08100067 CITY OF CUPERTINO
BUILDING.DIVISIOr'r PERMTTC�1V�TRAQT++> RIN'EURMA'I'ION '
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Bu1LD�rtDgopj3EsLARRY WAY WESTSHORE ROOFING INC P08100067
OW NER'SUNA4MES: PERMIT ISSUE DATE
SEKINE OSAMU AND MISAO 2814 AIELLO DR C 10/13/2008
NE: SANITARY NO. CONTROL NO.
(408) 694-0060
ARCHITECTiENGINEER: BUILDING PERMIT INFO
'BLDG ELECT PLUMB MECH
(� 0
o o LICENSED CONTRACTOR'S DECLARATION
rdi I hempy affirm Nat 1 am I'uensN under previsions Of Chapser 9(cwnmuuing Job Description
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secion'Mal,ofD!vmion 3 of&Business and Profiedians Cattle,and my license is RE-RF RMV EXT WDSHK INSTL 1/2"OSB FLT 40 YR CMP
in full(me and eFract.
Licennsa lac.g - CLS A 266Q
qqq Da¢ Lic.#
`q ARCHITECTS DECL,RA
L 2 1 uMcrsund my plans shall W used a public mcaNa
ed
eco t; Licensed professional
OWNER-BUILDER DECLARATION
<E I hereby affirm the I am.,up(from Ne Comramof,License Law for IW
C O following mann.(Setiod 7031.5,Business and Professions Codc:An,city or count
which requires a Permit in condone.aha,impmxe.demolish,or¢pair any structure
_Zy prior to its issuance.alsom7ui.fk applipm to,such permit to file a signed sammce,
dw he is licensed pursuant W the provisions of the Comxcmfs lams,Law(Chapte,9 Sq.Ft.Floor Area Valuation
z�g (commencing wild Sec0on 70W)of Division 3 of the Business and Professions Code)or $13000
yu Na he is exempt therefore std de basis for the alleged esemm .Any violation of
Sneaked 70313 by any,applicant fm a permit mpjccu the applicant le a civil penalty ofNumber
nomart art Nae five hundred dollars(5500). 316 0 2 012 !Vp Occupancy P Y Type
I,u owner of On pmpaty.or my employees wild wages as their sets compeaaden,
wall do Newark and Ne struauns 6 act Warded or offered for sale(Sac.7(566.Summus
and Prormom Cie:The Cantracmr's Liana law since mat appy in an awner of Required Inspections
property wide Wiidaoimpmves thvcon,andwho doessuchwork ltimselfathuough his
own employ=.provided Nat such improvements are not intended oroffered for ands.It.
however.the building or improvement U mid within ane year of completion,the nwner-
huilda will love the launched of proving that W did on,Wild sur improve for Persons of
ale.).
❑1,u Owner of the property,am exclusively computing with lisped contractors to
construct de project(Sec 7004,Business and professions Code:)The Contracmr's V-
cents Law does not apply to an owner of proper who Wilds or improves thereon,and
who contracts for such projects with a concramar(s)Bcened pmuant to lds Commuter's
License Law.
❑l am exempt under See .B k P C for Ws mason
Ower Data
WORKERS COMPENSATION DECLARATION
I hereby Nem anchor penalty of perjury ora of the following decimations:
I have and will maintain a CrNficale of Consent to calf-Ipua far wurcces Comped-
"ore.u provided fa by Section 3700 of the labor Cade.for the performe a of the
work(o which Nu permit is named.
1 have and will dolman Worker's Compensation Resonance,as required by section
3770 of the latter Calc,for lde perfarmrce of the wort far which this permit is issued.
Myworks/s'ChpKarem n Lim prim and Policy number art�:yLL�
Carrier. ,Till c �Dc� PolicyNo.,3(�GLA7—� 13
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
mus sacaico nsad ret W conplcmd if the permit ts foramen henmW denses(SILO)
or len)
1 Qualify dmt in the performance of the work(or which this permit is Wood.I than not
employ any pecan in my Warner an as m became subject in Oe Workers'Conpenadon
Lam of Califomia.Date
AMR.,
NOTICE TO APPLICANT:If,after making this Cenificam of Exemption,you should '
,acme subject in lde Worker's Compensation provisions of the Labe Code,you maw
.J 0 forthwith comply with such provisions or Nuam
peit anal de dcemed¢rated.
Z '-' CONSTRUCTION LENDING AGENCY -
.y., 1herb a(Rrm the there isacmorideimm leading a
F Y e genet Tor ldc perrurmamx of
Lathe work fur which this permit Is Round(Sas.3(191,Civ,C.I
EUnder.Name
rnde
z Ir's Addrtv
V 0 1 certify that I have read this application and sum that the Stuart informadun is
fy E nonan.I qme m comply with all cit cad county oNiames and site taws missing On
0 Wilding conswnion,aM Wmby authorise repmsentativeaof Nu city memaupnn lK
rye+, shove-m antioed pmpertY(or inses
cciom pumpots
E CL (We)agree to aur,indemnify and keep humbleas the City of Cupertino against
f/1 fimilitip,judgmenncostsandexpenses which may manywayacome addraustud City
C)z in censequcnce of the granting of this pendia
F-m APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date / .f-6-1
SOURCE REG NA I(2'b
to J Re-roofs
Signature afA IipHAZARDOU Data
Hans or fD0US MAng accuS DISCLOSURE Type Of Roof
Will theapplicantnofuture Wildinge.Chaptsmreorand Health
asd Safely u defined by the Cupertino Municipal Code.Chapter 9.13,and the Health and Safety
Code.section 25532(+)+
❑Yes ON. All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future Wilding Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
IL
haaNna air camaminanu as defined by the Bay Ama Air Quality M....cmcm all new materials for inspection.
ct1
QYp 0NLN
I have mad die baaadnusmemriala mquirements umkr Chaper6.95 afthe Cali(ar.
doesO th&SaRty Cade,Sepia,dod it as my i am125536.1 undersand a occu c Wilding
dao rot currtndy ham•,.....L that It p my mapontittility b Imply de as pant of die
mqu" �++which maw hemet prior in mendicants Ccrufseae ofQ
A 1 . 10073 . Signature of Applicant Date
Owns or mthorirsd agent Date
All roof coverings to be Class'1?"or better
' CITY OF CUPERTINO
• 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Seo : Twp: Rng: Sub: Blk: Lot :
APN 31602012 . 00
DATE ISSUED. . . . . . . : 10/13/2008
RECEIPT #. . . . . . . . . : BS000006329
REFERENCE ID # . . . : 08100067
SITE ADDRESS . . . . . : 10643 LARRY WAY
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : SEKINE OSAMU AND MISAO
ADDRESS . . . . . . . . . . : 10643 LARRY WAY
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2056
RECEIVED FROM . . . . : PAUL R FOWLER
CONTRACTOR . . . . . . . : PAUL FOWLER LIC # 21417
COMPANY . . . . . . . . . . : WESTSHORE ROOFING INC
ADDRESS . . . . . . . . . . : 2814 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
---------- ------------ ---- --- ----- --------- ----------
1BSEISMICR VALUATION 13 , 000 . 00 1 . 30 0 . 00 1 . 30 0 . 00
1REROOFRES SQ FEET 26 . 00 338 . 00 0 . 00 338 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 339 .30 0 . 00 339 . 30 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER i
------------ --------------------
CREDIT CARD 339. 30 MC
---------------
TOTAL RECEIPT 339.30
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ----------------- --- -------- - -------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
Community Development
N 10300 Torre Avenue
F 1` Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
4UPERTINO
Building De artment
JOB ADDRESS: 1061'? l . Y✓ /4 l� PERMIT #
l�G; Y Wei 1 0(?-164 CIO S 7
OWNER'SNAME: MlSGtc' 5)eK-111-e PHONE # ZL�
GENERAL CONTRACTOR: k&le FAX # /
I am not using any subcontractors: IO { 0/0
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
Septic Tank
Sheet Metal
Sheet Rock
Tile
RKA, o
3 .og
Ownerr/Contractor Signature Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
STelephone: (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 2007 IBC Standards
and manufacturers specifications on re-roofing.All roofs are Class "A"per Cupertino
municipal code 16.04.080.
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$176.18. The re-inspection fee must
be paid before another inspection can be scheduled.
IMPORTANT:
1. Flat roofs must have a minimum of 1/4 "per foot slope and demonstrate
that there is no ponding.
2. An I.C.B.O. report is required to be on the job site at the time on inspection.
I understand and will comply with the above stated policy on re-roofing.
Homeowner's Name: M tea O Se 1<<�•I�
Job Site Address: `Qp ` �3
Roofing Company Name: ecV S �Lof L
Applicant's Signature: 1'W\ Date: /1) 63l a b
• Greg Casteel
Building Official
Revised 07/30/08
J � 00 o c--7
CITY OF CUPERTINO
C REROOF
.CUPEVINO PERMIT APPLICATION
APN # / U o2 U U U Date:
Building Address:
Owner's Name: 6 f7 l lam' 1 l Phone #:
Ivt �4
Contractor: Phone #:: �/s G�.SG —oZza
✓V1°SK5kc)4e �of"G l k-L Fax #: `W —003
Cupertino Business License #: Contractor License #: ?872,2/
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles X Asphalt Shingles
Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings / ❑ Provide I.C.B.O. Report #
�( Tobe Removed ❑ Provide Mfgr. Installation Specs.
Job Description: �e"oye "(shpC (�� S GZ)q� �K$� V,?," oS�
def f j �O J S�i� ConfP
Residential Commercial
Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if
Green Building Checklist & attach it to the application or if there are any restrictions: ❑
applicable, include in plan set & the sheet index.
Valuation:
I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
Signature vv�
Revised 6/16/08
RI CITY OF CUPERTINO
�
REROOFCIT j
CUPEI,TINO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1RER00FC0M Re-roof Commercial B 1C6MMLROOF
1BSEISMICO Seismic Commercial B
1REROOFRES Re-roof Residential B 1SFDWLROOF
2G
1BSEISMICRE Seismic Residential B
1RER00FMRES Re-roof Multi-Family B 1MFDWLROOF
1BSEISMICRE Seismic Residential B
1BUSLIC Business License B
Revised 6/16/08
•