03090131 'CITY OF CUPERTINO
BUILDING DIVISION PERMIT
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gC4NTRACT�R INFOYiMA'I'70N .
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BDaDINGADDRESS: WESTSHORE ^ROOFING CO PERMIT"'63090131
770 TZJG121Z
OWNER'S NAME: 5869 WINFIELD BLV PERMTTISSUEOATE
TONT T,TTT 3
NE: (408) 629-2100 SANITARY NO, CONTROL NO.
ARCHITECrIENGINEER: BUILDING PERMIT INFO
BLODG ELOECT
PLUMB MEOCH
+00 LICENSED CONTRACTOR'S DECLARATION
� ❑ 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description
ZW with Section 7000)of Division 3af esus and Professions Code,and my license is \
'-oy ip full aomc dC'fed t'faC'�S/�� ZL� REROOF ����
Linens Cass C^3 LiW L�®
Date Cumm
q ARCHITECTSD ARATION
E '6 1 rat nd my plans shall Be used as public records APR
12
JyU q
Licensed Pndcssidnal [004
9 5 Oat I am exempt
from
DECLARATION
2 a P 1 hereby.(Seco on 1 am exempt Tram the GssionslCo License Law for the
,CO whichfollow
Paned i 7fUL5,Busluer.iness improve.
Code:Any cdynrmuare �1,1LD1s,w
nty
m which requires a permit to construct,alcor,improve,Jemnlich,m repair any svucwm BUILDING
uzj, prior an its issuance,also inquires the applicant for such permit to Glc a signed statement
psp that he is licensed pursuamtothe proviatwoofthe ComrroulWaLicense Low(Chapmr9 Sq. Ft. Floor Area Valuation
eh (commencing with Section 7")of Division 3 of the B usiness and Professions Code)or
Net he is exempt themfrum and Ne basis for the alleged exemption.Any violation of 37527021 . 00
Section 7031.5 by any applicant fora permit subjects the applicant to a civil penalty of APN Number Occu ane Type-
(:]
more than five hundred dollars($5W). - -' --' _ - p y
1,as owner of the property,or my employees with wages as their sale compensation,
will do the work.and theswmum is not intended or offered for sale(Sec.70144,Business 3 Ub -
v
and Professions Code:The Conanor's License Law does not apply to an owner of ME Reitired Inspections
property who builds or improves thereon,and who does such work dormice through his 307 — INSULATIN
awn employees,provided that such improvements are BN intended or offered for mile.If. 6O1 — ROOF TEAR OFF
however,me building or improvement is sold within one year of completion.the owner.
builder will have the burden of proving that he did not Wild or improve for purpose of 6 02 - ROOF PLYWOOD NAIL
B.I.J.
I.as awhxr of the 603 - ROOF BATTENS
❑ property,,Basin.exclusively comrsctlng wM li)heed droacmea m
cense Law oes not aSec.7044,wneoand Professions Co de i The Convacmr, Li. 6O4 - ROOF IN-PROGRESS
mnu Law docs not apply je an owner of property who builds or improves thereon,and
who commits for such projects with a comraaer(s)licensed pursuant m the Convector's
Licenu Law.
❑1 am exempt under Sec. B&P C for this reason
Own Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a CcniEcate of Consent m self-insure for WorkersCompen-
-tian,as provided for by Section 37W of the Labor Code,for the performance of the
work for which this permit is issood. .
❑1 have and will maintain Workers Compensation Insurance,as required by Section
37 W of the Labor Code,for the performance of the work for which this permit is issued.
MY Wo it 'SyC�orpk-Person.on Iran nm carted and Policy rumba
CaletF:S 1"�1� T as . Polio NQ.:�1��'_
!! CERTIFICATE OF EXEM FTIONYFRO RAYWO KERS'
COMPENSATION INSURANCE
(Thessulton need not hecompleted Kin,perm;,is formic hundred dollars($100)
of less.)
1 certify our in the performance of the work for which this permit is issued,I shall not
employ any person in any manner so as to heedme subject to the Workers'Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If,Brier mak;ng this Cenifmate of Exemption,you should
became subject to the Worker's Compensation provisions of the labor Cotic,you must
Oforthwith comply with such provisions in this pored,shall bo deemed revoked.
M N CONSTRUCTION LENDING AGENCY
1 hereby affirm that Nome is a construction lending agency for the performance of
Ya
on.work for which Nis permit is issued(See.3W7.Civ.C.)
QLender's Name
z Lender's Add..
J Q 1 certify that I have read this application and sum that the above information is
Hcorrect.1 agree to comply with all city and county ordinances and state laws relating to
•�U building construction,and hereby scullion representatives of this city to enter upon the
Wabove-mentioned property for inspection purposes.
ypw (We)agree to save,he gran indemnify and keep harmicss Nc City of Cupertino against
fn liabilities,judgmems,costs and expenses which may in any way accrue against said City
J z A APPLICANT
of UNDERSTANDS
of this perm;(.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
rRULA ULA IONS.fApplicen canmxmr Re-roofsHAZARDOUS MATERIALS DISCLOSURE Dalc Type of Roof
the applicant or future building decorum store or handle hazardous material
y the Cupenino Municipal Code.Chapter 9.12,and the Health and Safetys 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
es pLNu olio ap o". ,of fuwrc bdildmg ocddpant dx egd;poem or aevmea wombIf a roof is installed without first obtaining an inspection,I agree to remove
ous air conmu icanu as dcfincd by the Bay Area Air Quality Management all new materials for inspection.
❑Yes )(No
Ihave&Shfimthcha,Seed x25505, requirements3Bud25undcrChatand th5dfthe Cahfory �t/la, 71
lO�
ria Healthav Shanty CodaSecduns25505,355Awd 35underChasmnd95critc Caldmg at/t/� `t7, IL
does not currently have a mnant,Na it is my responsibility m ruddy the asupam of the
rct;cbmunu wh t merpriortoimusnccofa rufwmof upancy
7� �°F�,�10 Si a[ure ofApplicant �ba[e
i `
Owner or admdriced ascot T^ Da1e.. All roof coverings to be Class "B" or better
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
UPEkTINO
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: �TCw\
Job Site Address �V_1Q,, �e 0.642, 0D��kykb
Roofing Company Name: "
e, s A��Iz�le F4�O f�q 1r-,-C . /
A phcanYs Signature: �N11M,t/\ Date:
\�l/�61n10t�
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF
CUPEkTINO PERMIT APPLICATION FORM
APN# 2 2 Date:
�'lr7lo3.
Building Address:
Owner's Name: TOS L/� . � Phone
Contractor: t r�s�5�0�� p� Phone #: License #:
W FW �O$ Zq'Z100 7872Z�
Contact: dot �W(e e q-08 ne #2� Cupertino Business License#:
b —ZCaO
Type of Roof Covering:
Existing: Proposed:
X_ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles h
❑ Other(Specify) X Other(Specify)
Number of existing coverings / ❑ Provide I.C.B.O.Report#
XTo be Removed ❑ Provide Mfgr. Installation Specs.
I4Haved, Understand and Will Com ly With Cu ertino's Tear Off Policy: 7xzJption: pt Z3 �ooF sreMRCommercial
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there e any estrictions: LJ
Cost of Pro' t: T f Construction: O nc oup
I . e sb tie- ► s tG
Qty. if
A lic e Fee ID Fee Description Fee Group
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
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