06080082CITY OF CUPERTINO
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CONTRA. t,'�OR INFUR`MATT, z
BUILDING DIVISION PERMIT
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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
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LICENSED CONTRACTOR'S DECLARATION
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I thereby affirm Nal l am limiued under Provisions of Chapter 9 (Commencing
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�`r�7�gyR
wide Section 70nhcf Division 3.f the Boainess and Prolamin. Code.indm license is
en lull on n Z
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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
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I understand my plans Mu all he used public recorch
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1. an�g
Lkemed Professional
DECLARATION
OWNER-BUILDERomptFrom
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I hereby Orion that I am exempts the Contractor, Liccnu Law for the
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following moon. (Section 703 LS. Business and Pmfeasium Code: Any city SunCountyl..
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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
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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
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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
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Lendar,
i
IaMeh Add.
i I certify the, l haw Mad this application and sue that the above infmmatiun Is
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` 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
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04/04/03
11/10/01
03/25/94
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09/27/04
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12/20/03
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03/02/04
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07/26/04
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11/11/2000
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0988/00
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Westshore Roofing, Install list
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•
Aug 11 08 1255p
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SCUPEkTINO
•
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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
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10/31/03 ..._
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11/26/94
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04/07/03
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08/10/96__ - -
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08/01/05
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07/08/05 _
09/18/97 _
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03/15/01
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02/23/05
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09/14/04
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10/30193
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04/20/05
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06/17/02
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01/21/98 - - ...............
08/31/00...............
11/02/98
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04/19/93
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12/15/97
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09/13/00 " ' ...............
03/29/04
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08/24/00_ _
.08124/00
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11/17/94
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06/24/05
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08/02/95
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02/19/96
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06/05/00
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10/15/97
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06/15/01
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09/15/95
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07/28/03
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09/20/96
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06/23/97
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5/2/2005
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03/15/01 _
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10/22/97 '
OS
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•
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
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07/08/02_
..
10/16/03•_____.
08/07/02
10/14/94 --•-•
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06/23/03
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01/09/01
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10/16/93
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08/05/03
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08/16/95
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03/14/05
02/23/05
08/02/05
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08/27/02.
11113/01
11/06/02
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08/31/04
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07/27/01
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03/30/96
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08/25/05
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02/28/00
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11/11/02
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08130/05
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07/02101
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08/23/01
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02/15/96
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09105/96 %
IMI/04.
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10/26/95
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09/27/04
_02/24/05
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09/02/03. ..
09/09/02
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05/03/04
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09/21/03 ......
02/04/03"
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01/20/00 • ..
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02/20/96 .•-
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07/02/02
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1/3012006
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06/28/04
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05/17/95
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04/08/94
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05/30/93
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09/10/95
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12/01/98
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03/24/99
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09/22/93
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08/24/03
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10/20/03
0.....8_______
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