05080080 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT s CONeTRACTQR INF;OI.tMAT„ION, h°
BUILDING ADDRESS: WESTSHORE ROOFING CO PEBMITNO.05080080
OWNER'S NAME: PERMIT LSUE DATE
SU RONGHUEI AND CHYONG-TZER 102 OLD ORCHARD 08/10/2005
NE: SANITARY NO. CONTROL NO.
(408) 213-3750
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDGO ELECT IS PLUMB MECH
O l�
300 LICENSED CONTRACTORS DECLARATION Job Description
iF I Wmhy affirm that 1 am licensed under provisions of Chapter 9(commencing
with Section 7M)ofDiAsion3of the Business and Prolemon.Codo,and my tire.I.
in full forth and a «�.. -7q-77 TEAR OFF EXIST. SHAKE AND INSTALL GERARD STONE
?FI-� o. `es C Rraawr WcclA. rL • COATED STEEL ROOF SYSTEM, CLASS A
K ARCHITECTS DECLARATION
I understand my plans,hsll he used as public records
y� Licensed Professional
OWNER-BUILDERatI.. mplfrom
DECLARATION
s� F I W mason.
.(firm that 11. Business
from tits f onion t Co License law for 1W
0 o which g reason. er it t RBI.d, t.alneu and PraImprove,
dem ns h.or My city or county
S$� which requires a permit m cematmeL alar,improve,demolish,or repair any nronum
prior to its issuance,also requires tie applicant for such permit to rile a Signed Statement
<
Must M is licensed pursuant e provlaWN of dM Cnn
aIDebfi Licame Law 9 Sq.Ft. Floor Area Valu$iID�000
m di
zC$ (cmmmencag with Section 7MO)of Division]of the Business and Profratioru Code)or
3 dot he u aaempt therefrom and the basis f«the alleged eaemption.My violation of
Seerrn 7071.5 by any applicant far a permit subjects to applicant On a civil penalty of APN Number Occupancy Type
rat mom then five hundmd dollars(SSW). 35611076 . 00
❑1,as ownar of Ole property or my employees with wages as their Sale Compensation,
will do the walk,and the sw«ure is net intended or offered for sale(Sec.7044,Budrcas r
and Pmfesmam Code:The Contmnafs Licence law does not apply r an owner of RegUi a ti ns
Own
property who Wiprovidd that SuchImprovndwM10 me not
work M1im¢Iforomugh lIf, 1L1Y" '�1aN� p s�
Own Me iprovided Improvement
Is id Improvementswitsee Cot Year
of dura@mW forMe Md.mos.
if, �C•{t§ LJ/tJJpf slllform'®
however,the building or improvement a Cold within oro you of completion.far the owner
bueeer will have the buNen of proving Nat W die on Woe or improve f«p«pose of
Sala.). MAS Z
❑1,u owner of project
Sec.70Y..Business e a d comrmting wW:)TheeCoonactrsa . ?005
construct the es Out (Sec. an wneofend property
who ns Cade:)The Conuereon,and.tome law dose Out apply Co an owner of property who sedtls or improves thereon,and,
who contracts for Such pmjccu with ecanuumr(t)licensed pursuantmoe Contractors
Lium f
❑ m exempt
y n
antler Sec. ,ed PCf«dda won iy,�pll
Or Data
WORKER'S COMPENSATION DECLARATION
1 hemby M.under penalty of perjury one of Me following dechm".s
I ham and will maintain a Cereftesu of Consent to selhWure for Workers Compen.
Sutton,u provided for by section 77011 of the Labor Cofar the performance of the
work for which this permit is board.
I have W willmaintain W«keys Compensation I.M.as required by Section
700 of the LAW-Coal for the performance of the wart for which this permit is issued.
My Workee Cnmpensatianlf�t�tsu esmim and Policynum am: �y n
Carder. 1 Vx/ Poliq No.: I6 b!Z00(a
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thissotian need tet W completed If the permit is formic hundred dollars(SIM)
or M.S.)
1 certify that in the performance of Me work for which this permit is issued.I shall am
employ any person in any matuerso as to became subject to tic Warken'Compensation
Laws of Caffoona,Data
Applicant
NOTICE TO APPLICANT,If,after making this CC 1bflC1le of Exemption,you ShouW
become Subject r the Worker's Compensation provisions of the labor Code.you most
0 O forthwith comply with Such provisions or this pconiuhall W domed revered.
EM CONSTRUCTION LENDING AGENCY
(~ I Werby affirm that them is a construction lending agency for the Performance of
Drs the wmrk far which this permit IS Issued(Sec.7097,Civ.C.)
QLender's Name
Z Lenders Addw
U0 I cenify that 1 have read this application and Stats oat the aWve infcammuiun is
Dr I• eorted I agree to comply with all city and county ordinanecs and auu laws relating to /
0 building convection,and hereby authorim representatives of this city to enter upon the /
W shove-(We)ag d property rte indemnify
an Imcp ha
(We)arra o sion,sous indemnify sed tech hay to an the City rte Cupenal d Gly r
TSA liabilitiu,Judgmenu.c«u andexpenw which rosy In anyvny,arve agalnsttald City
U 7 in corm mote of Midnt of thispermit. yAP on ofth111ND WILL COMPLY WITH ALL NON-POINT Issuedb Date
Re-roofs
Signature of ApplicanuComrau«T Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Me applicant or future building Occupant atom or handle hvndaus material
as defined by Me Cupertino Municipal Code.Chapter 9.12.ane the Health and Safety
Amwern,Sactian 2553 Y? All roofs shall be inspected prior to any roofing material being installed.
❑Yet Na
Will the applicant or form Wilding occupant tau equipment or dcvicu which If a roof is installed without first obtaining an inspection,I agree to remove
Ilk,horardous air contaminants as defined by the Bay Arca Air Qoalhy Management all new materials for inspection.
Dimict7 1
MIS LINO
I have mad the hazardous material)equiremcnu under Chapurd.95of the Califon
ni.Holo&Safcty CWc,Sudom25m15.25577and255741uml mdouirthc building
dorst torte d h a u i,that it Ice my responsibility r notify the co quat of the
mgol ts NM1 WWI priorrmuanceofaCcrtSur ro Signature of Applicant Date
lie g I�
ni All roof coverings to be Class"B"or better
Owns onuthamade c �� Dau
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telepbone(408)777-3228
CITY OF Fax(408)777-3333
UPEkTINO
Building Department
JOB ADDRESS: PERMIT #
OWNER'SNAME: 4vt , w• PHONE # x/09 231-87,07-
.GENERAL CONTRACTOR: /2sa-f i* /r t. FAX # Y09 7-0231
I am not using any subcontractors: /0 0 '
gnature 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 k
T e
\T\LNV b
Owner on actor Signature Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
CUPEkTINO
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: ;
,.•I '. ' 1). Pre-inspection and/or.tear off.approval,
2) In-progress inspection approval.
3) Final inspection approval.
a) Spark arrester installation.
z' • 5: ' If.plywood is installed, a plywood nail inspection is required.
6.,.. . Any roofing which_is.applied-without first obtainingran_inspection,
L .F ,. c..... -
- — will require the removal of all'new- materialdown to the sheathing,
so a proper City inspection can be performed.
- •1� 7. ` NOTE. If yoii`call for a ply-wood nail inspection and the job is not ready,
you will be charged a re-insgectiori fee of$176,18.=The re inspection fee must
be paid before another inspection can be scheduled.
..
-,r, .IMPORTAI Ti
1. Flat roofs must have a minimum of N4" 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 swill comply with the above stated policy on re-roofing.
Ho meowner's.Name: a w
Job Site Address:
Roofing Company Name: 1.11r s l s h v Yt 120 o f f k%� /N C -
' Applicants Signature: �
Date:
Greg Casteel
Building Official
Revised 11/2/04
- "' Pdnred nn Recbcled PaDer n
O -0 $'o o g
.Q, CITY OF CUPERTINO
REROOF
ICA"CTINO PERMIT APPLICATION FORM
APN# ,35!o �!v rU� Date:
Building Address:
Pjd$ 1 �ftSt� lo
Owner's Name: VAVa. Sw Phone#: ZS3� 87bg
Contractor: Phone#: License#:
W2stS�nort ti`OZ� )-c , 1408 v33 -756 . 7872Z1
Contact: Phone#: _ Cupertino Business License#:
CJF.h rt-e.1 �OJV�tnh , q D1 S-
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes _ . ❑ Wood Shakes
oWood Shingles Wood Shingles
13 Other(Specify) ;? Other(Specify) Glcrwra S-tL\
Number of existing coverings a Provide I.C.B.O..Report�2S
To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read,Understand and Will Comply With Cu ertino's Tear Off Policy:
Job.Description: i h tea tl l rj &-e✓a "4 J-t u e%C
,. Cea-rt�" �c�l.' /Loa • -�,J`s-1.e� C/<St R .
Residential Co ercial ❑:Lt.
Fire Zone: Yes ❑ No ❑ Confirmed with Planning D10t. if
there are any restrictions: LJ
Cost of Project: Type of Construction: Occupancy grow •
IS000S��
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
2D
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