEISNIICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUIIAING
BUSLIC Business License BU MING
•
Sep 12 06 0215p Wes<Shore Roofing (4 0 8)21 32397 p.5
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
PEI�TOF INO Fax: (")�_3333
�U
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 34- 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: C�
Job Site Address: 'U 5 5 J I ��r`� �i4`y�►n R .
Roofing Company Name: �1��5�LNtQQQ�c7��rLq
Applicant's Signature:<`=`��— T � Date:
Greg Casteel
Building Official
Revised 11/2104
PrWad M A4ydedPysr