03040017 (2) CITY OF CUPERTINOnA.;� '^!r •r.
BUILDING DIVISION PERMIT VGONTRA 1WNW, h'I TION
BUILDINGADDRESS: PERMITNO.
1030 PENNINGTON LA WESTSHORE ROOFING CO 03040017
OWNERS NAME: PERMIT ISSUE DATE
WAN LICHEN 5869 WINFIELD BLV 04/02/2003
E: .8) 629
NO. CONTROL NO.
(408) 629-2100
ARCHITECTBNGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
ZO LICENSED CONTRACTOR'S DECLARATION
I hemby anlrm that I am licensed under provlsiw of Chapter 9(eommencing Job Description
win Sco0on IM)of Dlvhion 3 ofd.Business Profeuimu gdf.pof my license is PIIVAL.E®
m son m ) and C- (� (� t
5 ueenxeclas
Cmnrect EROOF
Da. Conn
3 ARCHITECTSDEC� oath GERARD METAL TILE APR 16 2003
1 ndetatsnJ my plw WII be unci u public recmda
LL ucansed Pooc"Wnal
OWNER-BUILDER DECLARATION BUILDING
f 1 hereby.here that 1 exempt from the Canitamar.License law for the
i p o follnwiro
ng uon.(Section]!131.1.5.Basions and Pmfcuinm Code:Any city or county
$ which ru Ntres a permit to construct,alter,improve.demolish,or repair any sWetum
prior to its haterm,atso requires the applicant for such permit to file asignedsumment
C that he is licensed puuusmmthe provisions nfaAContrutor'sLieemclaw(Chapter 9 Sq.Ft.Floor Area Valuation
(commencing with Section 7000)of Division 3 of the Rosman and Profteginm Code)or
Nal he is exempt dmmfmm and the basis for the alleged exemption.My vial.11on of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally of APN Number c a y Type
not mem than five hundred dollars($500).
❑i,as owner oftiAproperty,or mycmployces with"gas as their sole compensation, ir�lnAnqn nn
wllldo thewms,and the swctum la noHmmnded wonemd fonale(Sm.7044,13"imu
and Profegiom Code:The Conmmors Liana Law del not apply to an owner of Required Inspections
prop,rtywhnwudso,Improwtheroon.mdwhodoe.auehw«khimselforwoughhis 305 — FRAME
own employees,p`idea at such improvements are notimandea elm Bemd Imam.If. 307 — INSULATION
however,the building or Improvement is sold within one ofmm leom.The owner•
builder will have the burden of pmving tiu he did not Wild w Improve for purpose of
able.). 601 - ROOF TEAR OFF
❑I,as owner of the property,am exclusively convecting with Ilamed conuacton m 602 - ROOF PLYWOOD NAIL
construct the project(Sec.7044,Business and Promsiom Cade:)The Carouse's Li- 603 — ROOF BATTENS
am law docs vat apply to an owner of property who Wilft or improves thereon,and
who eunomw for such projects with aeonuaetmp)licensed pursuant to d.Coronas. 604 — ROOF IN—PROGRESS
Llccme Law.
0 l am exempt under Sm .B k P C for this moon
Owns Date
WORKERS COMPENSATION DECLARATION
I hereby affirm under penally of perjury am of the following declarations:
he andwillmalnWn$Certlftamofcomentioulf.imumfwwo eicampen-
-�� don,u provided for by Section 3700 of the Label Code,for No perflumem of the
work for which this permit Is issued.
❑1 ham and will maintain Worker,Compensation Instnme,u required by Section
3]00 of the labor Code,for the performance of the Arms for which this permit is tuned.
My Wf ere Cmmpe.nutla nwnnee rein and nu�s,�� ��
Ten Pau WORKER
CERTIFl ATEOP COMPENSATION
AN WORKERS'
COMPENSATION INSURANCfi
(Thh Auction need nothecelnpleted If 1W permit Is forone hundmdaollata(SIM)
or Ina)
I unify that in the performame of the work for which this Permit Is Issued.I shall not
employ any person in any manner an As to becomeubject to live Wascs'Comp meation
Laws of California.Data
Applicant
NancE TO APPLICANT.If.after making this CeNficau of Exemption,you should
become subject to the Worker's Compensation previsions of the 4hnr Cmc,you mug
0 forthwith comply with such provisions or this permit shall ne deemed revoked.
„zr y CONSTRUCTION LENDING AGENCY
L~ Ibemhy"no that then is a coruwulnn Andingageney far the performance of
C'> the work for which this poralt is inod(Sec.3091,Civ.C.)
W�Alenders Name
z Us ce.Mdresa
U O 1 artily that 1 have reed this application and mm that the above informallun is
Iy correct.l agree to comply with all city and county Ordinances and.late!awe misting to
O U Wlkling construction,and hereby euthorim mpmsenutives of this city to enter upon the
W above-mentioned property fel inspection purlwus.
(We)agree to um.Indemnify and keep harmless the City of CupeAno.16mt
Ara rrAA llsbiilocs.judgmcros,costs and expenses which may in try myac me against said City
Ut in consequence of the Standing of this permit
rte— APPLICANT UNDERSTAWS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOUR IIEaEGUL TIONS.I\
I{. �L Re-roofs
Sigmluxe Applicaml nl—or e D
HAZARDOUS MATERIALS DISCLow Type of Roof
Will cite applianl m future building oaupgt store m handle ingenuous material
u defined by the CupeNan Municipal Code,Chapter 9.11.ape ti.HeAth and Safety
Ccdc.Section 25531(x)1 / All roofs shall be inspected prior to any roofing material being installed.
❑Yu �No
Will tire applicant or furan building occupant use equipment or ticvicu costes If a roof is installed without first obtaining an inspection,I agree to remove
it heamnus air contaminants u dcfmcd by the Bay Arta Air Quality Management all new materials for inspection,
oict7
❑Yu No
lhevemW the havamnusmxtosisi.mquimmtnu under Chepsrfi.95ofdveGlifor-
.14Hsalth6 SdctyCodc,Sutiom 15X)5.35533 sad 25534.1.nd.and thgifthc Wilding
dao not currently have a Anent Net It h my re.pomibiliry.notify tha occupant m the
reyuinorm hichIbeMAN DItosof CcWfl fOcap y. S' atureo pplicant ate
rex out riutlsgcnl Date All roof coverings to be Class„B„ or better
..� Community Development Department
t .
Building Division
( .d' City of Cupertino
" 10300 Torre Avenue
Telephone: (408)777-3228
CITY T Fax: (408)777-3333
CUPE�T]NO
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/S" 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: G n l C WL
(�L h
Job Site Address: �� 1'f,Vl V) i A CAT,21a
Roofing Company Name: Q I
A plicant's Signature: Date:
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO o o
REROOF
CUPEkTINO PERMIT APPLICATION FORM
APN# - � �n
Building Address: 1030 NAM 6 1 a� Cu PC-Y,
h T�
Owner's Name: Phone#:
voyv r:i G key s st-1 -86V.
Contractor: C License#:
n
Contact: hkd rrov�l�r/ Phone bLQ , zCO(D
Applicant/Contractor: p F e5��e Fax#: V�c(ug
Building Permit Info: ` W
Bldg e— Oof; Elect Plumb Mech
Job Description: (OP W(WA cr--ellor4l Me(vLt
Residential:
Sq,Ft. Floor Area: $/Sq.Ft.: �0
Architect/Engineer: Valuation: �500
. Type of Construction: Occupancy Group: S1V�
IZes�r.�+nha� FaMt�
if
A li ble Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILIDNG
BENERGY Energy BUILIDNG
BSEISMICRE Seismic Fee Res BUILIDNG
BSEISMICOM Seismic Commercial BUILB)NG
BPLANCHK Plan Check Fee BUILIDNG
BUSLIC Business License BUILIDNG