09040133 CITY OFC J ERTINO
BUILDING DIVISION PERMIT '� � �� � '
;.:.
PERMIT NO.
BUILDING ADDRESS:
7504 H E TSH PERMIT ISSUE DATE
OWNER'S NAME:
S A CONTROL NO.
(4 08) 69 1-0060
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB ME�CH
p C LICENSED CONTRACTOR'S DECLARATION fob Description
K m 5 I hereby affirm that I am licensed under provisions of Chapter 9(commencing
t Z ro with Section 7000)of Division 3 of dire Business and Professions Code,and my license is
e<c, in full force and effect. �- Za RE-RF RMV EXT WDSHK& INSTL GERARD STN CTD STEEL
D n z License Class Contractor RF S Y S C L S A 25 . 5 S Q
= Date
ARCHITECTS DECLARATION
a< 1 understand my plans shall be used as public records
era
�yU
L C y Licensed Professional
OWNER-BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractors License Law for the
%p o following reason.(Section 7031.5,Business and Pmfessions Code:Any city or county
{i m 9 which requires a permit to construct.alter,improve,demolish,or repair any structure
.3 prior to its issuance,also requires the applicant for such permit to file a signed statement Sq.Ft.Floor Area Valuation
73< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9
x H (commencing with Section 7000)of Division 3 of the Business and Professions Code)or514626
that he is exempt therefrom and the basis for the alleged exemption.Any violation of APN Number Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars(5500). 36229016 . 00
0 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
sae.).
❑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 U-
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.
Q 1 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:
I have and will maintain a Certificate of Consent to self-insure for Workces 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 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 Worker's Compensation Insurance carrier and Policy number am:
Cartier. s'"To •�'''"' Policy No.:0(500/37'a
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars($100)
or Icss.)
1 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
Lawsof 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
Z forthwith comply with such provisions or this permit shall be deemed revoked.
Z 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.)
W A Lender's Name
Z Lendees Address
V C) I certify that I have read this application and state that the above information is
LL" correct.1 agree to comply with all city and county ordinances and state laws relating to
c Vbuilding construction,and hereby authorize representatives of this city to enter upon the
W ahove-mentioned property for inspection purposes.
Q.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
CA liabilities,judgments,costs and ex rises which may in any way accrue against said City
V Z in consequence of the granting thi rmit. Date
►� APPLICANT UNDEItSTA S A WILL COMPLY WITH ALL NON-POINT Issued by:
SOURCE GU ATION
----- Re-roofs -
Sign reofApplicant/Conuutor Dare 'I' of Roof
MATERIALS DISCLOSURE Type
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.
0 Yes �<No
If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use equipment or devices which
.nil hazardous air contaminant defined by the Bay Area Air Quality Management all new r aaterials for ins ection.
District?
Yes o
I have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building —.--
docs not currently have a ienan i n my responsibility to notify the occupant of the Date
requirements wh' most be l prio issuance of a ce r]icat�f 0ccupprrdy. Sign tur,:of Applicant
/ /�/a All roof coverings to be Class'j "or better
Date
Ow authorized agent
npr 24 2009 2: 32PM Westshore Roofing, Inc 4084560233 page 1
c/ U 13_3
CITY OF (-UPtRTINO
REROO#
CUUPERT NO PERMIT APPLICATION
APN # �� 0 Date: Z t)
Building dress:
Hoficrr^
Owner'sName: � YOgA �
Phone#:.
HOA: Yes Lj Noff If yes. Provide letter fro HOA
Contractor: �QS-tShpC�'L -�1�� �,n� Phone #: c.fo�.YS"b-p Z,O O
FaX #• YoS ys6 -oZ33
Cupertino Business License #: Contractor License#:
• �2z l
Type of R�3of Covering:
Existing: Proposed:
o Built-Up Roof o Built-Up roof
. 0 Asphalt Shingles o i Asphalt Shingles
W od Shakes o' Wood Shakes
o Wood Shingles o Wood Shingles
Li O er(Specify) ` Other(Specify)6°ird JA0( Coorlcd l
Number of existing coverings Provide LC.C.E.S. Report# ��5� /,Y,?/
To be Removed a, Provide Mfgr. Installation Specs.
Job Desc 'ption: gq~vt"**4e eooc-tIS1
�no� s�S•fiew� . Class A
Residenti I)21 Commercial EJ
Green B ilding: Please complete relevant portion of the Confirmed with Planning Dept. if
Green Bi ilding Checklist & attach it Ito the applicatioii or if there are any restrictions: ❑
a licab a include in plan set & the sheet indcx.
Valuation: 6 U . cg
I Hav R ad, U rstand and Will Comply with Cupertino's Tear-Off Policy:
signator
i
Revised 02/05/09
Rpr 24 2009 2: 32PM Westshore Roofing, Inc 4084560233 page 2
CIT)( OF C'UPFRTINO
RERO WR,
CUPE�T NO FEE SC'HEDtLE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1REROOFCOM Re-roof Commercial B 1COMMLROOF
1BCBSC Cal Bldg ')tandards B ALL PERMIT TYPES
Commission Fee
1BSEISMICO Seismic Commercial B
1RROOFR.ES Re-roof Residential B iSFDWLROOF
E
Z-S
1BCBSC Cal Bldg'Standards B ALL PERMIT TYPES
Commission Fee
1BSEISMICRE geismic R esidential B
1REROOFMRES Re-roof Multi-Faml ily B 1MFDWLROOF
p 1BCBSC Cal Bldg Standard`s B ALL PERMIT TYPES
l� Commissi on Fee
1BSEISMICRE Seismic R esidential B
1 BUSLIC Business License B
I
i
N
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
Fax: (408)777-3333
Building Department
Subj ect:. 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 r,!-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 buildir.g inspector. A final inspection and
approval shall be obtained from the b-iilding inspector when the re-roofing
is completed.
3. All roofs shall be inspected prior to ar.y 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 Raid before another inspection can be scheduled.
IMPORTANT:
1. Flat roofs must have a minimum of 1/ "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 aboi,e stated policy on re-roofing.
Homeowner's Name:
Job Site Address: Y 9S 0/y -
Roofing Company Name: l,J S T i 4 A-r
Applicant's Signature: Date: y�YA.
Greg Casteel
Building Official
Reviled 07/30/08