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04110131 ' CITY OF CUPERTINO - •o-'` -- Bu1LOINcpIVIs3oN PERMIT C�NTI2ACTQRIN �ATJON' �� euaDINC ADDREss:. WESTSHORE "ROOFING CO PERMIT"04110131 , - •OWNER'S NAME: - PERMIT ISSUE DATE ROSS ALI ONE: - = - " - SANITARY NO.... . _.h. _.CONTROL NO...,......- 408 629-2100 ARCHITEC IENOINEER: - BUILDING PERMIT INFO BLOCELECT nease PLUMB MECH t� o 0 0 a0, •- LICENSED CONTRACTORS DECLARATION .. Job DCSCrIpn00 v -- �n FF 1 hereby affirm that I am licensed under provisions of Chapter.9(commencing - with Section 70W)of Division 3 of the Business and Professions Code,and my license is in full force entl effect. 5qz uenxecl `� --1•amm 3s%72Z I - REROOF W/SHINGLE n�, 'Datil `( ContraclorRiTI iqq // ARCHITECT DECLARATION y 1 do norm plana ah deep i eons 3 - OWNER-exempERD LARATION actor - E Ihereby.a amrm Nat 1 1. cBusin from lbe Contractors e:Any c Law for the i e following..an. aeon t 7th Ls,Business and Pmfee moll coda:Any say or county p +�m which requires a permit m enuwm,Heq improv,demolish.or.,air eny acoelom 4000 H?eprior to its issuance.else requires the applicant for such permil to file a signed statement _. _, - . --V that he is licensed pursuant the pmvisiom of Ne Connector's License law(Chapter 9 Sq.Ft.Floor Area _ . —Valuation qZ B (commencing with Section 7000)of Division 3 of the Business and Prolamines Code)or IE 3 that he u eumpl Nemfrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit objects the applicant to a civil penalty of 3 1,6I3ABIQ&&eO 0 _`.Occupancy Type not mom than five hundred dollen(S5o)). 0'1,as owner of the property,or my employee with wages as their sole cmnpensetion, will do the work.and tie structure is not intended or offered for sale 7WA,Business - .` 'R and Professions Code:The Commences License Law does not apply an owner of - -- _ _ 'Required Inspections.. ' . -- ,:^, ,'+`-• i�..,'t',' ••„1> property who builds orimprnes ves thereon,entl who dosuchworkhinesslfor through his v men employees,provided thatsuch improvements are not intended oraffered forsele.If. - hewevey Ne Wilding or improvement is sold within one year of eampletion,the owncn builder will have the burden of proving that he did not build or improve for purpose of ' sale I. ❑1,as owner of the property,am exclusively contracting with licensed contractors to - constmet Ne project(Sec.7044.Business and Professioas Cade:)The Condemn's Li. cense Taw docs not apply to an owner of property who Wilda or improves thereon,and - - whocontracufor such projects with a contractoro)Ilenud pursuant to Ne Convector's . .. . License Law. ❑l am exempt under See. ,B&P C for this muon '1'3700 wner Data WORKER'S COMPENSATION DECLARATION 1 hereby M.under penalty of perjury one of the following dedaramme I have and will maintain a Ceniflcae of Consent to selpimure for Workers Compare urian,u provided for by Section 3700 of the labor Cade,for the performance of Ne .. _ work for which this permit is orad. ' a ❑1 hath and will maintain he performance ert ranteofMeCompensate luunnce,as his required by Scmion -” MyW mf the labor Code fon Insurance cancer a the work for am: permit is issued. My Worker's Compensation Insunn/ce canicr end Polity number am: ' Carrier. /G FU✓V/J Policy No,:1100.46 qQ e,246 CERTIFICATE OF EXEMPTION FROM WORT S' COMPENSATION INSURANCE (This scetion most not W completed if the permit is forms,hundreddollars($1110) or less.) I , 1 certify,that in the performance of the work for which this permit Is issued.I shell not - employ any peon in any manner ser m to become subject to the Workers Compensation - Laws or California.Data .. Applicant - NOTICE TO APPLICANT:If,after making this Cedifines of Exemption,you should become why.,to Ne Worker's Compensation provisions of Ne Labor Code,you most - .JO farthwith comply veldt such prvisionsarthis Permit mail be deemed revoked. Z ti CONSTRUCTION LENDING AGENCY [-m mN. Ihereby affirm thatthaeits enestrvcdnn lending agency for the poforromm of ' !Yi tW week fur which the pennis is issued(Sac.309'/,Ci,C.) UndeeW A Lamises Name Dz Lenders Addmas V 0 1 certify Met 1 have mad this application and state that the above information is ILm r cmrtcct.I agree m comply with all city and county eminences and state laws reading to 0building concoction,and hereby euthonse epcemotivu of this city m enter upon the a ahove-memioned properly for inspection purposes. (We)agree loan,indemnify and keep harmless the City of Cupertino against _ wh liabilities,judgments.costs and expenses which may in my way aeero,againstuid City t„)i`Z in consequence of the granting of this pmmil. —, APPLICANT UNDE STAND A WILL COMPLY WITH ALL NON-POINT 'Issued by: _ Date SOURCE RE L OyS. -•= o� Dam10 / Re-roofs St attar nUCenlome pale I HAZARDOUS MATERIA DISCLOSURE Type of Roof Will the applicant or future building occupant stare or handle havadous material C" defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety code,wenn 2ss3zmr. ❑Yes No All roofs shall be inspected prior to any roofing material being installed.: " . � .. - . Will[he appb,ant mr future building occupant use equipment or devices which - If a roof is installed without first obtaining an inspection,I agree to remove ,• .. mil Imeamous air contaminants u defined by Me Bay Arca Air Quality Management all new materials for inspection. District? Oyes Ihavemad the hazardous materials requirements under Chapter 6.95 of the Califon Zzz2y/a, nia Health&SafelyCmc.Secmu25.5t15,25533ud255W.1 undcrandlhatifthe Wilding _ (y ,��)`dors not cunendy have a se nt,Nal it u my responsibility m noddy the ecupme of Me7 V mquimmcn whi m lW Iprio u cc of Cc 'ficae of Occupmcy. y� Signature of Applicant Date own rile s Date All roof coverings to be Class"B"or better ._. Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 �UPERTINO Building Department JOB A DRESS: PERMIT # C✓ ti�,v 013 OWNER'S NAME: .�s P/,' PHONE # GENERAL CONTRACTOR: FAX # I am not using any subcontractors: c l I Sia Date Please check applicable subcontractors and complete the following ' ormation: 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 ck T• Into V Owner/ ontr�\tor Signature Date Community Development Department Building Division City of Cupertino 10300 Torre Avenue CITY OF Telephone: (408)777-3228 Fax: (408)777-3333 C U P S IST 1 N 0 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 nall 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 laid 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 LC.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: /C a 5-5 /1z, Job Site Address: / � GL f f. -fv-rw N� Roofing Company Name: _T� ✓(` Applicant's Signature: Date:,ff?7/ Greg Casteel Building Official Revised 11/2/04 Printed an Recycled Paper 1ECITY OF CUPERTINO d" REROOF 1 CUPRTINO PERMIT APPLICATION FORM APN# Date: / 2 o $ Building Address: Owner's Name: Phone#: pn5sL 4(og Contractor: Phone#: Lice se #: S C� Or<<n/� 6 8 ) Z — � Z Conta t: Phone#: Cupertino Business License#: �tir 40 l - 375 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) ❑ 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: F u ` WGG > ii Residential Commercial ❑ Fire Zone: Yes ❑ No ❑ Confirmed with Planni Wit. if there are anyrestric ' ns: LJ Cost of Project: Type of Constructio Occupancy oup Qty/,,f Apiflic4le 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