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05050100 CITY OF CUPERTINO BUILDING DIVISION PERMIT kaCONTRACTOR INFOR ATION BUILDING ADDRESS: WESTSHORE ROOFING CO PERMIT NO05050100 E—DF OWNER'S NAME: PERM"ISSUE DATE ONE: SANRARY 0. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH moo LICENSED CONrui under FINALED O :<�C I Mrtby affirm Nn I am lidW Bu under and Norman.., or provisions of Chapter Y(commencingmesis Job Descript LL U with Scorm,an cispe DivixionJaf lne Business and Professi record,.mtl mylicenu is j�_R infwlm¢wde t 7�7��1 REROOF W/GERARD TILE Liccnx Class L'¢.N L~� Das Contractor In I—n a9 PI- ARCHITECTS DECLARATION rtQOC —' Iundcrmnd my plansshall be cud L as Public memods JJ ■�mB to Liccrtud Professional Es IL®'U ©G 5 OWNER-BUILDERexemptDE Ce ConblON .�00 I hereby.('Sero that 1 1 exempt!sum the Cssions o Any city Law for the DO (allowing Professions Code Anyoily or county m which requires a penin to grans the alter,improve for demolishh permits or repair any tamcmrt Fiat Poona isissuance, ensedprsuant to the thovisio of for such permit kensrile a,Law statement S that Lac is licensed pursuant to of Divisionfthe Contractor's Lifau LaW(Chapter odc)or Sq. F[. Floor Area Valuation ¢�n Oom he exempt Section and ndth Divisionr the the Business and Professions Any violation or i $ Inn Section r 1.5 bthcrtfrom and Oe bur far du cts the exemption.Any violation of OOL MO than n by any applicant fora permit wbjects the applicant w a civil Penalty of 3 51a2U t t(;r0 0 Occupancy Type not more Nan five hundred dollars(5500). 0 huownerofthepmpeny,ormyemployemwiOwagesuthcirwlceompcnudon, will do Ne work and Ne structure is not intended M oRcrod finagle(Sm.7W,Business and Professions Code:The Conuactoh License Law docs not apply in in owner of Required Inspections property who buildsor improves thereon,and who does suchwork himself or through his own employ=,provided Oat such improvements are not intended oroRered forak.If. however,the building or improvement is sold within oOc year of completion.the owner. builder will have Ing Wohm of proving Nat he did not build or improve for putpox of .1,1. 0 1,as owner of the progeny,ma uelusively convecting with licensed wnmwbrs Ia construct the project(Sec.7(314.Business and Profusions Code:)The Commodes Li- cense Law docs not apply to an owner of propcny,who Wilds or improve Incrton,and who contracts for such projects with a convaelor(s)licensed pursuant o the COMMAOr a License Law. 0 l am exempt under Sec. .B h P C for this reason Owner Data WORKER'S COMPENSATION DECLARATION 1 hereby affirm..or,penalty of perjury one of the following derli moons: 1 haw and will maintain a Certificate of Conant to self-insure for Worker's Compen- sation,as provided for by Section 39W 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 Ins irerhce,as required by Section 37W of the labor Code,for the performasec of Ne work for which this permit is issued. My Work:e Campse,cation Insurance gamier and policy nurbber art: eA Carrier. 1 P Polity N..:,)`)S 16V / CERTIFICATED EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thr section recd not be completed if tK permit is forms,hundred dollars(SIM) or less.) 1 candy Nat in Oc performance of the work for which this Permit r issued.I shall sol employ any perms in any commerce as he become subject o the Workers'Compensation Laws of Ci lifomia.Date Applicant NOTICE TO APPLICANT.IL after making this Cmdri au of Exemption,you should become subject to the Worker's Compensation previsions of the Labor Code,you must .JO forthwith comply with such prnvisions or this permit shall be deemed myomd. z" CONSTRUCTION LENDING AGENCY Fw� Ihereby affirm Oat then is a construction lending agency for the performance of x the work for which this permit is issued(Sec.3W7.Co.C.) WIS, A Lindcr's Name . z Lender's Address U C) I Lenify,Oat I have read this application and slate Oat the above information is L. P correct I agree to comply with all city and county ordinances and sate laws relating to DU Wilding construction,and hereby auOmim rtpratemadws of this city to enter upon the r W alare-mentioned property(or inspection Purpmea (~y (We)agree m save,indemnify sod keep nartnlett the City of Cupcnino against (n liebilitie,judgmens,casts sad expense which may in any way seems against said City U to consequence of the granting of this permit. ^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOUR GULATI S a W.r:_a[ai 5=)R dS Re-roofs Signnu OfAtlificuffitiContrIgIlit Data HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or furore Wilding occupant stem or handle hazardous mnenal as dented by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safely Code. 0 oro z5532(a) All roofs shall be inspected prior to an roofing material beim Installed. ❑Yea pN P P Y g g Will the applicant or future building Occupant use equipment or devicu which If a roof is installed without first obtaining an inspection,I agree to remove it haandous air contaminants as derind by the Bay Area Air Quality Management all new materials for inspection. Vi<t? ❑Ye U rN. I have mad the Woardnus mamriab rtyvimntens underCWp¢r 6.95 olthc Califon ria Health&Safety Code,$eedons2S505.255JJ and 25574.1 untlersmntl Onifthc Wilding _ /�—D ` Ores not more haws Tenant,Oat it is my respoaihility m nodly the oecupat of the a mquin which mu et,�onuissuaeenracer"catee(aapaney. Signat eof pplicant Date - D Own nor auAfi&2 agent Date Allroof coverings to be Class"B"or better Community Development 10300 Torre Avenue ' ✓' Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 UPE(�TINO Building De artment JOB ADDRESS: PERMIT # OWNER'S NAME: PHONE # GENERAL CONTRACTOR: I am not using any subcontractors: — �c 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 Owner/Contractor Signature Date Community Development Department Building Division City of Cupertino 10300 Torre Avenue CITY OF Telephone: (408)777-3228 U P E f�T I N 0 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 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 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: choa (-) ' lob Site Address: c o..VII // Roofing Company Name: fil640 ,5,ne7 c Applicant's Signature: OH O' i Date: d� ® Greg Casteel Building Official Revised 11/2/04 Printed on Recycled Paper ,May 18 05 01 : 21p Paul Fowler 408 356-6571 p. 1 �-� CITY OF CUPERTINO .. RER.00F vS�S o CUPEkTINO PERMIT APPLICATION FORM APN # Date: Z IS Building Address: Owner's Name: Phone#: 'cam lw. C� wnc, yQ�s -ac]'3j Contractor: f Phone #: License #: Contact: Phone #: Cupertino Business License#: b_ca o C` 5-D Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles ❑ Asphalt Shingles W Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles _ ❑ Other(Specify) B� Other(Specify) (�7el/ Number of existing coverings ❑ Provide I.C.B.O. Report# 1' To be Removed _ ❑ Provide Mfgr. Installation Specs. I Have Read,Understand and Will Comply With Cu ertino's Tear Off Policy: Job Description: Residential Commercial ❑ Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if there are anrestrictions: i5 Cost of Project: Type of Constru ton: Occupancy group: I,-i, `79 0 _ Qty. if A licable Fee ID Fee Description Fee Group / BPERMFEE Bldg Permit Fees BUILDING 13ENERGY Energy BUILDING BSEISMICRE Seismic Fee Res ' BUILDING BSEISMICOM Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING �� � U6