05070035 (2) CITY OF CUPERTINO 'moors „„ ''� f ' " "' ` '•
BUILDING DIVISION PERMIT CIO 'IDRACITORfINFO�2�e���Q�
Bs, OwGADDRFss: WESTSHORE ROOFING CO WIER ,
OWNER'S NAME: PERMIT ISSUE DATE
STEVEN WONG 102 OLD ORCHARD DRIVE n7/nr,/2o0s
ONE: SANITARY NO. CONTROL NO.
408) 213-3750
ARCHITECIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Zt Q 1�
300 LICENSED CONTRACTOR'S DECLARATION Job DescrM
('� i batterybatteryaMan that I am licensed under provisions of Chepw 9(commencing tp7t'�
I l� {j
wI'Section 70110)of DiAs on 7 of the Bomas.and professions Code,and my liters,is 25 in full force mattress. REROOF W/ STEEL TILE
Liomscaaa LK.0 2005 Dab—Canumactor
ARCHITECTS DECLARATION - _ 2005
;6355 1 understand my plana Dull be used u public records
7 u
5 Licensed PmfCesinnsl [�U I ®�t�,
,a5 OWNER-BUILDER DECLARATION y®� ItlNf�\OVDB9
F I Wrchy.(sec that I em uempt from the ConwnoYa Livens,Law(,r the
O O whmving reason.(Salon 703I.S,Business and Professions,Code:My City or county
kS
$ which require.a Perrnir to Construct.alar,amp..demolish.or repair any.=to.
Zzy prior to is,Women.situ requires the applicant for such permit in Ole a signed moment
< that heislicensed pursuant toth.provisions ofthe Cormits.U..law(Chapter 9 Sq.Ft. Floor Area Valuation
€G (commencing with Section 7000)of Division 3 of the Business and Pmfeevons Code)or
$
that he u stamps therefrom and the basis for the alleged assumption.My vlolm,on of
Section 7031.5 by my applicant for a permit subjects the applicant to a civil penalty of eT0 Occupancy Type
not mom than Ove hundred dollen($500).
❑I,u owner ofte property,m my employees with wages as their sale compensation.
will do thework,and Lb.muclom 6mtintarbed continued formic(See704,4,wtroowButlneu Required Inspections
But—
and Profession,Cade:The Concudes License Law data t apply M an ns, e ns of q p
property who Wlldsorlmproaes thermn,and whodou.uchsimk himself,rllu,ugh his
own employes,provided that such Improvements and not Intended or offered forule.if, -
however,the Wilding or improvement 6 said within ane)ear of completion.the owder-
builder will have the burden of proving that he did not Wild or improve its purpose of
oleJ.
❑1,as owner of he property.am emlusively cosseting with licensed conuactma to
construct the project(Sec.7044,Business and PmfcW=Cade)The Conuactoes LI-
Cause Law data not apply to an owner of property who WOds or improv themon,and
who convects for such projects with s eonuxcbKs)licensed Pursuant a the Conwcbfs
License taw.
❑I am eaempt under Sec. ,B&PC for this reason
Owner Data
WORKERS COMPENSATION DECLARATION
1 hereby affiw under penalty of perjury am of dhe following accusations:
I love and will msinuin•CW ficata of Consent roself-Insure for WorkerYCompen-
utlon.as provided for by Section 3700 of the labor Code,fm the Performance of the
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insunnce,as required by Section
3700 of the latter Code,far thc performance of the work fm which this permit is Issued.
My Worker',Compensation insurance carrier and Policy number arc:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This bctlon need Our be completed lithe Permit 6 two=hundred dollar Mail)
or lass)
1 unify that In the performance of thc work fm which this Permit is issued,I Nall not
employ any person in any muddier an as in become subject to the Workem'Compensation -
Iaw.of Califomis.Data
Applicant .
NOTICE TO APPLICANT:IL after making this Cenifiate of Exemption.you should
become subject m the Workef.ComPemation previsions of the Taher Code.you mus,
OZ foMwith comply with such provisions or this Permit shall W deemed rev,kcd.
,z.i55CONSTRUCION LENDING AGENCY
'F� IWrebyalarm that there Is a mnswction lordlog.gemey far tau PertorananCoaf
!Yi7
ft wart fm which this permit is Issued(Sec.5097,Civ.C.)
QLender's Name
=)Z Laeder'.Addm.t,
U Q I certify Nu 1 have read this application and Nb that the aWvc information 6 s
tL E carrot.i agree to Comply with all city and County mdinaaea and swe laws rccadng u
C rUWilding construction,and hereby authorize¢prcmnuuves of this city to enter open use
W aWve-mentioned property fm inspection purposes
gy (We)agree to save,indemnify and kap hanniw the City of Cupertino against
f/1 liabilities,judgments,costs and expenses which may In anyway ams,against said City
in V APPLLIICANT UNDERSTANDSuence Of us Aof IND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Signature of ApplieaH Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant m futureni ipal Cg,.Chapt use o handle Health and material
u de0ned by Js,Cupertino Municipal Code.Chapter 9.11,and the Health and Safety
ads,Section 15531(a)7 All roofs shall be inspected prior to any roofing material being installed.
Oyu ❑No
Will the applicant or(nbrc Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
It havallous air canu riamu u dcfncd by be Be,Arca Air Quality Management all new materials for inspection.
u icR
❑Yes 0 N
I have read th locard,es.=data mqulmmcnmun@rChapwr6.9$ofthe Califon
n6 Hcalth&Safety Code,S cdons25505,15533 and 15534.1 understand and lfbe Wilding
data Out Carrcnlly have a unapt.that it u my responsibility In sadly de oaupant of the
an,
which mus,be met prior b Banns,of a Certificate of Occupancy. Signature Of Applicant Date
Owner Cr auth.risolagent Data All roof coverings to be Class°B° or better
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
aCOF Fax(408)777-3333
�UPEI�TINO
Building De artment
JOB ADDRESS: /0�� SCe 1160 �d PERMIT#
SG�c o 3.0
OWNER'S NAME: Srake4l W - PHONE# 41A8 213—37J�-
GENERAL CONTRACTOR NeSb &Ye (boa FAX# iog 2i3—s2,39-7
I am not using any subcontractors: M,' " 7 6G o� -
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 Y t A3 cff �oo nC z 1 3 5�
Septic Tank
Sheet Metal
Sheet Rock
Tile
7f6lo.
Owner/Contractor Signature Date
Community Development Department
P Building Division
` r City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408) 777-3228
OU PEI�TI NO 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 comply
„,,with the above stated policy on re-roofing.
Homeowner's Name:/S I” 6k"
Job Site Address: l�7^��� • (SJ�LP�I Lf t���,✓�(/2l CLL/ Cites�i7�l a
Roofing Company Name��V'''V//L�
Applicant's Signature: I'htN _ Date: ��
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF DS
CUPEkTINO PERMIT APPLICATION FORM
APN# -�s-� 0 g 00 f . Date: 7
Building Address: /01 pO SGelm.G B A
Owner's Name: SWIM w Phone#:
I VV '8�3 - -70 3
Contractor: 3�
' r es�s I_o(e Ko Phone#: License #: 7&7 2Z
yV YI -,3-7,z
Contact: ' rD�Ie✓ one#: Cupertino Business License#:
(iLWI 8 2-0 37-S�D
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
Wood Shakes ❑ Wood Shakes
Wood Shingles ❑ Wood ShinglesJ/Other(Specify) Other(Specify)G
Ll Other S7y
e&i/ T<
Number of existing coverings Z ❑ Provide I.C.B.O.Report#—Aj' X23
XTo be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: fZC4g0ve mjh / f Ids/av 6&1(a* Sl-pe( Vle
Residential Commercial . ❑ _ .. _.._.
Fire Zone: Yes ❑ No Confirmed with Planning Dept. if
there are anrestrictions: E
Cost of Project: 17 6VQ Type of Constructio : Occupancy group: S�
Ke -roo � .
Qty. if
Applicable, Fee ID Fee Description Fee Group
BPERWEE Bldg Permit Fees BUILDING
r 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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