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07080031 CITY OF CUpERTIN0 BUILDING DIVISION PERMIT -- PERMIT NO. BUILDING ADDRESS: 1167 CRESTLINE DR WESTSHORE ROOFING INC 07080031 PERMIT ISSUE DATE OWNER'S NAME: STANLEY KUO 2814 A SA ARCONTROL NO. rE: (408) 694-0060 BUILDING PERMIT INFO ARCHITECT/EN 3INEER: BLDG ELECT PLUMB MECH Z LICENSED CONTRACTOR'S DECLARATION Job Description O F i hereby affirm that I am licensed under provisions of Chapter 9(commencing wit6Scction70(x))ofDivision3ofthcBusincssa ofcssiuns ,�ndmylicense is REMOVE (E) METAL ROOF. INSTALL PACIFIC METAL TILE in full force and effect. 2 IQQ Z_ Lie" 1 s V Lle-n TO (E) ROOF AND NEW ADDITION 30 SQFT CLASS A o Date Contractor �? ARCHI-IECi-S DECLARA 10 1 understand my plans shall be used as public records U ti Licensed Professional OWNER-BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the 0 following reason.'(Seclion 7031.5,Business and Professions Code:Any city or county �i which requires a permit to construct,alter,improve,demolish,or repair any structure } prior to its issuance,also requires the applicant for such permit to file a signed statement ; ,Ft.Floor Area Valuation 0 that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 q $24360 e (commencing with Section 7000)of Division 3 of the Business and Professions Code)or ° that he is exempt therefrom and the basis for the alleged exemption.Any violation of pN Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 362290 3 8AD 0 Number not more than five hundred dollars(5500). ❑I,as owner of the property.or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections and Professions Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for sale.If. however,the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contracwrs U- cense Law docs not apply to an owner of property who builds or improves thereon,and. who contracts for such projects with a contractors)licensed pursuant to the contractors License Law. p I am exempt under Sec B&P C for this reason Owner Dale WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations have and will maintain a Certificate of Consent to self-insure for Workers Compen- anon,as provided for by Section 3700 of the Labor Code,for the performance of the work Cor which this permit is issued. ❑I have and will maintain Workers Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Worker' cs or�tsps Insutantc Cartier and Policy nut{tb O/ O Q Cartier.S�IIf'WWW��f�` VN\ Policy No.: LV• CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or less.) I certify that in theperformance of the work for which this permit is issued.I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California.Date Applicant NOTICE TO.APPLiCANT:If,after making this Certificate of Exemption,you should become subject to the Workers Compensation provisions of the Labor Code,you must O forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of > the work for which this permit is issued(Sec.3097,Civ.C.) a Q Lenders Name Lender's Address 0 I certify that 1 have read this application and state that the above information is r correct.I agree to comply with all city and county ordinances and state laws relating to U building construction,and hereby authorize representatives of this city to enter upon the y (7a above-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against y liabilities,judgments,costs and expenses which may in any way accrue against said City V L �Z in consequence of the granting of this permit. Date P" APPLICANT UNDERSTAND AN WILL COMPLY WITH ALL NON-POINT Issued b): SOURCE REGULATIONS. Re-roofs Signature of Applicant/Contractor Date Type of Roof MATERIALS DISCLOSURE yp Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Code,section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes ❑No Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, agree to remove .it hazardous air contaminants as defined by the Bay Area Air Quality Management all new r iaterials for inspection. Jistrict? C3 Yes ❑No / 1 have read the hazardous materials requirements underchapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505.25533 and 25534.I understand that if the building docs not currently have a tenant,that it is my responsibility to noufy the 9ccupant of the Date requirements which be et prior to issuance of a Certificate of Oc o S ignaturt:of Applicant All roof coverings to be Class"B"or better Owner or authorized hent Date Community Development -.; 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 Fax(408)777-3333 CITY OF CUPEkTINO Buildin De artment JOB ADDRESS: PERMIT # x`67 c�esN.cr� d OWNER'S NAME: qn� - �pN �!0 PHONE -4, b$ g`Ig- GENERAL CONTRACTOR: ,$t4p(e 0 'Z l�C FAX# - I am not using any subcontractors: Date Signature Please check applicable subcontractors and com Tete the followin information: SUBCONTRACTOR BUSIN ESS 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 g 6 It -� Date owner/Contractor Signature CITY OF CUPERTINO 2 ITEMS OF 4 PERMIT RECEIPT OPERATOR: CathyS COPY # 1 Sec: Twp: Rng: Sub: Blk : Lot: APN 36229038. 00 DATE ISSUED. . . . . . . : 08/06/2007 RECEIPT #. . . . . . . . . . BSC00002259 REFERENCE ID # . . . : 07C80031 SITE ADDRESS . . . . . : 11E7 CRESTLINE DR SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . . STliNLEY KUO ADDRESS 1167 CRESTLINE DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-5034 RECEIVED FROM WESTSHORE ROOFING CONTRACTOR PAUL FOWLER LIC # 21417 COMPANY WESTSHORE ROOFING INC ADDRESS . . . . . . . . . . : 28'_4 AIELLO DR C CITY/STATE/ZIP . . . : SAN JOSE, CA 95111 TELEPHONE . . . . . . . . : (408) 694-0060 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- - --------- ---------- BPERMFEE VALUATION 24, 360. 00 331 .56 0. 00 331.56 0. 00 BSEISMICRE VALUATION 24, 360. 00 2 .50 0. 00 2_ ------ 50 0_00 ----- TOTAL PERMIT . 334 .06 0. 00 334 . 06 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- ------------ CHECK 570. 02 3021 --------------- TOTAL RECEIPT 570. 02 CITY OF CUPE `I"INO t „ G C U CITY Of PERMIT APPI✓ICATION FORM APN# 3 C��/` 2 y �v Date: �q / U J U U Building Address: 1/67 UeSH W C?wner_'s Name: � G1 to� Phone#: Contractor: (PS n00 E(0_5 I0,C License#: 7 7 Contact: �. ner- CupertinoBusiness License #: W I Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles ❑ Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles / r El Other(Specify) L1 Other(Specify) M�Ir000 Number of existing coverings l ❑ Provide I_C.B.O. Report# p/I`o be Removed ❑ Provide Mfgr.Installation Specs. I Have Read,Understand and Will Comply With Cu 3ertino's Tear Off Policy: ^ Job Description: I o�� 1 Q OA ,71�C,1'flhG� a C �'LG tocrw V-00 a,&A�Q- 1��In/ GID�OC( t01� Residential Comme al ❑ 30 9( CW,�5 A Fire Zone: Yes ❑ No Confirmed with Planning Dept. if there are any restrictions: Cost of Project: Type of Constru,:tion: Occupancy group: S F g- ' 2A(3bd Re, 9-00r- Qty.- -00FQty:if Applicable Fee ID Fee Description Fee Group BPERMFEE 3ldg 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 Telephone: (408)777-3228 Fax: (408)777-3333 Building Department Subject: Re-roofing policy for the City of Cupertino I_. 1'1101 to pern]it 1ssIILIrice, `TOLL insist �OIIIFi W I I h 111-)) t 11 L SLcIEld 11�a 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 bui:ding 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 appro jal. 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 Raid before another inspection can je 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 tae job site at the time on inspection. I understand and will comply with the above stated policy on re-roofing. Homeowner's Name: A " C�,\,yj L KBO Job Site Address: 010,_1 C4 6-V ', "I Roofing Company Name: VV �S J�V'C _ � \�C' Applicant's Signature: Date: 0 ` Greg Casteel Building Official Revised 11/2/04