07090093 .777777777
CITY OF CUP,.ERTINO �T
BUILDING DIVISION PERMIT
BUILD N MSS: PERMIT NO.
MANN DR WESTSHORE ROOFING INC 07090093
OWNER'S NAME: PERMIT ISSUE DATE
LAI JACK K AND GLORIA H 2814 AIHLL0 DR C 09/14/2007
NE: SANITARY NO. CONTROL NO.
(4 08) 69r6-0060
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
i p Q LICENSED CONTRACTOR'S DECLARATION Job Description
m p:. I hereby affirm that I am licensed under provisions of Chapter 9(commencing
z� withSccdon7000)afDivision3oCthcBusincssandProfcssiunsCodc,andmylicenscis REMOVE 1;XISTON WOOD SHAKE AND INSTALL ASPHALT
H in full force and effec
.v24 License C17. Lte.ri Z" SHINGLE.
y o Datc Contrantor
ARCHrrEi DELLA TIOrT
C U I understand my plans shall be used as public records i nC
a
m H Licensed Professional
y OWNER-BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the
;C0 following reason.(Section 7031.5,Business and Professions Code:Any city or county
9 which requires a permit to construct,alter,improve,demolish,or repair any structure
Z y prior at its issuance,also requires the applicant for such permit to file a signed statement ,
a that he is licensed pursuant to the provisions of the Contractur's License Law(Chapter 9 r
,,q.Ft.Floor Area Valuation
a H (commencing with Section 7000)of Division 3 of the Business and Professions Cadc)or $11094
that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of �,p Number Occupancy Type
not more than five hundred dollars($500). 32645010 :t7
❑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 oroffered for sale(Sec.7044,Business Required Inspections
and Professions Code:The Contractors License Law does not apply to an owner of q P
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements arc not intended or offered for sale.U.
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 Contractor's Li-
cense Law does not apply to an owner of property who builds or improves thereon,and
who contracts for such projects with a contractor(s)licensed pursuant to the Contractors
License Law.
❑I am exempt under Sec. B&P C for this reason
OwnerLADate
WORKER'S COMPENSATION DECRATION
I hereby affirm under penalty of perjury one of the following declarations:
❑I have and will maintain a Certificate of Consent to self-insure for Workers Compen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
work for 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 Workers Compensation Insurance
carrier and Policy number are:
Carrier._!5a!4 1 e& Policy No.
CERTIFICA •OF EX PITON FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is far ane hundred dollars($100)
or less.)
I certify that in the performance of the work for which this permit is issued.1 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 Worker's Compensation provisions of the Labor Code,you must
Oforthwith comply with such provisions or this permit shall be deemed revoked.
Z' CONSTRUCTION LENDING AGENCY
(--t I heresy affirm that there is a construction lending agency for the performance of
C>!+> the work for which this permit is issued(Sec.3097,Civ.C.)
WC1.Q Lendces Name
Z
Lcndees Address
U O 1 certify that I have read this application and state that the above information is
II4 r r correct.I agree to comply with all city and county ordinances and state laws relating to
Ubuilding construction,and hereby authorize representatives of this city to enter upon the
W above-mentioned property for inspection purposes.
LL (We)agree to save,indemnify and keep harmless the City of Cupertino against
�n liabilities,judgments,toss and expenses which may in any way accrue against said City i
U Z in consequence of the granting of this permit. Date
t-t APPLICANT UNDERSTANDS AN ILL COMPLY WITH ALL NON-PO Issued by:
SOU ATLONS.
l Re-roofs �-
Signature of App t/ ontractor I
D Of R)of
HAZARDOUS MATERIALS DISCLOSURE Type
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Codc.Chapter 9.12,and the Health and Safety
Code,Section 25532(a)? All roofs,hall be inspected prior to any roofing material being installed.
❑Yes fo'
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
emit hazardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
District?
❑Yes
1 have read the hazardous fials requirements under Chapter 6.95 of the Cali
fon-
nia Health&Safety Code,Section 2550�5�e5
34.1 undcrstandthat ifthe building4ignure2)'
does not currently have a tenant,that itn ity to 'fy the occupant of the
deo
rcyuircmcns ni bcmetprior
te o an` fpplieant Da
owner authorized a est Da All roof coverings to be Class"B"or better
CITY OF CXPERTINO
RE AOOF
CUPEkTiNO PERMIT APPLICATION FORM
070 01 D093
APN# 34 -45-olo Date: O
Bu ldin Address:
0400 **Ptw Mo.
Owner's Name: % Phone#:
C-71 CW CA -45 1- --tz.`1
Contractor: License#:
Contact: Cupertino Business License#:
�,brl-e Qom (qo7 6 ct oc>b U 411
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles 42r*'Asphalt Shingles
,Q1 Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report#
JY To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read,Understand a d Will Comply With Cu)ertino's Tear Off Policy:
Job Description: Ow0q
(Zc �
w +G cxi*�i twd 6h A :;n l 11%sigil 1 .a%d
Residential*11 Commercial ❑
Fire Zone: Yes ❑ No- ' Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost;f Prboject: Type ofConstruc;tion: Occupancy group:
t
Qty. if
Applica le Fee ID Fee Description Fee Group
BPERMFEE 131dg 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
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 apprcval.
2) In-progress inspection approval.
3) Final inspection approval.
a) Spark arrester installation.
5. If plywood is installed,a plywood nail:nspecti.on 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: (7 l o r ox L i t
Job Site Address: Jo Ltiga mK n h )(,; kt
Roofing Company Name: weJi'sh(JV-t
Applicant's Signature: Date:
Greg Casteel
Building Official
Revised 11/2/04
CITY OF CUPERTINO
2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: bethe
COPY # 1
Sec: Twp: Rng: Sub: Blk:: Lot:
APN . . . . . . . . : 32(45010 . 00
DATE ISSUED. . . . . . . : 09/ 14/2007
RECEIPT #. . . . . . . . . : BSC00002648
REFERENCE ID # . . . : 07C90093
SITE ADDRESS . . . . . : 10400 MANN DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : LAI JACK K AND GLORIA H
ADDRESS . . . . . . . . . . .
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1141
RECEIVED FROM . . . . : BED' FOWLER
CONTRACTOR . . . . . . . : PALL FOWLER LIC # 21417
COMPANY . . . . . . . . . . : WEETSHORE ROOFING INC
ADDRESS . . . . . . . . . . : 2814 AIELLO DR C
CITY/STATE/ZIP . . . : SAD JOSE, CA 95111
TELEPHONE . . . . . . . . : (4C8) 694-0060
FEE ID UNIT QUANTITY IMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- -- -------- ---------- ---------- ----------
BPERMFEE VALUATION 11, 094 . 00 191. 16 0 . 00 191. 16 0.00
BSEISMICRE VALUATION 11, 094 . 00 1.20 0 . 00 1.20 0. 00
-- -------- ---------- ---------- ----------
TOTAL PERMIT 192 .36 0 . 00 192 .36 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 192 .36 MC
---------------
TOTAL RECEIPT 192 .36