05040189 • CITY OF CUPERTINO �`•" •^ 'a. ''Bwxv3v'.!a- .•. .*;w'ix"'.::? * '�'` 3#'i�+.,cf`
BUILDING DIVISION PERMIT ,`CONTRACTOR INFUR1, WTION• g"
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BUILDING ADDRESS: WESTSHORE ROOFING CO PERMfrr1D05040189
OWNER'S NAME: PERMIT ISSUE DATE
E: SANITARY 90. C OL NO.
RCHITECTIENGINEER: BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
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Oij lumby LICENSED CON7Ext ad.,provisions
DECLARATION �C■ !tl O�®®
yn uJ 1 ..70afllmbea1amf ft Buunderpd Prollnsof Chapter9(myIf.. Is [I}•'�Vyat, E
IN Scerce,dX))of Divltlon3of Nc Bugrnrss orb Prs(cstlar Ca&,roti my1¢enseb
n in full forte s,0 ttsmt
'�a ucen Lte.g 1 l I REROOF W/ TILE
Dam Contractor Inc.
eg4qp ARCHITECTS DECLARATION 2U�[
Sof 5
Y G I undmvsnJ my plena Mell Iso used u public records
C�
Licensed Professional p
m Oat I"m BUILDER DECLARATION ®�' ®y Ik1 B
<� 1 hereby eflirm Net I em exempt from the DECLARATION
License,law for Ne ® ago r\®�
00 (allowing moon.(Sutiun 70313,Business and Professions Cale:Any city or county e
. $9 which extu nes a permit to conmact,aher,Improve,demolish,or term any aVaeture
prior to its issuance,also requires thenpplicaal far such permit r file a signed statement
€< matWtslicensedpursuanttotheProvisionsortheConuamer's LicameLaw(Chepeer9 Sq.Ft. Floor Area Valunon
8 (commencing with Section 7M)of Division]of the Busineaand Profetlmu Cade)or
�..
that be4 aaempt Waitress,and the buts for the alleged esemptien.Any violation of �,W�T ,,�.k,
Section 70313 by any applicant for a permit subjects the applicant be a civil penalty of 3�"V 1V'VO'lY'4r0 0 Occupancy TY(�
mat marc than five hundred dollen(S500).
❑1.as,owner ofthe property,an my employee with wages u their sole compensation,
willdo thawak.and Wemnica e Is not Ntenled abolfered(or With,(See.7044,Budrcu
and Professions Code:The Coombe,License Law doe not apply M m names of Required Inspections
properly who builds or im prove Neaman.and who d¢s amh wmk himself or through his
own employcca,provided amsuch Improvements are enumerated mrmlfered formula.if,
however,Ne Wilding or Improvement Is mid within am year armmpliaWn,Ne owner•
buil&'will have iW burden of proving that M did mat Mid or improve far purpose of
els.).
❑1,as owner of the propmy,ann exclusively contracting with licensed mnwnws to
construct the project(Sec.70X,Business and professions Code:)The Cbuaerots Li-
cense raw dmu not apply to an owner of property who builds or improv Nemon.and,
who contracts per such projects with a conumeor(O licensed pursuant in We Continuants
License Law.
❑I am exempt rode Sec .B&P C for this mason
Owner Dam WORKERS COMPENSATION DECLARATION
1 hereby of on under penalty of perjury arc of Ne fallowing delan0ov:
haw end will mtlnmin 4CeNRcam of Currant m fair-issure fm Wmketa Compere
utlon,u provided for by Section 3700 of tirc labor Code,Iso Ne performance of tiro
work for which this permit u usumd.
I haus and will mainuin Worker's Compensation Insuran¢,u required by section
3700 of the Labor Code.for the performance of the work fm which this permit is issued,
My Worker�'s..Caompewdm{q_4,n,�� nits and Polity number am:
Carrier: sJ n r1�'.e- v " a PoImy Na.: l cii5 —Z OO�
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Mi..0.need rot be completed if ted permit lafmome hundred&Ons($100)
or tesa.)
1 Unify than in the pmro mance of the work for which this pormB Is Issued,I shall not
employ anypenon in my s,mncr an at in became subject in da Wonken'CompcnseRon '
Laws of Caliromis.Dem
Applicant
NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should
become subject to We Worker's Compensation provisions of We Labor Cade,you mum
.,0 foMwOh comply with such provicnro or this permit shall W eecmed revoked.
„Z,m ti CONSTRUCTION LENDING AGENCY
[+ I hereby alRtm Na them Is a construction lending agency fm led performance of
C$•7
the work for which this permit ts issued Ism 3097,Civ.C.)
Ig1 Ian&ts Name
2 Len&ts Address
V p I Unify that 1 have mad this application and sum that the above informadun is
I7r
commit,1&I=to comply with all city and county ardinan¢s and rote laws relating in
O U building construction,and hereby authorm:representatives of this city be cnur upon Ns
Lid abovomentiabd properly fm inspcctiom puryoses
It.. (We)aSm.in save,indemnify and keep hamlw We City of Cupertino against
v,v fag
liabilities.Judgments,casts am expenses which may in my way amine against aid Chy
V' in com#.q nee of We
gmnf of N' emit.
APPLI A of
ON Ds WILL COMPLY WITH'A(.L NON-POINT Issued by: Date
SOUR UL ONS II • INT
Re-roofs
Signgurco pplicant/Cam ter Dam
HAZAR Us M ALS DISCLOSURE Type of Roof
Will da applicant U future building occupeal gain or handle haerdos,material
as defined by the Catacomb Municipal Code.Chapter 9.13,and the Health and Safety
one.Smdan3553ua)711 All roofs shall be inspected prior to any roofing material being installed.
Yu u
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
t haaumumi
dous air cnanu u dc0ncd by the Bay Area Air Quality Management all new materials for Inspection.
tsuict7
0 Yes •lis
It,va mad We haurNas malerlalsmquimmcnuun&rChapterd.95 a(Ne C.lifory
nu HulthISafctyco&��Eo
534.I un&mmod Nmirim building
dcoa t m he biiiey m mdfy the Mquint of We
ya w hs, Cc rut se of tkc pane. Signature Of Applicant Date
�� �� All roof coverings to be Class"B"or better
Owner in so..rimd.gant Dam
Community Development Department
+ Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF
OUPEkTINO
Building Department Fax: (408) 777-3333
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$176.18. The re-inspection fee must
be paid before another inspection can be scheduled.
IMPORTANT:
1. Flat roofs must have a minimum of 1/4" per foot slope and demonstrate
that there is no ponding.
2. An I.C.B.O. report is required to be on the job site at the time on inspection.
I understand and will comply with the above stated policy on re-roofing.
Homeowner's Name: l Lac e S rn k
Job Site Address: zo$ 6 I TU k ol C-'�
1n-
Roofing Company Name: WN e_ IanA'�!nl �V
Applicant's Signature: Date: I- Pj
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINO
i REROOF
CUPERTINO PERMIT APPLICATION FORM
APN# 13 U b O Date:
Building Address:
2�$ 61 T„ Iw
Owner's Name: _ Phone#:
kLc-kA e -Tsc:, 40 -125 -25 I
Contractor: 1 n Phone#: License#:
12S3S�larL `ZoOfil 1v�C. �$'
7.1--�-5ZSd . -7W-[
Contact: Phone#: Cupertino Business License#:
(Soi�j r�•�1 �pv�.w.n. I{O�8 Z13-3`7SO
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ,e' Other(Specify) CV" 7,'kQ— -
Number of existing coverings ❑ Provide I.C.B.O.Report#
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
I Have Read,Understand and Will Comply With Cu ertino's Tear Off Poli cy:
Ob Description: oUP_rk-J (pw-vk. S T,ke Ove✓
CXtS-t ,•� Wno� S�nrnLGL, Cla$c C3 NCCL. w�•3 .
Residential Commercial ❑
Fire Zone: Yes ❑ No.2r Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project: Type of Construction: Occupancy group:
Qty. if
Applicable 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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