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03070208 CITY OF CUPEM INO BUILDING DIVISION PERMIT CQTRACT R INFORMATION�_ Bu1l.DINC AODREss: WESTSHORE ROOFING CO PERMIT N003070208 OWNER'S NAME: 5869 WINFIELD BLV PERMIT ISSUE DATE MARK SNESRUD 07/28/2003 ONE: (408) 629-2100 SANITARY NO. CONTROL NO. ARCHITECUENGINEER: BUILDING PERMIT INFO LDG ELECT PLUMB MECH loo LICENSED CONTRACTOR'S DECLARATION a I homb afnrm that 1 Cm licenxd under provisions of Chapter 9(commencing Job DesCrlp[IOn s< withsecti ))nf, that 3 of life Business and ProfeSihos Code.and yliunscls iq< int rceandcrcect. / Z REROOF Inst Co.' `3 Lic.N ` 0 7 I �� ,y Q��.-,J� to Cumncmr A HITGCTS DECLARATION '] f lunderstandmyplanashallheusedupublicrecords AUG 0 t 2003 G Licensed Pmlcssional OWNER-BUILDER DECLARATION 1 1 i y I hereby affirm that 1 am exempt from the Contractor's License Law for the 0 BUILDING pgD following mason.(Section TIn1.5,Business and Professions Code:Any city or county tMG <$ which requires a permit In cnnsuuct.alter,improve,demolish,or repair any structure 84500 zzQprion,,its issuaocc.alsurequires the applicant fmauch permit to fileasignCd Dammam EESG that he is Hcensad puramenE to he provisions of life Contractor's License Law Chapter 9 Sq. Ft. Floor Area Valuation tl- (commencing wi th Section 7000)of Division 3 of the B ahmis and Profcssions Cale)of $ that he is exempt therefrom and dte basis for the alleged exemption.Any violation or 34250018 . 00 Section 7031.5byaty applicant for a permit ubjects Ne epplicut to s Civil penalty of APN Number Occupancy Type N not mart an Grc hundred out[...(SSW). - -1,as no, fthe property,or my employces with wages u then sale compensation, will do the work.and the awcmte is not intended or offered fornle(Sec.]044,Business J U b — YFAMnptt and Professions Code:The ContnctoM1 License Lew does not apply to In owner of 3 0•� — IN.S,ULAy~•ryUt[�d Inspections property who builds or improves thereon,and who doessuch work himxlfor through his 11 LV own employees.provided that such improvements are not intended or offered forule.If, 601 — ROOF TEAR OFF however,the building or improvement is sold within oro yew of completion,the ownco- builder will neve Use burden of proving that he did not wild or improve for purpose of 602 — ROOF PLYWOOD NAIL "le')' 603 - ROOF BATTENS 01.as owner of the proparty,am exclusively convening wit licensed convenors to 604 - ROOF IN-PROGRESS construct the pmjcct(Sec,7044.Business and Propose m Code:)The Contractor's Li Came taw docs not apply to an owner or property who wilds or improve themon,and who contracts for such pmjeeu with a contractor$)licensed pursuant to the Convector's License Law. ❑I am exempt nder Sec. B h P C for reform Owner Date WORKER'S COMPENSATION DECLARATION 1 hemby amtm under penalty of perjury one of the rallowing declaetiou: I ban and will maintain a Catlneate of Consent o selbin&ore for Worker's Cumpmr cation,a provided for by Section 37M of the Labor each.for the Performance of the work(or which Nis permit is issued. ❑I have and will maintain Worker's Compensation Insurance,u required by Section 37M a( boaChat.far Ne perramanccCf the work far which Nis permit is issued. My ricr. gfa Cnmpcnsatiu nsunncc cense POl�y NOY numl¢l iQ—� CERTIFICATE OF UEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thu section need not be completed irthe permit la fm one hundred unit.(SIRE rr Icsa.) I certify Nat in the performance of Ne work for which this permit is issued,1 shall not employ any person in any manner x a an become subject to the Worker's Compensation Laws or California.Date Aralscam NOTICE TO APPLICANT:If.after making this Cenificate of Exemption,you should become&object to the Worker's Compensation previsions or the Latoo Code,you must _ 7Z forthwith comply with such provisions or this permitahall he deemed revoked. Z O CONSTRUCTION LENDING AGENCY - 1 hereby affirm Nat them is construction lending gcncy for tic performance for Y� the workfur which this permit is issued(Sec.3097,Civ,C.) 31 Q Lender's Name - =z fenders Address s J Q 1 certify that I have road this appliotion and site that the be.infmmetiun is y f collect.l agree to comply with all city and county ordinances and state laws relating to 0U building conswetion,and hereby authorize representatives for this city to cuter upon the 4 al ov -nounioned properly for inspection purposes. .. (We)agree to ave,indcmni fy and keep harmless the Ci ly of Cupenino against h liabilities.judgmenta.costa and expenses which may in any way accme against send City UZ to consequence of to granting of this Permit. APPLICANTEXNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date 50 CE RSCULATQ�IfS:t1 _ 7[�jf� (�� ll Re-roofs igmw o Appli asOComnco" w/ Data HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building maapant Dore nr handle ha�uus material as defined by Nc Cupertino Municipal Code.Chapter 9.13.and the I1caIN and Safety ode Section 25532(x)? El Y., ❑Nu All roofs shall be inspected prior to any roofingmaterial being installed. 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 h harandaus air cuntamutimi u defined by Nr,Bay Area Air Quality Management all new materials for inspection. istrict? ❑Yes [D No I have road the havaNuus materials requirements under Chapter 6.95 of the Califor. Dia Health KSof Calc,Sccuuns 25505,25533 and 25534.1 undnatand that ifdlo wildi time not carnally h a tenant that it is my mepansihility a noul'y the cecu the myu' cn hich mlauarCerf.ctnlnCetor(Dead Signature of licant Date owns rr Non odagctu 2 Data 03 All roof coverings to be Class "B" or better F Community Development Department Building Division a City of Cupertino 10300 Torre Avenue Telephone: (408)777-3228 4UPEkTINO CITY OF 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 j 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 I understand and will comply with the above stated policy on re-roofing. ; Homeowner's Name: M2/MfZS (LI.A']ZfC SN1 Sc,?- 0 • ;I Job Site Address: Z 3©I I(O (10-55 ttytc C l.([E7e--n Kr) 3' Roofing Company Name: k 11 AA12plicanfs Signature: Date:—YW to-3 . a • Greg teel Building Official ]' c Revised 1/30/03 Printed on Recycled Paper ' j�l CITY OF CUPERTINO REROOF CUPEI,TINO PERMIT APPLICATION FORM APN# /1• q2_ 5-0 0/6 Date. Building Address: 230H.0 V055 kv-C . G 1Peyz: 1 IS©1 4!�-4 15011+ . Owner's Name: Phone#- MJMMAV< 5KIZSQuUD 40bZSS—SIZ Contractor: „ESm$HOREYROOFIN INC•. ;Phone#: License#: 7g ZZ( ?,586.9 Winfield Bill I Contact: y,San`Jose;CA95123 Phone Cupertino Business License#: L SCALL FOR FREE ESTIMATE 1 —7-7S 4oe=629=21o_ cI Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ A 1CShinglesq.Arft trS t g es ood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other(Specify) ❑ Other(Specify) 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 Policy: Job Description: -eA_r Ofd eV(stn q W oo AS rtfS i ti Residential Commercial ❑ Fire Zone: Yes ❑ No ❑ Confirmed with Planning De t. if there are any restrictions: LJ Cost of- foject: /` ype of Construction: Occupancy group: / I5rrD Qty. if AppliqFee 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 � z263� / ° 76--0'