05100041 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT �CCyNT1iA' ATO'Ii',INT'(?ItMr�'TIphI"•�'`;
a. 5r,n5,•9i,A .N. �'s+°!f%P=,�;k^P • RXu,3F o J use,
BUILDING ADDRESS: WESTSHORE ROOFING CO PE"MITNO'05100041
7465 PROSPECT RD
OWNER'S NAME: PERMIT ISSUE DATE
GARY ZHAO 102 OLD ORCHARD DRIVE 10/11/2005
]NE: SANITARY NO. CONTROL NO.
(408) 213-3750
ARCHITEC(ENGINEER: BUILDING PERMMNFO
BLDG O PLUMB MECH
O
00 Z, LICENSED CONTRACTOR'S DECLARATION e$ Il II00
Qr� 1 hereby affirm Met 1 am IIansW under provisions of Chapter 9(commencing
with Section]000)of Division 3 ofd.Busrcas ant Professimu Code.W my licua¢u
REROOF-ISNTALL ST
ivfullforaandeaecL .ZLe
a 2 Weeno�
Daktfsll l�/3C Contractor -'
E —T CSDECLARA O Nay
�y 1 understand my pies)hall be used u public record 'OV 2005
Ds
5 C Licensed Professional
OWNER-BUILDER DECLARATION ■■■ ryprs��®
I hereby alarm Nat I I exempt from Nc Conions Co :Myc Law for the �/ i (h tah�
OO followingvireo.. emits ]mmu Busher.and improve.
doeuns Cade:MYr m or county L taj',\9
$ which requbte a permit re).res Me alar.improve,demnlW,mrepair any tvuewre F a 6+.v $15105
prim k its issuance.,Sim n...11.the p.istdiapplicant for such ractor.to file
cusse Law
statement y �-.(
(home I,licensed pSection700)of Divions.f de eBuinesssndPree law(Chaptar9 Sq.Ft.Floor Area Valuation
(commencingwithIDnd of Divutonr the
Al Baintesadon,Prefectures Cndc)sir
9
that he ts exempt tMrefom and Ne Eels for tie Alleged eanmptlaL My NOIWon of
Section 7031.5 by my applicant(or a permit subjects the applicant in a civil peadty of 3 rkIN RgN@Fr Occupancy Type
no(more Nm five hundred dollars($500).
❑1,a owner of the property,or my employees with waste a Much auto compensation,
wiH do the work and the structure is no(intended or offered for sak(Sec.7044•Bud. Required Inspections
and Plainsman,code:The Conuanofs License law dors ret apply(o an owner of q P
property who build,or improves,demon,and who does tush work himself or duough his _
am employes,provided thatauch improvements am not intended oroRered forsale.If, s
however.the building or Improvement is old within one year of omplctio,Ne owner.
builder will have Ne burden of proving Ont be did not build or Improve for purpose of
tile.).
❑1.as Owner of the property am emiusively contracting with licensed conaeakll k
constrct elm project(Sec.7044.Business and Professions Code:)The Conmctor's Li.
came law does not apply to an owner of property who build,or imparts iceman,and.
who conular.for such projects with a eontracurds)licensed pursuant an the Con(netor'a
Lic em law.
❑l am exempt ucar Sec Bh PC fm this mason
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby alum(under penalty of perjury am of tie fallowing dalmadons:
1 haw Ond will mdmdn a Ccmf(cato of Consent to salf-imam for Workers Compcn.
-tion,u provided fm by Sado 3700.f the labor Code-fm ice imulma m on.f the
W
ok for which Nssu
is permit Is issued.,
❑1 haw ant will maintain Workees Compensation InsunnCe,as required by Section
3100 of the Labor Code,for the performance of the wart for which this permit is issued.
My Wader'.LCompansed =ran /ynier and Polity number are:
Cartier.. ys` to l't!l policy No.:
CERTIFlCATE OF EXEMPTION FlIOM WORKERS
COMPENSATION INSURANCE
(LEU sNan wed not becompleed lithe permit Is fm am hundooldollw($IM)
or lea)
1 Certify that in the performance of the wart for which this Permit u issued.I shill net
employ any person in any meaner an as k become subject o the Workers'Camp u ation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:IL after making this Cenifram of Exemption,you Nmld
berate Objet in the Worker's Compewdon provisions of Ne Labor Code,you muse
.JO forthwith comply with such provisions or Nu gerund 0411 be named muted.
, CONSTRUCTION LENDING AGENCY
F coy+ thereby calibre NatNem t,•conummvn loading agcacy far the pedmmaecoof
ai 7 Ne work Asir which this Pont,is issued(Sec.31191.Ch,C.) '
WW Q Lendee,Name
z Lender's Adders
U Q I cardfy that I have read this application W,site that tie above Interrelate,u
Lt. ^ conn I agree to comply with all city ark county andiwwxs and tun taws mladng k
Q rV' building concoction.and hereby authods reptuanutiwa of this city to enter upon Nc
LT) shove-men,iomd popert7 for Inspection purposes.
Ly (Wc)agree to caw.indemnify and keep harmless tin City of Cupcnino against
t I Iiabilities.judgments,cosn ad expenses which may in anyway aconic against said City
U incomgw=ofthcgrsntingof NispamiL
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON DINT Issued by: Date
SOURCE REGULA /
Re-roofs f r
Signa f anVC r Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building weapon,core or handle haardoa material
as de0ned by the Cupeniva Municipal Code,Chapter 9.13.and the Health ad Safety
IniaH.Iffia;SafctyC�,Sxd=25505.25533ad25534,lun&mmdthmi(Lhe
d),Section 25533(1)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes ONO
Vin the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
It haesrdna err contaminants u dented by the Bay Am.Air Quality Management all new materials for inspection.
uict7
CYes ONO
I hew mad the haallosmucdalsonquiremcnu underChapterd.95of Ne Califon
e building
cs o,cuncnt ve a knant.Nat It u my responsibility to notify the oaulamt ftheuimme muse met ' issuanceoI CcrdIII I(Be Signature of Applicant Date
own r aranthariz neem d .,) All roof coverings to be Class'B"or better
Community Development
10300 Tone Avenue
'✓' Cupertino CA 95014
Telephone(408)777-3228
CI Fax(408)777-3333
�UPE�TINO
Building De utment
JOB ADDRESS: ,�� ��� 2` Rd .1 PERMIT#
o o 0 �t
OWNER'S NAME: r PHONE # Ltp
GENERAL CONTRACT FAX # UaB-2,317
/
I am not using any subcontractors: � L 0�
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
Owner/Contractor Signature Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
CITY�F Telephone: (408)777-3228
U PEI�TINO Fax: (408)777-3333
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-rooting
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 U ,^�Z
Job Site Address: 7 H 6 1 r°S P (---t R
Roofing Company Nam x
A plicant's Signature. Date: �� \� ri l�
\�1J�51J�10C.X1
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
RE ROOF 6
CUPERTINO PERMIT APPLICATION FORM l
APN#� !S_ p ��1} Date:
Building Address: )'C/
7 bs Proms �cr R� -
Owner's Name: Phone#:
CS�•r �X4U `lob- �yb
Contractor: Phone#: License#:
S'1SVo-E
V4-f- Rot� Iv�c. u{ag 2-13,-SI-31 So 787
�.kZZ 1
Contact: Phone#: Cupertino Business License#:
&Ac o le.� '4Antir . t{og Z13-37So
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
.,�W Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ . Other(Specify) ,d Other(Specify °
Number of existing coverings I ❑ Provide I.C.B.O.Report# NrR- 423
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: 10
Job Description: ly%S-t°.\\ Cr«-a S- KA- Coo.-ted 3-tz�( ` -le r-00-fIT-U -,. ovc -
-P- L wDca SKkr CIAss Q
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are anrestrictions: LJ
Cost of Project: Type of Construction: Occupancy group:
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
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