07060082 CITY OF CUPERTINO
BUILDING DIVISION PERMIT GdlTktii10T± R I }� IfaN:
PERMIT NO.
rBIUILEJff�ADDRES ANSDALE AVE WESTSHOLE ROOFING COMPANY 07060082
lJ PERMIT ISSUE DATE
WNER'S NAME:
YEARY HERBERT E AND PAMELA L 2814 AIELLO DR 06/12/2007
SANITARY NO. CONTROL NO.
JNE:
(4 08) 694:-0060
BUILDING PERMIT INFO
ARCHITECT/ENGINEER:
BLDG ELECT PLUMB METH
0
p Q LICENSED CONTRACTOR'S DECLARATION Job Description
1 hereby affirm that I am licensed under provisions of Chapter 9(commencing
ZU with Section 7000)oCDivision3ofthcBusinessandProfessionsCode,/gndmylicenseis REROOF—REMOVE (E) INSTALL COMP OVER 15/32" OSB,
.r<y in full force and effect. ZZ / 3 O
r ? License CI s Lam•N
LOU Date Contractor Q SQUARES, CLASS A
� ARCHITECTS DECLARATION ✓ Q
J a J I understand my plans shall be used as public records
)yU
U.f' Licensed Professional
y OWNER-BUILDER DECLARATION
> 1 hereby affirm that 1 am exempt from the Contractor's License Law for the
3 p O following reason.(Section 7031.5,Business and Professions Code:Any city or county
e m which requires a permit to construct.alter•improve.demolish•or repair any structure
z prior to its issuance,also requires the applicant for such permit to rile a signed statement Ft.Floor Area r Valuation
_ that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 q $14 5 0 O
2 t-$ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
,,5.. 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 3 6 912 0 0 Aftl Number Occupancy Type
not more than five hundred dollars($500).
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.).
❑1,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 Contractor's
License Law.
C]I am exempt under Sec B&P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
1 have and will maintain a Certificate of Consent to self-insure for Worker's Compen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
0 1 have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My corker s C
Carns�(t n Insrtyance carrier and P Policy nu ate
rri
r�Q•.�- C t, `^a1/t�l Poli No.:
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 the performance 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 Worker's Compensation provisions of the Labor Code,you must
,J O forthwith comply with such provisions or this permit shall be deemed revoked.
Z" CONSTRUCTION LENDING AGENCY
[~r rA I hereby affirm that Were is a construction lending agency for the performance of
(Y> the work for which this permit is issued(Sec.3097,Civ.C.)
W Q Lender's Name
z L.cndersAddress
U C) I certify that I 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
Ubuilding construction,and hereby authorim representatives of this city to enter upon the
a above-mentioned property for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
Hliabilities,judgments,costs and expenses which may in any way accrue against said City ! /J
U,Z in consequence of the granting of this permit. Dace
�. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
SOURCEATIONS.
/� ��Z v�t* Re-roofs
Signature o Applicant/Contractor Dare Type of R sof
HAZARDOUS 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.,hall 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 i! installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new m iterials for inspection.
District?
❑Yes ❑No
I have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Heal W&Safety Code,Sections 25505,25533 and 25534.(understand that iCthe building
docs not currently have a tenant,that it is my responsibility to notify the occupant of the
require n It It must be met prior to issuance of a Ccr ifica of occupancy. Signature of Applicant Date
—IZ o7 All roof coverings to be Class"B"or better
Owner or authorized agent Date
CITY OF CUPERTINO
2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: suew
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN 36912009. 00
DATE ISSUED. . . . . . . : 06/12/2007
RECEIPT #. . . . . . . . - : BS000001616
REFERENCE ID # . . . 07060082
SITE ADDRESS . . . . . : 10350 LANSDALE AVE
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . .
OWNER YEARY HERBERT E AND PAMELA L
ADDRESS . . . . . . . . . .
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4516
RECEIVED FROM . . . . : WESTSHORE ROOFING
CONTRACTOR FOWLER, PAUL LIC # 21417
COMPANY WESTSHORE ROOFING COMPANY
ADDRESS 2814 AIELLO DR
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 14, 500 . 00 223 .56 0 .00 223 .56 0. 00
BSEISMICRE VALUATION 14, 500 .00 1. 50 0 .00 1 .50 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 225 . 06 0 . 00 225 . 06 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 225 . 06 3013
---------------
TOTAL RECEIPT 225. 06
Jun 11 07 05:03p WedShore Roofing (408)213.2387 p.2
' • 13w'lding Division
I0300 Tom Aveauc
C mliao,CA 95014-3255
Tekphoac: (408)777.3228
0aw,
- Fax (408)777-3333
�t��EF�T�NO
Building De agent
Subject: R eroemg policy for the City of Cuperfmo.
1. Prior to Fermat issuance,you mast agree to comply with 1997 TJBC Standards
and manufactures specifications on reroofing.
2 .New roof coverings shall not be applied without first obtaining all inspection
sand written approval from the building inspector.A,final inspection and
approval shall be obtained from the building inspector when the reroofing is
completed.
3. All roofs shall be inspected prior to any roofing installation.
4. To receive a final sign off from tine City the following steps are required.
1) Freinspection and/or tear off approval.
2) In progress inspection approval
3) Final inspection approval
a) $park arrester installation
5. If plywood is installed,a plywocd nail inspection is required.
6. ,Any roofing which is applied without first obtaining an mq eetiorn,will
require the removal of all new material down to the sheathing so that the
Proper OtY inspection can be pe:donned.
MWORTANT:
I. Flat roofs must have a minimmm of 14"per fcsat 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 of inspection.
We understand the above policy or, reroofing and will comply with this policy.
I•fomeownersName: Y'6
Address: .
Reroofing Company, e: 1 S d fid.
Applicants signature: —Date.6 ,��/
Joe Antonucci
(Odef Building Offjal)
W25/0i
Jun 11 07 05:04p WestSbre Roofing (408)213.2367 p.3
Community Development
10300 Torre Avenue
SIS
Cupertino CA 95414
Telephone(408)777-3228
Uff OF Fax(448)777-3333
CUPEkTINO
Building D e artm ent
JOB ADDRESS: PERMIT
OWNERS NAME: PHONE #
GENERAL CONTRACTOR
I am not using any subcontractors,
Signature Date
Please check applicable subcontractors and com tete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets&Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring:Carpeting
Linoleum/ Wood
Gass/ Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Y-A �4
Ilo
Owner/Co tractor Signature Date