04050170 (2) CITY OF CUPERTINO - ` "^ '�Y'r.. s `�-^ }X1� '�f" "''�
ffiYU
BUILDING DIVISION PERMIT
COL\,L.,"CTOR I� M � ,
BUILDING ADDRESS: WESTSHORE ROOFING CO PERMIT NO 04050170
OWNER'S NAME: PERMET ISSUE DATE
Ah ROBERT CHAN
NE: SANITARY NO. CONTROL NO,
IF
(408) 629-2100
ARCHITECffENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECN
uOp LICENSED COWMACTOWS DECLARATION
rd 1 her b W. that 1 em licenxd uvr�Jer p-�-Prion of Chapur 9(commencing Job Description
r� with Section) Divis(on3afdm BuslasyFU Plo(ualom Cadc,entl my license is
in ren mroea at /// z REROOF W/ COMP .
C1e - 3 9 Lk.«
Da� T-- 04
contmmar /
Y ARCHITECT'S DECtl R TION
Y 1 unhersund my plans shall he used in public records
�yU
a Liccnud Profcssionel
g S OWNER-exempt R DECLARATION
4 0 f 1 hereby.(firm shat 11. exempt Imre Ne Contractor's License Lew for the
00 following reason.(Section 71131.5,Business and Re,confns Code:Any city as county
$ which requires n permit to construct.plane Improve,de Permit
t or repair my ismctmc
y that he its issuance. requiter lhevisiocanl(a,Connctor.Lt...gacdstammcm
0 (ems inmi.j;witpursuant mthe ProvisionsofNeConuxsohLittnxLaw(ChaPmr9 Sq.Ft. Floor Area Valuation
(commencing with Section nand)of Division 3 the
Ilse alleged
exem pt on.An inns Cade)or
$ Net M u eumpt therefrom and Om breis for the alleged eumption.Any violation of
Section 7031.5 by any applicant for a permit subjects me applicant in a civil penally of 3 @a%2 lA*er0 0 Occupancy Type
nos mom than Ove hundred dollars($500).
0 1,as owner of the property,Or my employees with wages as their sole compensation,
will da Ihework,and the structure is nolinumbal craffered forsale(Sec.7044,11usiness
and Pmfaseions Code:The Conuacmrs Licenx Law does runt apply to an owner of Required Inspections
property who builds or im proves thereon,and who docs s uch work himself or through his
own employees.provided that such Improvements an not intended oro@red forsale,if.
however.Ne building or improvement la sold within one ysn of completion,the owneo
builder will ham the burden of proving Nes he did not build or improve for purpose or
ssleJ.
0 1,as owner of the property,am exclusively contracting wird licensed ro.=,a.la
construct the project(Sec.7044.Business and Professions Code:)The Contractor's U.
cove law does not apply to an owner of propeny who Wilds or improves Unman.and
who contracts for such projects with a conuacmr(s)licensed pursuant to me Contractors
License Law.
0 lamuempsonder Seca ,B&PCfimthisreason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby afRnm under penalty of perjury one of the following declarations.
T have and will maintain a Certificate of Cement to xl6insure for WorknesCompcn-
setion,ssprovided for by Section 3700 of Ne Labor Code.fat the performance of the
work for which ria permit is issued.
0 I have and will maintain Worker's Compemauan Iocurmce,as required by Section
3700 of the Labor Code.for me performunee or the work for which this permit is issued.
M Worker.ComPensetionlnsumncceanicrmdPoliry go- W
Came. r F Policy No.;
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed hits,Permit is Torose hundred doll am(SIM)
nr less.)
1 certify that in the performance of the work for which this permit is issued.l shall not
employ any person in any m namrso u to become subject to the Workers'Compensation
Laws of Calif..!..Data
Applicant
NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should
become subject to one Wort Campcnuuon provisions of the Leon,Code,you must
.`0 fonhwith comply with such provisions or this permit shall be dccmrd mvnked. '
'y ryN.. CONSTRUCTION LENDING AGENCY
[—t k far which this
than them issued(Se.constructionlending agency l'nr me performance of
E
the work fur which Shia permit is issued(Sec.J097,Co.C.)
Q
Le
nder'a Name
Lenders Addnesr
L)Q I cenify that I have mad this application and nam that the above information is
cancel.I ague to comply with all city and county ordinances and sante laws relating to
0U building conswnion,and hereby nomadic mpmxnmtins of this city to enter upon the
l.[7 above-mentioned pmpeny for inspection purPosnas.
py (We)nems to rove,indemnify and kap harmless the City of Cupcnino against
h
liabilities,judgmental,costs and expenses which may in any way accrue against mid City ,
U Z in consequence of me granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON�POINT Issued by: Date
SOURCE E ULATI0 �Z S
s-
Re-roofs
Si tuts ofApplicaHDem
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant nom or handle Health and
az k,Sed io Ilse Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
ode.sc0cties zss3z(a)? All roofs shall be inspected prior to any roofing material being installed.
Yes �Na
Will 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 hammons air contaminants as krined by the Bay Area Air Quality Management all new materials for inspection.
7DW,ict?
❑Yes 4tNoI have mad the huxerdoussmmaterials requirements under Chapter 6.95 of Jan Califor.Heath&SafnyCodc,Sado.35505,25533 and 25534.1 understand that ifthe(wilding ���cs nos currently have a mount,mal it u my msponsollity notifytheacupmtofme ��uirem i• `ust met 'or so its ance of a Cc toOccu rya
J -se-OL S• naureofApplicant Date
Owner or am orizcd agcnl Dam All roof coverings to be Class "B"or better
• - Community Development
aClOF
10300 Tone Avenue
Cupertino CA 95014
Telephone(408)777-3228
Fax(408)777-3333
ICUPEkTINO
Building De artment
JOB ADDRE%S;r RMIT #
K W
OWNER'S NA -
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors:
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 Irmo cS-
Septic Tank
Sheet Metal
Sheet Rock
Tile
OvTr6contractorXignature Date
10/28/03
� y
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408) 777-3228
U I'E INTI N O Fax: (408)777-3333
Building Department
Subject: Re-roofing policy for the City of Cupertino
1.1 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.
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: I<, /
OiSEZ-r l,N19uo-
Job Site Address: ( OW& W I LLOWEWOK LJP& .
Roofing Company Name- S S d Z
A plicant's Signature: Date:
Io ,
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN# 3 Date:Z _ v 517-009 .
Building Address: 1 I_
�m (o W 1 �� Ot.l1jYODF wo,Id
Owner's Name: �`- �� � Phone#:
YX ((08 2,5� - ss -0
Contractor: hone#: License#:
S 0 v0 ln� �yyc qog 671 ��UD 79 2Z
Contact: hone#: Cupertino Business License#:
w..0 • X63 &zq 21100 'u-�S7
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
Asphalt Shingles � Asphalt Shingles
�' Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings Z ❑ Provide I.C.B.O.Report#
To be Removed ❑ Provide Mfgr.Installation Specs.
I/Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: Kia, Z 'lrr! woo 1, Gd"^P o,v tv,S-}ct1I Sd -c-ow
0VRLr i5/3Z, C). S .e sro k
Residential Commercial
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Det. if
there are any restrictions: LJ
Cost of Project: 'i Type of Construction Occupancy groups
Qt
AplKliq6blFee ID Fee Description Fee Group
BPERMFEE Bld Permit Fees BUILDING
BENERGY Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
2, /