05030298 (2) CITY OF CUPERTINO "
BUILDING DIVISION PERMIT 7.,CO'1VTRACTOR INFUIt1VIAtTION.
BUILDING ADDRESS: WESTSHORE ROOFING CO PERMITNO05030298
OWNER'S NAME: PERMrT ISSUE DATE
W
N[: SANITARY NO. CONTROL NO.
(4ng) c29-2i on
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
u00
LICENSED CONTRACI'OR'SDECLARATION Job Description
w❑ 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing
iW with Section/000)of Division 3 ofthe Business and Professions Code,and my license is
in full fore and effect.C— 1
�� License Cy}sf S`1 Lica ( �2 REROOF W/COMP.
=w Dau Dig
pp l Gr
ARCHITECTSDECLARATION
1 undersand my plans shall W used as public records lV✓
DyU !/
;may
Licensed Pmfcssional
OWNER-BUILDER DECLARATION
use
<P I fusio affirm that 1 1. exempt from the feummiis Co e:Any c Law for the
p O following mason(Section](131.4 Business and improve.
deions Code:Any city or county 0
K which m4uires a pennil In construct.eller,improve,demolish,or repair any structure
on
prior to its issuance,also mtuims be applicant for such Permit to file a signed suument
r='< that he is licensed pursuant of be provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuatl00
WyFFG (commencing with Section/000)of Division 3 of the Business and Profession&Code)or
that he is exempt therefrom and the basis for On alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects be applicant to a civil penalty of 3 6iTNII'OutberO 0 Occupancy Type
not mom than five hundred dollars Wrap). _
❑I.asownor of Ne pmpeny,or my employees with wages 0 their WIC compensation,
will do be work.and be structure is notmmnded or.fomd fnrsale(Sen.'R/M,Business Required Inspections
and Pro(essioru Communities Cc&:The Conities Licems,Law does not apply to as owner of q u
property who builds or immovcs thereon,and who does such work himaelf or through his
own employees,provided Nat such improvements are not immnded or offered for sale.if,
however,be building or improvement is sold within one year of completion,be Owner-
builder will have me burden of proving Nat he did not Wild or improve for purpose of
.in J.
1,as Owner Of NC pfopeny,am exclusively contracting with licensed contractors t0
construct me project(Sec.WCA.Business and Professions Code:)The Contractor's U.
come law does not apply to an owner of property who Wilds or improve thereon,and.
who contracts for such projects with a em ractor(s)licenaed pursuant to be Contractor's
License I.
❑1 am exempt under Sec. .B&P C for this resson
Owner Date -
WORKER'SCOMPENSATIONDECLARATION '
I hereby affirm under penalty of perjury one of me following declarations: -
I is vc and will maintain a Ceniriicau of Consent in ulf-insure for Worker's Carolina-
cation,as provided for by Section 37M of be labor Code,for be Performance of the
work for which this permit is issued.
have and will maintain Worker's Compensation Insurance,u required by Section
171 of me labor Code,for me Performance of be work for which this Permit is issued.
My Worker's Compensation IInmran_et�e carrier and Policy number am:
Cartier: S-r L'F e f `v�U' Policy No.:1 t0"1 0 7-0 Q try
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Ends suction need not W computed if the Permit is for one hundred dollars($100) t
or Icss.)
1 Comfy that in be performance of the work for which this permit is issued,1 shall not
employ any person in an yn tgersmas�tic oma subject the Workers Compensation
Laws of California.Dail
APPlicant �-C�ST'iwr �/�•>+sYW
NOTICE TO APPLICANT:If,after making this Ce a¢of Exemption,you should
become subject to be Worker's Compensation provisions or be Labor Code,you must
.JO forthwith comply with such provisions or this Permit shall ba deemed invoked.
'Z"-' CONSTRUCTION LENDING AGENCY
[-•tom I hereby alihm bat there is a Communion lending agency for the Performance of
a be work fur which this Permit is issued(Sec.3097,Co.C.)
aQ Under',Name
z Lender's Address
U 0 1 certify that 1 have mad this application and sure that be above information is
corrcni.I agree to comply with all city and county ordinances and state laws relating b
0U building Construction,and hereby anNofion rapresemifloOr Of this city to enter upon be P
r 14 .hove-mentioned property for insp,ction...awx a
(We)agree to save,indemnify and keep harmless me City of Cupertino against
CoA liabilitiesjudgments,costs and expenses which may in any way accrue against said City
U Z in consequence or be granting of this Permit.
^' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Signature of ApPlicar Dem
HAZARDOUS
US MATERIALS DISCLOSURE Type of Roof
Will be applicant or(Mune building occupant store or handleardous material
u defined by due Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Codc.Section 25532(.)? \ All roofs shall be inspected prior to an roofing material beim installed.
❑Yes ❑NM P P Y g g
Will meapP Meant Pr more bmdain g occup r or devices worn If a roof is installed without first obtaining an inspection,I agree to remove
4uipmen
it harardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
DisVim?
❑Yes No
lhave maJ Ne hanand
e.Suc usmnurials requirements 55N under dursudthat6.95 ofbe lanimn> ya ^ �I �OI Q�
ria Hcalm&Safety Code.Sce out t 25505.amonitis 25533 and nts un.1 rCh,t r buifbc Wilding / v �-
does n t cprtently havea na 4 t it is my rC maibility to notify tW=UPWI OI the
mqu twniL mMat rtoiaM anr.cF sten rap �. SignatureofApplic nt Date'
��� All roof coverings to be Class "B"or better
Owner'.,amhoriactl.gem Dam
SAYOF
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
Fax(408) 777-3333
�UPERTINO
Building De artment
JOB ADDRESS: PERMIT #
i v 3 S 1 6uc- (2, -b 3 doZ�E�
OWNER'S NAME: LV,.Q h PHONE # t�v ( -
GENERAL CONTRACTOR: J2 StS rc Lo o b i v4 1 CFAX # ag Z 13— ?,
I am not using any subcontractors: 3 3 o "0-5
Signature Date
Please check applicable subcontractors and complete the following information:
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
��� )L:� 33DaS
Owner/Contractor Signature EVate
- • Community Development Department
Building Division
�( 1a City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408) 777-3228
U����I�O Fax: (408)777-3333
Building Department
Subject: Re-roofing policy for the City of Cupertino
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 followin_g steps are
required:"
1) Pre-inspection and/or tear off approval. ;
' -' ' .. 2) In-progress inspectiori approval.
3) Final inspection=approval.
a) Spark arrester installation.
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 chargedya 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: e-S
lob Site Address:
Roofing Company Name:
Applicant's Signature: Date: 3 3 os
Greg Casteel
Building Official
Revised 11/2/04 -
• Printed on Recycled Paper _ -
CITY OF CUPERTINO rv'3 n2 8
>( � REROOF S
$CUPERTINO PERMIT APPLICATION FORM
APN # S 6 � , l U U I - Date: 3d D
Building Address:
Owner's Name: Phone#:
\„les\e n C VQ,v\ - ({68
Contractor: -- - Phone#: License#:
P_:D' %V\ x.13 - 3-15a
Contact: Phone#: Cupertino Business License #:
90 "tog
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof _ - - [ c ❑ Built-Up roof
❑ Asphalt Shingles Asphalt Shingles
Wood Shakes / ❑ Wood Shakes
O 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:
r• . JobDescription:t egLy-..K.ir.R,u s t ,kw o4H54w 'ice _' c� wstatl 0 ��"" C5
os
Residential o z-F Commercial- ❑
Fire Zone:k_:_Yes ❑ No: ❑.r _=i;: ._ Confirmed with Planning Det: if ;•:
there are any restrictions: .LL1l
Cost of P o, t: p o T e of Construction: Occupancy group:
c� o O X,C
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