05100218 (2) CITY OF CUPERTINO " ' °
BUILDING DIVISION PERMIT . », (� I2A�axrtoRMATI
-
BUILDINGADDRESs: WESTSHORE ROOFING CO PERMITNO.05100218
NEWS NAME: PERMIT ISSUE DATE
CHING P
PHONE: SANITARY N0. CONTROL NO.
(408) 213-3750
ARCHITECT/ENGINBER: BUILDING PERMIT INFO
'BLDG ELECT PLUMBMECH
o
i0o LICENSED CONIT(ACRSR'S DECLARATION - Job Description
knotty afnrm that I am licensed under provisions of Chapter 9(commencing
with Soda 7000)of DivWon Willa Butircaawd Pmfeasuno Cade aWmylkemeu
' nfvnf"a°weren
Lk. ZZ REMOVE EXISTING WOOD SHAKE AND INSTALL GERARD
?�Z Liccno Cl R
Dan Cantraelor STONE COATED STEEL TILE
ty ARCHI ECi'SDECLA A
q� I understand my plane Mall be used as public recorN 4_O0htkS
ucF'NAL�®
50CCCO C�1 omwd ftacsianel f
3OWNER-BUILDER DECLARATION
q 1 hereby aparm that I am exempt from the C.trMors License LAW for the
D pO following damn.(Sects 70714 Best=and ProfcWam Cade:Any ally or county
59 watch tequkm a pmniI to camtmel,eller.Informs.demolish.Or repair my rmcture
-Zi pore w its issuance.also requires the applicant for such permh an forte a signed aWemmt
c
that he is licensed pursuant to the provisional of the Conusctur:Licence Uw(Chapter 9 Sq.Ft.Floor Area IUotI9000
€� (commencing with Section 7000)of Division 7 of the Busness and Proresaona Code).
�.. that Its is exempt therefrom and the boss far dm alleged um talon.My violWmet
Section 7051.5 by any applium for a permit subjects the applicant to a civil Penalty of APN Number a OCctipanc Type
not mom than five hundmd MI. SSM). 35904024 . 0 0 d fi
❑1,u owner of the pmpeny,m my mploym withwage a tiehmte mmpenadon,
will do the wam,and themuclum is notimendedaraRered forsale(See.704/.Business Required Inspections
and Profession"Cade:TW Cm
anuwr&License Law does ec
q p WE Apply w an owner of .
property who buildaaimpoves dooan,and whodoes each w"rkhimaelfm through his
own employees.provided lost such improvements ate ant intended araResrd fen sale.If.
however,the building or improvement is sold within am year of oompindon,the owne-
hullda will have time burden of proving than he did not build or impmw far purpose of
ale.).
❑1.as awma M the property.am eaclusivelY conuaYin6 with Bcima d cenusemrs w
consu en the project(Sec.M44,Busio es and Professions Cade)The Customers Li-
come Law dues tet apply w an owe apr"peny"iw Wilds ar improves Neem.ame.
who contract,for such pmjem MN a momma,mr(&)Iimnad pursuant on the Contractors
Lite.Law.
❑Iamacmptundc3ec. ,Bl PCfarthboAam
V Das
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penally of perjury can of the following declarations:
I h&w end will msinwn s ce omm of Conn m ulf-inaum f"r WarkeraCompen-
ad.,as provided far by Section 7700 of the tabun Cade,fm nos performance of Ne
wok for which this permit is Wood.
❑I have ad Will maintain Waiters Cumpem athm Iamrmm,as acquired by Section
3700o1iNe labor Code.far the part.allies ork far which this permit is rimed. .
My Workef,Cam esu' s huu }arrin W Policy number
Grder.✓�- asC1 ERl7a lPolicy N" rcL6
-
FlC OF NFROM WORKERS'
COMPENSATION INSURANCE
oda send.aced tet becmmplewd If the permit Is foram hundred dollars($1 00)
or less)
I certify that In the performance of the work for which this permit is iaaum.I shall an,
employ any person In my summer an as w beeamo subject in the Workers'CompensWon
Laws of Calif"mise Data
APPlic.1
NOTICE TO APPLICANT:If,afar making this Ccniacate of Emmpdan,you ilwuld
became subject in the Waters Campensaden provisions of time IAbar Cade,you roue
.J O forthwith comply with such provisions or Nu permit Nail he deemed rewked.
Z 0 CONSTRUCTION LENDING AGENCY
.
tom 1 kneby'Mon Na chert[et,construction Wbing agency for the performance of
IY r7 Ne wark fur which this permit 4 noted(See.3057,Civ.C.)
it.^n. Lender:Name
O z Lender:Address
U O 1 county that 1 haw read this application and soon that the @bow infmmation u
U. r' caret.I agree to comply with all city andcounty aminwes and soon lam reeding w
O(S J^ building conarunion,and hereby authorize repoaenutiws of Nu city to mtuuponf
LT7 show-mend-..popery f impecd.purposes
(We)&time to taw,indemnify and keep harmless the City of Cupertino agaimt
CA IiabiliticsjWp"cnu,cru and expenses which may In soyerneagainstaeW City
U Z A PLIC NT"oftim UN UNDERSTANDS AND WILL COMPLY WITH A�t`L NOV-POW Issued by: Date p'27-c f
SOURCEREGUTADONS.L{fllr'y� `
. 1O �& o
Signsurt of Applimnu'C"nuecwr aRe-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or fmum building aaupmisime mhandk haallons material
dented by the Cupertino Muntctul Cade,Chapter 9.11,aim the Health,and Section 155310)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yee ❑No
Wilt the applicant or ruture building=upon,ala equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit haaaens all canalminmu u infrc l by ds Bay Arta Air Quality Management all new materials for inspection.
Dios ct7
Oyes ON.
I haw mad thehaatNa:maloiaoorequiremcnu umicr Chape,6.95afNe Califon
nia Health @SarmyCode.Smtians153a5,15553 uW 25554.1 undemaW twitted Wilding
does.t currently haw a ant.Nit It u my PSPomihllity w notify the aceupant of the
oquimnems soh' ust mctpriorwiauanmafa Cutincm�of(Occup cy. / Signature of Applicant Date
1"62T��� All roof coverings to be Class"Br'or better
Ow.r ar mtharip a em Dow' '
CITY OF CUPERTINO
Om 1 of 1 PERMIT RECEIPT OPERATOR: suem
COPY # 2
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35904024 .00
DATE ISSUED. . . . . . . : 10/27/2005
RECEIPT #. . . . . . . . . : 31763
REFERENCE ID # . : 05100218
SITE ADDRESS . . . . . : 808 ROSE BLOSSOM DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : CHING PIN CHANG
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4214
RECEIVED FROM . . . . : WESTSHORE ROOFING
CONTRACTOR . . . . . . . : PAUL FOWLER LIC # 21357
COMPANY . . . . . . . . . . : WESTSHORE ROOFING CO
ADDRESS . . . . . . . . . . : 102 OLD ORCHARD DRIVE
CITY/STATE/ZIP . . . : LOS GATOS, CA 95032
• TELEPHONE . . . . . . . . : (408) 213-3750
FEE IDUNIT QUANTITY AMOUNT PD-TO=DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 19, 000.00 266.76 0.00 266.76 0.00
BSEISMICRE VALUATION 19, 000.00 1.90 0.00 1.90 0.00
---------- ---------- ---------- ----------
TOTAL PERMIT 268.66 0.00 268.66 0.00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 268.66 16960
TOTAL RECEIPT 268.66
•
Community Development
10300 Torre Avenue
r ' J' Cupertino CA 95014
Telephone(408) 777-3228
PCITY OF ERI �N� Fax(408)777-3333
Building De artment
JOB ADDRESS: gOg �3�tsso>~. Dy. PERMIT #
Cb
OWNER'S NAME: U^% PHONE # c(og ZI § TZ S 0
GENERAL CONTRACTOR: FAX # '10 8 2l; 39
I am not using any subcontractors�" La(27(M�-
Sigriature 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
E- TUile .
Owner/Codbractor Signature Date
CITY OF CUPERTINO
a REROOF
OCUPEkTINO PERMIT APPLICATION FORM
APN# 3159
1 O Date:
J_I
Building Address:
ose gl°SSoM
Owner's Name: CV, Phone#:,
Contractor: Phone#: License #:
Wcrtskam V�006408-Z (9 -3ISO 7872-ZI
Contact: Phone#: Cupertino Business License#:,
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
/ef Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ,' Other(Specify)Gtmf� JtOya Cpr^1Yd 5+0'-1
Number of existing coverings ❑ Provide I.C.B.O. Report#N to R LtZ3
To be Removed ❑ Provide Mfgr. Installation Specs.
Mpt Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: 4m ell wood\ Sbwlc>L kv 5--to. x Gond
Stet) r;\2
Residential 0Commercial ❑
Fire Zone: Yes ❑ No K Confirmed with Planning De t. if
there are any restrictions: LJ
Cost of Project: Type of Construction: Occupancy group:
�q �� Q.Q-►�,o-� SFR .
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
Community Development Department
Building Division
• City of Cupertino
10300 Torre Avenue
ISCITY OF Telephone: (408)777-3228
CUPERTINO 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-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$176.18. The re-inspection fee must
be paid before another inspection can be scheduled
IMPORTANT:
1. Flat roofs must have a minimum of 1/4 "per foot slope and demonstrate
that there is no ponding.
2. An I.C.B.O. report is required to be on the job site at the time on inspection.
I understand and will 0l,';,')
comply with the above stated policy on re-roofing.
Homeowner's Name: Cly i,') P 1 h Cv��!n
Job Site Address: go$ ROse Q \63S 6yvi V*Jkloil
Roofing Company Name: W'1 k,)Y2 �0 oit (\(\C.
Applicant's Signature: Date: vZ oJ-_
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper