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06080082CITY OF CUPERTINO • r•'. z,"a ='Y r », ° fk `^# f9,',": CONTRA. t,'�OR INFUR`MATT, z BUILDING DIVISION PERMIT a BUILDINGADDRFSS: WESTSHORE ROOFING COMPANY pCKMITNo. 06080082 21030 GARDENA DR OWNER'S NAME: PERMIT ISSUE DATE HARRY PLATZEK 2814 AIELL ONE. SANITARY NO. CONTROL N0. (408)..694-0060 ARCHI7ECr/ENGINEER: BUILDING PERMIT INFO its a 0 0 LICENSED CONTRACTOR'S DECLARATION TT�(v) . O$Crlplt n 4es•� I thereby affirm Nal l am limiued under Provisions of Chapter 9 (Commencing y „ �`r�7�gyR wide Section 70nhcf Division 3.f the Boainess and Prolamin. Code.indm license is en lull on n Z Lk. a l."L}''lY�H REMOVE EXISTING CO i1NP�3I T �0 YEAR COMP Lice. I_w — Dam connector v ASPHALT SHINGLES. CLASS A ARCH(IEC17S DECLARATION A+�(7 y I understand my plans Mu all he used public recorch / I 1. an�g Lkemed Professional DECLARATION OWNER-BUILDERomptFrom yl I hereby Orion that I am exempts the Contractor, Liccnu Law for the an following moon. (Section 703 LS. Business and Pmfeasium Code: Any city SunCountyl.. �. which requires permit m surer the abu. Improve, demolLah are sig any smcmre Cp]'9 Permit t a Its m n sa inquirer the applicant for such pennitso rile a signed schem=e the Contractor's Liamasc law (Cbapmr9 $q. F[. Floor Area aluati�19000 than Wklmcmed Pursuammthe proviaions of that be b ed pursuant (commencing with Sauan 7000)o(Divide. 3 ofthe BusinmatM Profenioas Codc)ur ' that he W exempt therefrom and the basis for the a mical eumption. Any vloladon of ,U N Number Occupancy Type Secdon 7031.5 by any applicant for a permit wbjecu the applicant in a civil penalty Of net more Sun 0w hundred dollars (55(104 32608044.00 Q I, u auras of the propmy, Or my employer with wage as Heir sok eompe"atlon, ns Re uilCd Inspections win de dee werk. and mnswctum is Out intended or o(rovd for ask (Sm. 70th, Buircaa and Profeac ear Cedc The Consensuses Lkue law don ore apply m an aura of q P property, who build, or im Prows thereon, and who does such work himaelf or through his own employe. Provided tho Such impmwm ails am tut intended"offertd for am. IL ' bowem, dee building or improvement is sold within an year ofcmapkum. the owncr- builder will have that burden of proving that he did am Wild or improw for purpose of sakJ. Q I, as owner of she Property, am "elusively contracting with finned Conmctors to constmet dee project (Sec. 7044. Business and Profesdon Code:) The ConmSCIM S U- ceuu law don not apply m an ovnet of property who Milds or impowlt themen. and. who contracts for such projects with a conusnor(s) licensed pursuant m to C4n1mgnOr`S . Limun law, Q laeceamptunder See .B&PCfuthumasoa OwnerDam WORKER'S COMPENSATION DECLARATION I thereby afrim under penalty of perjury one of the following declunloas: 1 Mw aM Sunt mainu)n a CeNBuam of co..i m stir i. for workeescompen- uuen, as provided for by Section 3700 of the labor Cade. for the performance of dee work for which this permit is issued. ve and will maintain Workers Compensadon Insurance, as requited by Section 700 of the labor Code, for Ne performance afore work for which than peri, is issued ' My Wor to Compeputio unnCegkrrMr and Paliry ooOl Cartier. Polley Na: t7 CERTIFlCA OF EMPDON FROM WORKERS' COMPENSATION INSURANCE (Thu Section used not W completed If the permit is foram hundred dellen ($100) or less) I Certify Nat in the performance of the work for which this permit is Wuod, I Shall on, employ any person in any Summer so u in become subject to the Worker' Compensation Laws of Caiifomts. Due Applicant NOnCE TO APPLICANT: If, &clef making this CmiOcem of Exemption, you should become Subject to the Weakens Compensi provision of the Labor Codc, you mus forthwith comply with such provisions a this permit shall W deemed evoked. CONSTRUCTION LENDING AGENCY I hereby a(Bnn Ommarc m agency for the pertormance of s ed (Sm. 30 7, Cing the work for which tide permit u issued (Sec. 309'7, Civ. C.) Pe ' Lendar, i IaMeh Add. i I certify the, l haw Mad this application and sue that the above infmmatiun Is " ` coact. l agree m comply with all city and County ominsoca and rote laws relating m Wilding construction. and hereby amhorim mpreunutiwa Or this City to enter upon the show. mcnduncd property for im,muan ptopous. (We) agree to Saw, indemnify and keep hsmlmss she City of Cupertino agaiast i Iiabilitin,judgmcm. coast and exp. which may in any way... against Said Cityin of the of ' APPLICANT UNDERSTANDS ANDWILLWWILL COMPLY WITH ALL NON -POINT Issuedby: _ Date SOURCE REGULATIONS. Re -roofs Type of Roof Si uu of ApplianUCanuacmr Dam am HAZARDOUS MATERIALS DISCLOSURE WnI the,pPli"nt or fume building Occupant smm"handle hmallous material as dcli ed by me C"Mom' Municipal Code, Chapter 9.13. anal the Heald and Safety coda, Sem an 35533(,)7 QYn All roofs shall be inspected prior to any roofing material being installed. 011. If a roof is installed without first obtaining an inspection, I agree to remove e applicant or fun building occupant man equipment a dcvmU which Will thra mit huxudnus air eonumimar m u de0ned by Can Bay Arca Air Quality Management all new materials for inspection. District? QYn 16N. 1 haw mal the hevudnm materials require== undcrCMPmr6.95 Crum Califor• nia Health&Saletycade, Sc,u=25S05.35533 and 35534. f unM=d thsifum Wilding if docs not currently how a tenant, that It IS my mvpenlhility to runty the accupant or the V royulrcmenu "be. uan¢of. certiificameffkanpanry. "Signature ofApplicant ate m All roof coverings to be Class "B" or better Owner or wthorimd agent Dam " Aug 11 06 1255p WedShore Roofing (408)2132307 p.2 Community Development Department Building Division City of Cupertino 10300 Torn Avenue tUPEkTINO Telephone: (408) 777.3228 Fax: (408) 777.3333 Building Department Subject- Reroofing 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 align 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 in specdon, 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 -rid ready, you will be charged a re -inspection fee of $176.16. The ro-inspection fee must b„£naid before another inspects n can be scheduled IMPORTANT: 1. Flat roofs must have a minimum of t14 " per foot slope and demonstrate that there is no ponding. 2. An I.CB.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 reroofing. Homeowner's Name: //�� job Site Address: 'L10�0 ��GM0 Lr: Roofing Company Nam A& "J0%erC f<a •t -r /rte.. Applicant's Signature: ZW Date: I l i to (a Greg Casteel Building Official • Revised 17 /2/04 PrIAW m Rec>c*o PN*r •.............. 04/04/03 11/10/01 03/25/94 ............... 09/27/04 ............... 08/16/94 ............... 12/20/03 ............... 09/29/96 ............... 02/02/99 ............... 05/16/94 ............... 05/23/99 ............... 05/05/04 ............... 12/06/95 ............... 11/18/02 ............... 07/24/01 ............... 04/20/99 ............... 12/15/94 ............... 11/02/93 ............... 09/11/96 ............... 07/03/94 ------ 06/11/99 ............... 4/17/2006 ............... 07/19/96 ............... 04/24/00 ............... 10/24/00 ............... 10/17/99 ............... 08/09/02 ............... 02/27/98 ............... 10/22/99 ............... 08/13/02 ............... 01/27/03 ............... 10/06/98 ............... .... 06/1....9 8/9....... 04/11/94 ............... 06/16/03 ............... 08/18/04 ............... 04/20/94 ............... 11/29/04 ............... 04/27/94 ............... 03/15/94 ............... 09/12/95 05/28/97 ............... 08/24/00 ............... 04/10/97 ............... 09/03/02 ............... 03/02/04 ............... 07/26/04 ............... 11/11/2000 ............... 0988/00 ............... 03/04/99 ............... 0286/99 ............... 04/03/99 ............... Westshore Roofing, Install list r Y • Aug 11 08 1255p y SCUPEkTINO • E WedShore Roofing (408)2132387 p.4 Community Developmcla 10300 Torte Avenue Cupauuo CA 95014 Telephone (408) 777.3228 Fax(408)777-333) d1ding De artment PERMIT # e PHONE# 0 ..aJ ,..,. 1... 1 FAX # I am not using any subcontractors: Stg1, tune Please check amlicable subcontractors and complete the following information: • Owner on actor Signature ate - SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets 6r. Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum / Wood Class / Glazing Heating Insulation Landscaping Lathing Masonry Ornaaaental Sheet Metal Painting / wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile • Owner on actor Signature ate - Westshore Roofing, Install list 05110/95 __ 10/31/03 ..._ .'•' '� _ .. _. ... __. 11/26/94 ............... 04/07/03 ............... 08/10/96__ - - ............... 08/01/05 ............... _ 07/08/05 _ 09/18/97 _ _______________ 03/15/01 ............... 02/23/05 ............... .. 09/14/04 ............... 05/19/04 ............... ... 10/30193 ........... y, .. .. 04/20/05 ............... ' 06/17/02 ............... 01/21/98 - - ............... 08/31/00............... 11/02/98 ............... 0...... --'--- 04/19/93 1..... 12/15/97 ............... 09/13/00 " ' ............... 03/29/04 ............... , 08/24/00_ _ .08124/00 .............. - • 11/17/94 ............... 06/24/05 1...... 08/02/95 ............... 02/19/96 ............... 04/13/99 ............... _ 06/05/00 ............... . 'Y,• ...... H W;;;; ..... 10/15/97 ............... 06/15/01 ...............- 09/15/95 ............... 05/10/05 ............... 07/28/03 ............... 11/06/98 _ ............... .. 09/20/96 -- 06/23/97 ............... 04/19/96 _______________ " 5/2/2005 ...............- 03/03/04 ............... 03/15/01 _ -- 10/22/97 ' OS ............... • am 1 of 1 PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN .....1..: 32608044.00 DATE ISSUED.......: 08/11/2006 RECEIPT #......... 35612 REFERENCE ID # ...: 06080082 SITE ADDRESS .....: 21030 GARDENA DR SUBDIVISION ...... CITY .............: CUPERTINO IMPACT AREA ...... OWNER ............: HARRY PLATZEK ADDRESS ..........: CITY/STATE/ZIP ...: , OPERATOR: amyw COPY # : 3 RECEIVED FROM ....: PAUL FOWLER 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 --------------------------------- BPERMFEE VALUATION 7,000.00 BSEISMICRE VALUATION 7,000.00 TOTAL PERMIT : METHOD OF PAYMENT ----------------- OTHER TOTAL RECEIPT : • AMOUNT ------------ 137.86 137.86 AMOUNT PD -TO -DT ---------- ---------- 137.16. 0.00 0.70 0.00 137.86 0.00 NUMBER 7 ----------- MASTERCARD THIS REC NEW BAL -------------------- 137.16 0.00 0.70 0.00 137 86 0.00 Aug 11 06 1255p WedShore Roofirg (408)1132397 p.t CUPERTINO CITY OF CUPERTINO REROOF PERMIT APPLICATION FORM APN # Bldg Permit Fees Date:.17 BENERGY Epergy BUILDING Building Address: �• Seismic Fee Res O r• #-tVW% BSEISMICOM Owner' =& BUILDING Phone #;4o$t%It(a Plan Check Fee ! BUILDING BUSLIC Contractor:Phone #: BUILDING License #: 78?2Z1 o INCn , ,402, W-oobo Contact: Phone #: Cupertino Business License #: t�rltM 1Q�w�+►h• o - 060 Type of hoof Covering: Existing: Proposed: O Built -lip Roof t] Built -Up roof /�/ Asphalt Shingles Asphalt Shingles f e u Wood Shales Wood Shalss O Wood Shingles O Wood Shingles O Other (Specify) o Otter (Specify) Number of existing coverings 0 Provide LC.B.O. Report d U To be Removed a Provide Mfgr. Installation Specs. I Have Read, Understand and Will Com ly With C o's Tear Off Policy: Job Description; awvt tVI Tift7 t..•v^f &,r4 thrall 3e 14^00 caf Residential mmercial p Fire Zone: Yes ❑ No 6r Confirmed with Planning Dcvt. if them are any restrictions: Cost of Project: T e Of�suvion: Occup c,K!roup: 3 0+7 ^ Qty. if Anoticable Fee ID Fee Descrintiou Fee Group BPERMFEE Bldg Permit Fees BUILDING. BENERGY Epergy BUILDING BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING BPLANCHK Plan Check Fee ! BUILDING BUSLIC Business License BUILDING 0 1 1 Westshore Roofing , Install list ............... 07/08/02_ .. 10/16/03•_____. 08/07/02 10/14/94 --•-• {1 ' ' i• .. .t f E, 06/23/03 en 01/09/01 ............... 10/16/93 ............... 08/05/03 ............... , 08/16/95 ............... 03/14/05 02/23/05 08/02/05 ............... 08/27/02. 11113/01 11/06/02 ............... 08/31/04 ............... 07/27/01 ............... / 03/30/96 ............... 08/25/05 ............... _ 02/28/00 ............... 11/11/02 ............... 08130/05 ............... ' 07/02101 ............... 08/23/01 ............... 02/15/96 _ 09105/96 % IMI/04. n..... 10/26/95 ............... 09/27/04 _02/24/05 .............. 09/02/03. .. 09/09/02 ............... 05/03/04 ' 09/21/03 ...... 02/04/03" ............... -- ' 01/20/00 • .. ---•- 02/20/96 .•- ............... .1. 07/02/02 ............... 1/3012006 ............... _ 06/28/04 ............... ' 05/17/95 '- - 4: 04/08/94 ............... 05/30/93 ............... 09/10/95 ............... 12/01/98 ............... 03/24/99 ............... ' 09/22/93 ............... 08/24/03 ............... 10/20/03 0.....8_______ •