03060047 (2) CITY OF CUPERTINO vim` "' n FET' T"V
TQRIIFUMATIUN
BUILDING DIVISION PERMIT RAC
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S+d,SCONT*i,r'�tBM'
BUILDING ADDRESS: PERMIT NO.
WESTSHORE ROOFING CO 03060047
NAfddqBf)ft PERMIT ISSUE DATE
5869 WINFIELD BLV 06/05/2003
NE:
(408) 629-2100 SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: BURRING PERMIT INFO
BLDG ELECT PLUMB MECH
Ofl r�O O
LICENSED CONTRACTOR'S DECLARATION Job Descriptio tf.�lG®
1 kroby afliw Nu I am licensed u der provisions of Chapter 9(rommeneln{
with Sec 7 )of Division 3 ofdm Basi ed Profcaswns Code.tMmYlicenale
t< in full to de tt
came _ L zz l EROOF JUN 13 2003
Da ARCHrrECTSt RATION
I understand my plans shall be used u public rectum BUILDING
YU
s Lkenud Professional
OW NEmBUILDER DECLARATION
II I harm .(Siem that I I.S.eosin from Wt Contrumr's :Anse law for the
O O wichrfollowing noun. emit t 783 LBusiness and Winona.
dcrons Code:Any city or county
5$
poor
requires a permit re ants the a@r.kfor Such
demmsh,or e a sir&MYgned utumum
pnmmiscensed It.also orho the thcapplic o for Co m rce m fmlean Law(tatemros
<
than Mttnsedpursuersm 0)Ml`D Wcv3lkConuucessamttnulaw(Chapter9 Sq.FL Floor Area tion
E (commcmir{witdomimeand basisfrOrNeBusineOaedororesrionsladomof $14
3�
that h la uempl Nvefmm end Ik basis for de ellcLcd excerption.Any violsdon of
Section 7031.5 by any applicant for a permit aubjecv she applicant to a civil penalty of ZYP
Act more Nen five hundred dollen(5500). 3 6'C'U'L'UCI'L"e�0 Occupancye
❑I,u owner of the property,or my employes wIN wa{ea u Neh sole rompewsim.
wilier Newons and Ne she C mle arx's Lndedmoaertoes nor (Sec.70N,B nee of 305 - FRAME Required Inspections
propand pmfwlom Cam:mp Canuemon License taw aero alt apply u in owner of q P
Own enywkts.Provided
Nercoaand who Are not
orselforthrouga his 307 - INSULATION
however,the e6 provided prvementat such psmemenuarcne car ofooroRered forOwner, 601 — ROOF TEAR OFF
however,the building or improvement Is Old within one gals of mprove for
to we of
balder will M1aw the burden of proving net build orimprow fm purpose of 602 - ROOF PLYWOOD NAIL
caw.).
0 1.As owner of the property.am exclusively contracting with licensed contractors M 603 - ROOF BATTENS
consumer the project(Sce.7ae.Business and Professions Code:)The Cmuuuh Ll- 604 — ROOF IN—PROGRESS
cense Law does not apply to an Owner of property w1bo builds or improv themon,and,
who eommeB for such projees with a cmuamor(s)licensed pununt m the Conuuter's
License Law.
❑I not exempt under Sec .B$P C for this won
Owner Des
ANIL
WORKER'S COMPENSATION DECLARATION
I krtby affum under penalty of perjury ons of the following declam0ons:
I hawand will malnlain a Certificate of Consent Ioself-Insum for Walker's Compen.
sales,u provided for by Section 3700 of the labor Com.for the performance of ft
work for which this permit is issued.
❑1 haw and will maintain Workces Compensation Insurance.AS required by Section
3700 of the labor Code,for the performance of Om work fm which this permit is Woods.My Wohaae.Cam 01 nce nnim and Policy rump am:
e Yet-�TIJ� PolkV No: 2003
CERTIFICATE OF EXEMPIC _0. 1WORK&S'
COMPENSATION INSURANCE
Missection need norkcomplated If sk permit is from hundred dollars(SIM)
or less.)
I cenify that In the performance m the work for which this Permit is issued,l shall not '
employ enyperson In any manner O as An become subject 10 dale Workers Compemnian
Laws of California.Dam
Applicant
NOTICE TO APPLICANT.IL after making this Certificate of Exemption,you skald
become subject to the Worker's Compensation provisions of Ne Labor Crile.you mus ..
�`{ forthwith comply with Such provisions m this permit shall k deemed revoked.
zy CONSTRUCTION LENDING AGENCY
H Ikrcby efRrm tha,Nes ha construction lending agency fm tho porformantt of
0G> the work sum which this permit is issued IS=3097,Civ.C.)
Q lendm'0.
e Namc
.7. Z Lender's Add.
Q I coolly that 1 haw read this application and sum Nat shave InfmmminIs /
W
0 corrccs.l agree m comply with all cityty and county ordinances andfid ante lava raisinglesng m
0 building construction.and hereby aurkrim mpreaeMOWS of this city to color upon the
LS( above-mentioned property for inspersion purposes
(We)agree to Ow,indemnify and keep humles,the City of Cupertino against
V) fiabilWn,judgmmta,cosuandexpmv which may in anywayaceruc egalnstsaid City
U in consequence of the z APP ANT UNDERSTtr NDSof thls D WILL COMPLY WITH ALL NON-POINT Issued by: Dale
REG LATION .
Re-roofs
Sigauurc of AppliwMCon or D•te
HAZARDOUS MATERIALS DISCLOS Type of Roof
Will the applicant m future Wilding Occupant am or handle situations material
As defined by 0m Cupenino Municipal Coda Chapter 9.12,and the Health and Safety
Com,SecOm 35533(x)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yat
WIII the applicant or future building uccupam OI equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit heONnus air contaminants O defined by the Bay Ama Air Quality Management all new materials for inspection.
District?
❑Yes Nu
I hew mad Ne wallousmsuruB rcquimmenu underChapterh.95af NeGlifar-
nu HOINi SefetyGode,SoW=25305.25533&W M3<.11 wW=In W dw ifthc Wilding
does rode currently haw I malars It s my responsibility 0
rten car.mNariud.gen, fy ecet of alk
quimns, a km br CNfica
ignatu Applicant Da
th
All roof coverings to be Class"B"or better
Community Development Department
Building Division
r J; City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
IUPEkTINO
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.
3. 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: kj\lt t'n Lx
Job Site Address: Df-,
Roofing Company Name: S 1.
A plicant's Signature: Date: F71 Jed
9Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO D 3 v ��
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN# 8 Z Date: b 5 0�)
Building Address:
1pQy C�ra,v��',e,�-,r �r•
Owner's Name- Phone`U ` I Pic,
S Phone#:
W (L40 i s I � f
Contractor: Y Phone# oo License#l:� l
�,JEs��l�ofe� oly C
Contact: Phone#: Cupertino Business License#:
Pav( Fowler (yo) �Z�.Zl6U
Type of Roof Covering:
Existing: Proposed:
❑1 Built-Up Roof 13 Built-Up roof
N Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles {� `
❑ Other(Specify) El Other(Specify) I Jt'kx-CA l Xm kkJ
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: I �.b ,C, �tti C X \
v� 1 �2,c, J , over SSC �oj WVIAQos o
thtc�w
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning De t. if
there are any restric
C o ecC 0nC7_,1— of ComrlfEytiOOccupancy grouNI p
Qty. if
A pliate 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
2z°7 I