04090295 (2) CITY OF CUPERTINO �5°.>tn»wY .* r �g�s°,N♦ '' - -BUILDING DIVISION PERMIT '��V � l/�NFO4�15'Al1TION •,t �.� • ,���*
�� ..< , T, ,,01 � Sy,, w
BUILUDING ADDRESS: WESTSHORE ROOFING CO PERMITNQ,409029S
10989
OWNER'S NAME: PERMIT ISSUE DATE
DAVID CHENG _586.9--MINPIET-1) RIM
NE: SANfTARY N0. CONTROL NO. '
(408) 629-2100
ARCHITECTIENGINEER: BUILDING PERMIT INFO w
PLUMB MECH
+i+oo LICENSED CONTRACTOR'S DECLARATIONO
I hereby affirm that I am licencod under provisions of Chapter 9(commencing _ Job Descfl do
with Section 70M)of Division 3 of Inc Business and Professions Code.and my license is
in ftrll roree soda e N L2. REROOF W/ GERARD STEEL' /
DRQ License CLss Lie.N OCT
Y 2004
rat- Dam YY JO O M Con DECL�/d v Y
�yndcg4pd pq
ARCHITECT
DECLARATION BUILDING d "ans{yl�dpp h;recnNa �/�I�®'� w -
yG� Liven d rfevronal 7/s/ -
g 3 OWNER-BUILDER DECLARATION
40 0 I hmahy affirm that 11. exempt from the Comncmra License Law for the
OO following uiresa (Section AD1.5.Businessand ProfeWuli Code:Any city at county
$ which ur in its issanpermit re uine;the ptrees improv,deermit t,fie a sigsoy nronum
-iy thatheitscensed e.also pursuant to
previsio ofnt f Consuch permitmounce Law(ned hmmem -
p < tcommesccgwithSntion7 the pmvivionsnfdmComromrinhenmLaw(C Code)
Sq.Ft. Floor Area - Valuation CIE
E (cat he is(commencingwithScntnn 7 and of Division r the
the egad ess unitexempt on.Any
Cnde)of
3� that he le exempt Nemlmm and Om buil far Ne alleged exemption.Any viola0on of '
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not mom than five hundred dollars(5500Occupancy). eld 0 P y ' Pe
0 I.as owner of the property,army employers with wages u their sole Compensation,
will do the work,and the."come is natimended oroaercd fonalc(Sec.7044,Business
and Profe olons Cade:The Conuacmra License Law does nut apply to an owner of Required Inspections ..
propeny who buildaar improves umraan,and who dossoch work himselforthrough his
Own employees,provided that such improvements are not intended aro@rtd formic.If,
however.Ne Wilding or improvement is cold within arm year ofcompletion,the owner- - -
Wilder will have the burden of proving that he did not Wild or Improve for purpose of
sok.).
C]1,as owner of the property,am exclusively contracting with licansed contractors to
construct the project(Sec.7044.Business and Profession Cade:)The Conuacmr's Lt. .
cense Law does not apply to an owner of property who Wilde or improves Nemon,and, -
whocontnctsforsuchpmjectswithaconuumr(a)licensed pursuant to the Commicori - -
License Law.
❑l can exemptunderSec. ,B&P C far Ws mason _
Owner_ Y / h I F Data
WORKERS COMPENSATION DECLARATION ..
1 hereby aRrtn under penalty of perjury am:of the following dedandiorm
I ham and will maintain a Certificate of Consent to self-hnum for Workc6Cumpcn-
udon,as provided far by Section 3700 of the labor Cade.far the Norcross.of doe -
work for which this permit is issued.
1 have and will maintain Workers Compewdon Insurance,as mquimd by Section
3700 of the lobar Code,forum performance of the work for which mu permit is issued.
My Workers Compensation Insurance artier and Policy number art:
Cartier, 4 q c ick'VO Policy Na.: OA. Af -Loa as
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE t
(@Is section need not W completed if the permit is foroaehundred dollars(SIM)
err las.)
1 century mot In to performance of the work for which this permit is issod.I shall not
employ any person in any mannerso u to Weomc subject o the WorkersCompemaadon
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If.after making this Cenificate of Exempion,you should
become subject in the Worker's Compensation previsions of the labor Code,you most
.JQ roMwith comply jive such prevision or this permit mall be domed moked.
z CONSTRUCTION LENDING AGENCY
I-t ice. I hereby same that then is a cons4uctinn lending agency for In,performance of
C the work for which W s permit is issued(Ser.3097.Civ.C.)
fg1 0 Landers Nsmo
Z Lenders Address /--
O Q 1 moify that I have rad this application and suite time the above information is
0 F cortex I agree m comply with all city and county Oadmances and auk laws relating m
pU above-mentioned
hereby mthon purposes. utives of NisCity menter upon the
V) ahavo-ms,Judged property for inspection purposes.
g3. (We)agree to save,indemnify and keep harmless the City of Cupertino against
V) inconsequnce ncota,of the
Stats inintl expenseswhichmay in any wayaccrue against said City
f, 7 APPLI ANT NDERSTANDSng of this permit.
F7 APPLICANT NDERS ANDS ATI ANDS ILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE ! S. /
�// -/ S � a
—ra
01� Re-roofs
Signaturta Anpplic VCon or Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will ua:applicant or future building aceupant nom orhandle hamdous mammal
as de fined by ftCupertino Municipal Code.amear 9.12,and the Health and Safety
Code,pra.25532(.)7 o All roofs shall be inspected prior to any roofing material being installed.
I
If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or future building Occupant ase equipment or devices which g P g
7dox;
mit WWdnua air contaminants u defined by the Bay Ama Air Quality Management all new materials for inspection.
District?
❑Yrs
I hove newt the haurdous materials mquiremcros under Chapter 6.95 ofine Califon w
xHealth&Safety Cade,Sectio.25505,25533 omd25534.Iundcotand that ifthc Wilding
not currently have a Meant,Nat it is my responsibility to rml'y me Occupant of me
qulmmcn w hmusWme 'oroisfuancofaCcniIicamo(Occupancy. Sign ureofApplicant Date
owner drIpthorixed ageniv Dam All roof coverings to be Class "B" or better
r- Community Development
a - 10300 Torre Avenue
1' Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
�UPEkTINO
Building Department
JOB ADDRESS: PERMIT #
ja 9g-f 1071ve f2 6 0 C-)OWNER'S NAME: kC PHONE # t 08 P
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors: �� �-3�T� Y
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
O-0I
Owner/ ontractor Si tore Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408) 777-3228
CITY OF Fax: (408) 777-3333
UPEkTINO
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: y t CL R hs�• I 1
Job Site Address: lori� Iv•K� A �ipSq Wa
Roofing Company Name: _Q0-CACP,"VT_ �J
A plicant's Signature: Date: 0 O
Greg teel
Building Official
Revised 1/30/03
Printed an Recycled Paper
CITY OF CUPERTINO
REROOF
CUPEKTINO PERMIT APPLICATION FORM 74
APN # -3s% I / Date: 3 b O t'�• .
Building Address:
Owner's Name: C� Phone#: p� S 1( q 85 D
Contractor: License#:
1b'-(221
Contact: Cupertino Business License #:
CTX00r14,\ 1p . vim . Ct{c� Z1S7Sa
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles �rQr S, t
❑ Other(Specify) 0", Other(Specify)
Number of existing coverings Provide l.C.B.O.Report# N F Z '•{2.J
To be Removed ❑ Provide Mfgr.Installation Specs.
• I Have Read,Understand and Will Comply With Cu ertmo's Tear Off Policy:
Job Description: �vwv4L )) l,—Tv- wow e+, 1'54-11 Crc-wr. pCw.n yV ti Sl�../c+u S-tiv.Su
60,fe4 Steel P4ow+ J s4A—' 0oerfw �,J S!✓ It P� ov) e�R
Residential Commercial ❑
Fire Zone:: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: U
Cost of Project- Type of Construction: Occupancy group:
! 7 0o O
QtY• •f
A i le 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
Z ZSR/