04110132 (2) CITY OF CUPERTWO _ ___ ' -�: ? raft'd^ r"�- '*�e' `s-''`
BUILDING DIVISION PERMIT • C®NTRAC"°TQR INFQRMATION
b. .•Yn' '4itiR"F. u. F`Ffi.'fe+ri SSSS tz alai r" ..& W.fiv .•.
BUILDING ADDRESS: — - WESTSHORE ROOFING CO PERMIT..b4110132
20681 MC CLEIIAN
OWNER'S.AML: P®2M17155UE DATE '
. GAIREL GANDRUD 5869 WINFIE D BLV 1111912004
ONE: .. -
SANITARY NO. 'CONTROL NO.
(408) 629-2100
ARCHITECVENGINEER: BUILDING PERMIT INFO
_ BLDG ELECTPLUMB MECH
0 0 0 0
u00 LICENSED CONTRACTOR'S DECLARATION - Job Description
U i hmcbY aNum Nal 1 am Issued under provisions of LTeprdr 9(commencing p
^� with Sasioe and
(IrDlvision3o(J.Bu9rcsa and Rofrssiau CoM.mnd myliccns is
imrunroaandert REROOF W SHINGLES
'z ueentte a f'-Ym, Li �S(� 2 2 f
i8 W
Iq-
Data 71-//ly//ter.../O� comDECL DECLARATION SJ'1G1
IUR�, ,dna l?nsehetl c rely uly(0 mamob - -
c
LicensedI{{ fAAcssro //77 // A
OWNER-BUIIDER D9 LARATION
p 1 berchy affirm last I am exempt(mrA Ne Commoner License Law for Nc
O o following mann.(Section 71131.5,Business and Professions Cade:Any city or county 88000
i$f which requires a permit to construct,also,Impmw,demmimh.or rcpsir any structure,
poor to its RNent also requires ole applicant for such Permit to Ble a signed Intentent
bo mat he is licensed pursuant to the provisions of the Connector's Li.ns Law(Chapter9 Sq.Ft.FIOOC Area. Valuation. _
$ (commencing with Salton 7000)of Division 3 of the Business and Professions Code)or
Attempt he is empt thcmfmm and de basis for lac alleged cmmption.Any violation of
Secdon 7031.5 by any sppllu 1 fon permit Subjects the appliunl m A 6111 penally of
not mom Man fin hundred dollen(M). bkWN&Ykelo Q ccupancy Type
O 1,u owner of W pmpeny,m my employees with cages u their mle compenudon,
willde thewon.and meawausackmtimendcd«offered(oresie(Sce.7b4,Businea - -' Required Inspections
and Poressions Code:The Cenuano8 License Law does out apply to an owner of - - - •" - _ q - '
p epeny who bui lds or improves thereon,and who does such work himself or through his
own employee,provided that such improvements an not intended oro@nA foredo If. '-
however.the building or improvement is sold within one year ofeampledon,me owner- -
builder will have W burden of proving that he did not Wild or improw for purpose of '
sic.),
1,As caner of the property am exclusively contracting with licensed contractors to _
construct tiro pmject(Sec.7044.Business and Professions Code:)The Contractor's Li. _ .-
mum Law does not Apply to an owner of property who Wilds or improves Blemon,and,who contracts for such project with a contnctor(S)licensed pursuant o We Cenmeneh
License Law. -
❑IamexemptunderSee. B,4 P C for this meson
Owner Date
WORKER'S COMPENSATION DECORATION
I hereby of rat under penslly of perjury oro of me following decimations:
I haw and will maintain A CCIUReste of Couenuo self-iuum for Worker's Compen-
.0em,as provided fm by Section 3700 of On labor Code.for me performance of the -
work for which this permit Is issued.
I have and will maintain Worker's Compensation Insurance.As acquired by Section - '- - - - -' ' '-• - - �'" ' - - -- - _
37W of the ISWr Code,for me performantt o(the work for which this permit is issued.
My Work es don lmurSnntt carrier end Polity number are:
Carrier. .l i'mr747A POBcy No.:4Q64qu—.?Co
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE „
(This suction nccd not W completed irlhe Permit IS form.hundred end.(SIM)
or less.)
I ccnify than in the performance of me work for which this permit is issued.I shall not
employ any peran in my insurer sea as s become subject to the Workers Compenation
I.A.of Califomia,Das
Applicant '
NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should
become subject s me Workers Compensation pevimions of me Labor Code,you must
.JO forthwith comply with such provisions or this permit shall W deemed revoked.
„zt r+ CONSTRUCTION LENDING AGENCY
[-ate I hereby arm that then is a construction lending agency for me performance of
E
> me work for which this permit u issued(Sec.301 Civ.G
tL)n 1<ndcYs Nart
= z Lender's Address
U0 I modify that 1 have mad this application and stste that the show information is
U, F correct,I Agra in comply with all city and county ordinances and sate laws relating to
OU building construction,and hereby suthorn repmsenedves of this city to enter upon Ne
�0. ahovomcntioned poll for inspecdon purposea.
(We)agree le an.indemnify and keep h undicst the City of Cupertino against p -r
tF-t(Z) IlabiUties,judgments,costs And exposes which may in any way same against aid City
U Z in consequirm of me gaming of this permit.
^ APPLICANT UN RST DSA W 1 CO L WITH ALL NOWPOINT Issued by.., Dahl
SOURCE R U - -
"� Re-roofs
Signet c pp can "mm for Date
HAZARDOUS MATERIA ISCLOSURE Type of Roof
Will lheapplicam urfmurc building mcV anntorc mhandlc hvudous massiel
as defined by the Cuanino Municipal Code,Chapter 9.12,and the Health and Safety
AELCods, Imx zss3zan All roofs shall be inspected prior to any roofing material being installed. -
❑Yes �{O Will the applicant or fume building mcupanl use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
.if hmardouS air coeaminan u defined by the Bay Arca Air Quality Management all new materials for inspection.
District?
❑Yes
Iha SgeiyCehasrthmsmatcnalsrcquimmentsu.lis Chepsrb.95or Ne Calif.- T
ale s-1 co Said,have ASretimv tie it I my nord75534,1 As notiwd face
em.
a Wilding
the � L/dors ret curtendy have•stmt lass it u my msponsihilisy s notify lac aaupanl Of theV _
mquiremcnt. It mm p' 'ssvencc a erdfiateofOccupancy. SignaureofApplicant Date
owner Aamnri.eda enl Del 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
UPEkTINO
Building Department
JOB ADDRESS: PERMIT#
OWNERPHONE #
GENERAL CONTRACTOR: wes-lsl.rore 1 hc. FAX #
I am not using any subcontractors.
ignature 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 tstSko re. Ro o�t
Septic Tank
Sheet Metal
Sheet Rock
Tile
;., l l o
Owner/ ontractor Signature ' Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY Of Fax: (408)777-3333
CUPEkTIN®
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.
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 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: _LlAletcL KlItiDPOO
Job Site Address: ; )hlel
l✓ . J CC i� v ivy,
Roofing Company Name: -
Applicant's Signature: Date:
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINO ( /
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN Date:
Build inddress:
Z cE� D .
Owner's Ne: Phone#:
Contractor: Phone#: License#:
Contact: Phone#: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ " Built-Up Roof ❑ Built-Up roof
❑ .Asphalt Shingles = )id. Asphalt Shingles
Wood Shakes ' `' ❑ Wood Shakes
. ... _ ❑ Wood Shingles - _ - - " ' ❑ Wood Shingles -
❑ Other(Specify) El 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:
of 0111 _ _-Wo s.. . 1114k- _ YQ yflApe COMAa C2 05
Residential Commercial ❑,,
Fire Zone: Yes ❑ No ❑ Confirmed with Plannin
there are any restric ' ns:
Cost of Project: Type of Construction: Occupancy grou .
Qt3'•
A 'ca e 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
a
• 10300 Torre Avenue
Cupertino,California 95014
CIN OF - Telephone (408)777-3218
CU P E IST I N 0 FAX (408) 777-3333
COMMUNITY DEVELOPMENT/BUILDING DIVISION
October 29, 2004 /LO
Homeowner <
21821 McClellan Road
• Cupertino, CA 95014h CAT., - -
i�
SUBJECT: Permit#: 04060167-need plumbing final inspection C
Dear Homeowner: SOS --a-Our records indicate that the above listed permit is due to expire on December 18, 2004. �a
If due to circumstances beyond your control you have been unable to schedule an
inspection, you may submit a letter to the City of Cupertino Building Official
• requesting a one-time extension for his review. Please state in the letter the reasons for _ -
your request. Please include your name, contact phone number and the address of the
project. If you do not include this information, the extension will not be considered. If no
extension is granted and no inspection is called before the expiration date, this permit will
be voided and the permit application discarded. After this point, you will need to submit
new plans for plan review and pay permit and plan check fees to be issued a new permit.
If your records show that the permit card was signed and released by an inspector as
being complete and final, please notify this office at your earliest convenience. We will
update our computer files and close your permit, and we apologize for any inconveniencethis matter may have caused.
Thank you for your attentior.to this matter.
Sincerely,
CITY OF CUPERTINO
Christy Akatiff, Administrative Clerk'
•
Printed on Recyded Paper