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CITY OF CUPERTINO
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BUILDING DIVISION PERMIT
CONTRACTORINEORMATION
WR L4iIms
BUILDINGADDRESS:
WESTSHORE ROOFING CO
PERMIT ND. 05110145
I
22560 STEVENS CREEK BLVD
,
OWNER'S NAME:
PERMIT ISSUE DATE
STEVEN SULGIT
102 OLD ORCHARD
NE:
SANITARY NO. CONTROL NO.
(408)213-3750
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTORS DECLARATION
Job Description
hereby affirm that 1 me li..d under Dmvisiom of Chapter 9 (ro eff.fl ng
whatfessiam Code mdm licencis
y
%� ,,p�
in inn imine ane ercect. _�, ?�2Z�
Licnnm Clus Llo.p
REROOF-➢TC�SAAK�rR-' ALL COMP.
Q E�
Da¢ Contractor
�i—
ARCHTfECTS DELLA ATION yC� IN
1 undcts.nJ my plain shall bo used u public tttoWs �/
DEC 43- 2005F
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby alarm that 1 am exempt from Na Comrscmrs License Law ror Ne
following reuon. I.S, Business and tins Code: My vtiry or county
ff\\C
event 170]
ere. de
which requires a permit re eomuvq ells. Wprow, demolish, Of repair end atmcturo
$8000
prior to its ienedprsu n: testbofor mchhe 9
- — v
Sq. F[. Floor Area
Valuation
annitmicense aw(Ch.mmtdust
the vision of
i islicensedn7")ofDivsion3 ftheBuxessadce�hw(Codo)orapter
to
Division Codc) or
and profession,
with Sere
1
d(commencing,heis the r the W cgcd cu
dot W u emmpt Nemrmm ltd Ne buss for d. Jleged awptiom MY violation of
from and My
!
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not mart than, five hundred dollars ($SW).
C 1. u comer of the Iemporly. or my employees with wages u their sole eompewtion,
Required Inspections
will do the work and Nemodule coat intended or offered for sale(Sec. 7014, Bur.
and Profassians Code, TW Canuxtora Liam: Law arcs not apply in an .. of
property who buildaerimpmves dermn, and who doessuch werlehimself or through his
own amploycra, pmvi led that area improwmena are not intended mattered forsale. B.
however, are Wilding or improvement is sold within one yeti of oompleticn, lie oweer-
builder, will lore the burden of proving that he did Out Wild or improve for purpose of
sale.).
C I. u moor of the preopen, em audusiwly canuactiorg with Boned mnuaetors to
mm act the project. (Sec. 7064. Business; and Professions Code:) The Conuacmrs U.
ceue Law does not apply on an owner of DroPenYwbo Wilda or improves thereon, and,
who conuxcls for such projeca with amn racmr(s) licensed pummnt to the Convenors
License Law.
C lamuemptunder See .B&PCforddi&.
Owner Data
WORKERS COMPENSATION DECLARATION
1 hereby antor under penalty orKgmy rote of the following dec i ations:
1 haw aM will main.,. a Certificate of Consent m selrA.mm fm WorkersCampers-
men. u Provided for by Section 37M of Ne Labor Code, for the pmfarmmr¢ of the
,
wort for which this Permit is issued.
C 1 have and will maintain Workers Compensation lersomica. as required by Section
37W of the tatter Code, for the perfatmmec, of the ort for which this Permit Is issued.
'
My Wortre Cpm rsma n bugran<e canner and Policy number_
Cartier. JllL-•N•IFInP.l4Jl Policy No..4=
. CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Dosscctioe need not be completed'JNe permit is fortune: hundred dollars (SIM)
or Ws)
I certify Out in the perrormam. of the work ror which this permit is Loved. I mail for
employ any person in my mannerm as to become subject to the Workers'Compeuation
Laws of Califamia. Date
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
became subject m the Wmkera Care, uau m provisions of Nc Labor Code you muss
' fonhwiN comply with such provisions or this permit shall be deemed revoked.
l Cat
1Wr dam 4CTIONLENDINGAOENCY
' lending agcmy lar Nc perlotman¢of
them4ecomSec.
which do Pe
the wort for wnicn Nis permit u issued (Sec. 7091, civ. C.7
3
Lenders Name
-
Lenders Address
j I certify, that I have had this application and soon, that the s Were information is
' cmroct 1 agree to comply with all city and county aNinemcu and sae laws mhung in
Wilding construction. and hereby authorize represmaNvs of this city to comruMn the
move -mentioned property for Imptt4es purwhich
,
(We) agree la saw. Indemnify old tcep barmlras ted City of Cupemno against
j Iiaboo,mno.. cnu, ceau and may in any way cecina against slid City
in cansequcnce of Ne granting of Nu pcmniL
of this permit.
' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date2-S _ o Q'
SOUR R ULATIDNS. /
Re -roofs J y
Sigmtum of Applicu no'Conmicmf Doc
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will the applicant or forum building occupmtnoro or handle hvardous material
u defined by the Cupar no Municipal Code. Chapter 9.12. and the Health and Safety
-
ode.5❑Yes ON. ection25532(arl
All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant um equipment or devices whim
If a roof is installed without first obtaining an inspection, I agree to remove
mit harvMu air contaminants u defined by the Bay Ana Air Qiulity Management
all new materials for inspection.
District?
I]Yes CN.
I have nerd the harards.s m Oon.1,requimmenu underClopterti.95 ofthe Cadifor
ids HulthAtSafelyCede.Scctiau 25505.25533 and 25511, lundcrs.M Natifdc Wilding
does not currently haw a.nmL Net it of my msponsibllity m notify the aceupmwf Jin
n 1 0
mquiremenoo ohm mL be IllCl priorm Lssmarcc araeenines. or i
Signature of Applicant Date
(, ' ,
All roof coverings to be Class "B" or better
g .
Owner or N�s mud agcm Date .
CITY Of
�UPEkTINO
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax(408)777-3333
Building Department
JOB ADDRESS:creep
220 .St'e,�le�s
PERMIT #
OWNER'S NAME: 5}r,4i +i t St(
PHONE # JGF 243r O
GENERAL CONTRACTOR:
FAX # fbQ0 zl - zgq
I am not using any subcontractors: 1'`"iv , Z8-Q:5-
Signature
$'QSSignature Date
Please check applicable subcontractors and complete the following information:
Owner/ Contractor Signature
Date
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
aAMEw,
CITY OF
UPEI�TINO
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Building Department
Subject: Re -roofing policy for the City of Cupertino
Telephone: (408) 777-3228
Fax: (408) 777-3333
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: SfCVPAA y Stt I I
Job Site Address: 22 P�-'Aro S'1 cAe^s Cl�"cnft�� ,Q
1L4 -
Roofing Company Name:: �We&�ko f E �®o (-1 t� 61�P
Applicant's Signature: � Date:.
• Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY or
CUPEkTINO
CITY OF CUPERTINO
REROOF
PERMIT APPLICATION FORM
of -a C, I `e 1,
APN #
I�
Date: 4L -Z8'O.t�b
Building Address: 22
5 60 Jr t��PJf�`J C.f2eK ��
Owner's Name:
st-o►en !;40th
Phone #:
ZSZ— 2,303
Contractor: Phone #:
W251CSIno4e IAC- 4"
License #:
787 zz(
Contact: Phone #:
fa�
Cupertino Business License #:
213'3_7SD
Seismic Commercial
Type of Roof Covering:
Existing: Proposed:
❑ Built -Up Roof ❑ Built -Up roof
❑ Asphalt Shingles jd Asphalt Shingles
XWood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other (Specify) ❑ Other (Specify)
Number of existing coverings L ❑ Provide I.C.B.O. Report #
❑ Provide Mfgr. Installation Specs.
To be Removed JC5
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑
Job Description: V
WoTd s1notA�e foe) 1Fln'rut 15%32 06,36141 30,if- ComP
Residential Commercial ❑
Fire Zone: Yes ❑ No 0/ Confirmed with Planning Det. if
there are any restrictions: LJ
Cost of Project: �QO Type of Construction: Occupancy group:
S IF 91 SIF R-,
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
C