05100042 (2) CITY OF CUPEWrINO
BUILDING DIVISION PERMIT 1 CONTRACTOR^INFORMATION:s
Bm1.DIrvc ADDREss: WESTSHORE ROOFING CO PERMITNO.05100042
11480 ARR N N
aNER'S NAME: PERMIT��OATS
OW
GONG XIN HE 102. OLD ORCHARD--nRIVE 10 /11 /200S
ONE: SANITARY NO. CONTROL NO.
(408) 213-3750
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
trop LICENSED CONTRACTOR'S DECLARATION Job D05Cllptl0❑
wC 1 hereby affirm that 1 am licensed under pmviilou of Chapter 9(commencing
iW withS don7q )of Divisi.n3ofthe Busirteuand Profcmiuu Code anderyliceecis
.<= in mu force and efrew
<= in Z2 REROOF-ISNTALL STONE COATED STEEL
J�? Data Clear LIC.g
�'O Data-Comraztor rt� ��®
p�p'J` ARCHITECTS DECLARATION IY"PYA
1 undcmtand my plans shall W used u public records IF
JyU
a t�, Licensed Pierced...I
�0� OWNER-BUILDER DECLARATION
I 1 herchy allirm that 1 am exempt from the Contractors License Law for the nrT c�6 2005
–
no following meson.(Section 7131.5,Business and Pmfessiou Code:Any city nr county
ie m� which".I,.a Permit m construct.alcor.improve,demolish.or repair any structure 14aa,Cr $15000
yi< prior m its issuance.also require the applicant for such Permit m file a signed sulomcnl 1 �,a.
Fxo that Wislicensed pursuanuuthcpmvisiovoftheContracmriLt... awroutine,9 Sq.Ft. Floor Area 7� y 5, `Valuation
ec r– (commencing with section 7")of Division 3 of the B usincas and Professions Cook)or 7
i $ U 11L
Nat he is exempt therefrom and the buffs for dlo alleged exemption.Any virtual..of
Section 7031.5 by any applicant for a Permit subjects the applicant 10 u civil penalty of .3 AW ROKFT U Occupancy Type
not more than five hundred dollars(S5W).
❑1,as owner ofthe proprny,ver my emplayce with wages u their salt comPe^siatian,
willdothewokindNeswcwmismtinme dw.BcmdN,sm (Sec.7044,Bu the. Required Inspections
and Professions Cade:The Con rmer's License law does e not apply ro an owner of q P
property who builds or improves themon,and whodma swhwork himself ordtrough his
own employees,provided that such improvements am not intended oroRered formic.If, a
however,the 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
role.).
❑1,as owner or ft pmpcny,am exclusively contraming with licensed convazmm to
construct Ne project(Sec.7004.Business and Professions Code)The Contractors Li.
terve law does not apply to an owner of propeny.who Wilds or improve the¢on,and
who contracts for such projects with a contractor(a)licensed pursuant o the Convector's
License Law.
❑I.m exempt under Sea .B&PC for this moon
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penally of perjury One of the following declarations:
I haw and will maintain a Ccr ificate Of Consent to self-Insure for WOfkLrsCOmpen-
1031'.W
tion,u provided for by Section 3700 of the Labor Code,for the red.....f the
rk for which this Permit is issued.
1 have and will maintain Workers Compensation Insurance,u required by section
of the labor Codc,far the pe fosmance of the work for which this permit is issued.
y Worker's memsatiun Insurance carrier and Policy number am
rtier. ( / Policy N..:�/b 1�
CERTIFICATED EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need no(IN completed if the permit is for one hundred dollars($100)
or less.)
1 certify Not in the Performance Of the work for which this Permit is issued.I shall not
employ any person in any manner m m he become subjects.the WorkersCom,malation
laws.(Califomia.Date
Applicant
NOTICE TO APPLICANT:If,after making dins Certificate of ExcmPlion,you should
become subject to the Worker's Campcnmtion provisions of the Labor Code,you must
.JZ forthwith comply with such provisions ser this Permit shall deemed revoked.
zO CONSTRUCTION LENDING AGENCY
j-+ I hereby affirm Nat Caere is a construction Lending agency for ft Performance of
a 7 the work for which this Permit Is issued(Sec.3097.Civ.C.)
W Q Lender's Name
0. Lender's Address
U 0 1 cenify that I have read this application and sonic that the above information is
W P comet-I agree to comply with all city and county ordinances and am laws rotating w
0U building Construction.and herebyauthmit rcirmsenteowS of this city to Color upon the
G above-nenrioncd pommy for inspection prophesies.
(We)agree or save,indemnify and keep lormlee the City of Cupertino against
Hfq liabilities,judgments,cosa and expense which may in any way accrue againaLsed City
U in eonse,wom,of the granting of this Permit.
SOURCANTANT UN s AND WILL COMPLY WITHALL NONPOINTIssued fs9 Dale
APPLICANT
R TI D WILL
LIM.�C_ s/k1// / Vim"
.�/ // 6 G Re-roofs
SignatureA IicamuCon for am—
HAZ� DOLS MATERIALS DISCLOSURE Type of Roof
Will the applicant Or future building occupant store or handle hitour material
u def ned by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
Cme.sectir.2553x(anAll roofs shall be inspected nor to an roofing material bei. Installed.
❑Yes 16z_
P P Y g g
1 I If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or furore building occupant use equipment s devices which
lit harardnua air conmminanu nod by the Bay Arca Air Quality Managcmtnl all new materials for inspection.
O,avict?
QYe ❑Nu
1 have mad the havardnus makerialsmquimmcnn under Chap¢r6.95 of the Califor.
nia Health Sk Safcty CWc,Sections 25505.M533 and 25534.1 undCramed thatifmc Wilding
docs not cunenrly hive a tenant,that it is my responsibility in notify the Occupant of the
tegeirema^tawhic stbcmet'rim rnonan..facerti0eau:ofOcapan . Signature of Applicant Date
Owner a thonrcdaF t Data All roof coverings to be Class "B"or better
Community Development
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408) 777-3333
OUPEkTINO
Building Department
JOB ADDRESS: _ I( 4 eb Oka/som Laq -e PERMIT#
6�-i�00 1--t Z
OWNER'S NAME: '_ 2 �l� PHONE # Ltog ' Z5-3- 3038•
GENERAL CONTRACT �&V FAX # 8 Z( �3
I am not using any subcontractors: -4&Z
Signature Date
Please check applicable subcontractors and complete the following information
60 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
Owner/Contractor Signature Date
r Community Development Department
Building Division
- Y,: , City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
Fax: (408) 777-3333
SUPEkTINO
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:
Job Site Address: 6 Cln&rs C1,t^ LXA V�_Q- '
Roofing Company Name
vV25 Vo-fo- �_ooi1 \,V\C_
A plicant's Signature: Date: U l I b
eGreg teel
Building Official
Revised 1/30/03
Printed on Recycied Paper
CITY OF CUPERTINO
�" RE ROOF
CUPEkTINO PERMIT APPLICATION FORM
APN# 6 Z v U
Building Address:
i I L1 8 o
Owner's Name: Ne, (Tov 5 k t h Phone #:q0 9-ZS 3 - 3 0 3
Contractor: t 1 � Phone #• License #:
WeSrsl�m� P-9OAi lv�c-. 1A11T L11) -31 S o 79 7 z�z 1
Contact: (TC, A^^w�.��n n Phone#:Ua� 2,13- 315 Cupertino Business License #:
�j r-te.� 1`v
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ElAsphalt Shingles
/gWood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) /0' Other(Specify)�°C�`� 0+� Cok-t6A S-fee,l .
Number of existing coverings ❑ Provide I.C.B.O.Report# N��ZLI Z.Z
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
JPI Have Read, Understand and Will Com 1 With Cu erlmo's Tear Off Polic
Job Description: ns iw\\ Crcr� rd St �e Cd �cd S to e\ a{ SSS i� o t r
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning De t. if
there are any restrictions: Ll
Cost of Project: Type of Construction: Occupancy group:
15'0 o o Pie- ]Zai 'S I2.
257(1�, Zsoo .
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Energy BUILDING
f BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK' Plan Check Fee BUILDING
BUSLIC Business License BUILDING