04110096 CITY OF CUPERTINO ----- - -: .,. awn- „e,....;a;,a... :• 6 - . ...'—" --- - ----- — -'
BUILDING DIVISION PERMIT • COW RA.CTOR-INFORMATIOW".
1BUILDING ADDRESS: WESTSHORE ROOFING CO PERMITN"04110096
10789 ALDERBROOK LN -
OWNER'S NAME: - PERMIT ISSUE
- - - _ Y
ROSE SELTENREICH 5869 WINFIELD BLV - 11/ 6/20.04
ONE: SANITARY NO. _ "CONTROL NO.
(408) 629-2100
ARCHITECTA3NGINEER: BUILDING PERMIT INFO
-ELECT _ PLC y L� _
Lo`o LICENSED CONTRACTOR'S DECLARATION _
.wF I hemby Million Nat I tin licensed trader prow....of Chapter 9(commencing _- lob Description
iii wi0S uon7")of Dtvuion3afft Businesaand Pmfcssmm Code.m mYlicuiu is
_`cy in fun four and ellect EROOF - - - - - - -
b g'z License Class -'�S Lic.g S(��7 1 R - --
Ef,p Date,
c n�J m P at beuuJ Phlic recarN "CAC�AR beHnETS DECLARFO!N
Littnsodvf
oNl - sip/ - - -
S Oat I am exempt from Contractor's
0 I hemby affirm Net I 1 exempt from the Camons Co License Law for the
y00 following mason (Sauun 71131 5,Busiae..and Pe,deco i Cale: po mart mm. l
$of which requires;.pearl m uomwct,altee Improve,h Permit r t fl rtpsig city statement i '. � - - �4 0'0 0._ .
prior miu Issuance.also rcgoms iM applicant for such m file uignml su¢mcm . _ ___ - ___
< Nat be is hcemcd purauanuo the provisions of the ContractwY License Law(Chapter 9 —Sq.Ft. Floor Area___ _ s/ _� Dalion___ —'
¢�$ (commencing with Section VOW)of Dmsion 3 of the Broinn¢and Profesiions Codc)or '- _
_ Oat he is exempt thertlrom and the basks for dte dlcgsd cxempdon.My violation of L^f
Section 7031.5 by airy.ppiimi fm a permit subjects f applicant to a dvil penalty of
not mom Nan five hundred dollars($500). V CUpanCy Type
0 1,as aver.of We property,Or my employees with wages as their sole compavuan, -
w ill&tim work,and the structure is not intended or aRerW for safe,(See 7061,Business I
and Profeaamm Cade:The Contractor's License taw doe not apply in an owner of - - Required Inspections
progeny who builds orimproves therem,andwho dommch work himstlfor Wough has
ownemployces,provided thaisuch improvemau enotinim mo @red formic.IL _-
howeves.Ne building m improvement is sold widtin one year of u mpleuan,the owner
budder will have the burden of proving Nn he did not bold or improve for purpwe.of
sale).
❑1,as owner of the propsn,,am exclusively contracting with licensed convectors to
construct the project(Sec.7016.Business and Professions Cade.)The Conuacmrs U.
ecose taw doe not apply to an owner of pmperty who builds or improve thereon,and
who contracts for such pmlecu with a camrumr(s)licensed pursuant to the Contractors
License taw
❑I am exempt under Sec. ,B k P C for this mason
Owner LOW 14 i if Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of peoury one of the following dociumbons: _
1 have end will maintain a CeNficate of Consent m self-insure fm Workers Compcm
sauon,as provided for by Section 37W of the labor Code,for the performance of the
work for which Nis prom,is issued.
❑1 have and will mountain Workers Compensation Insurance.as required by Section
37W of the labor Code,for the performance of the work for which this permit is issued.
My Workers /
Comrpeiisup onLlnsuran ce caner and Policy number am:
Carrier. aWl) Policy Na 060 169 G
CERTIFICATE OF EXEMPDON FROM WORKERS'
COMPENSATION INSURANCE !
CThlesection need not becompleted if the pencil is future hundred dollars($I M)
or less).
I comfy Nat in the performance of the work for which this Perm,is issued.l shall not
employ any person in any manner m u to become subjeet to the Workers'Compensamn
Laws of Cal for Da _
Applicant 0 r
NOTICE TO APPLICANT I,a ter m;ing Nis Ccmfrcate of Exemption,you should I
become Subject m the Worker's Compensation Provision of the tabor Code,you most
.Jz forthwith comply with such prnvisons or this permnsluil be decmcd revoked.
z O CONSTRUCTION LENDING AGENCY
(-< I hereby affirm Nat them is M emums inn lending agency mr the performance of
the work fur which Ou perm,is issued(Sec.3097,Ov,C.)
W Q Unites Nam-
z Lenders Adi
U Q I ceNfY Nat 1 have red Nis y adcounty o sou that the shave information misting o i
W H armtt I agree to comply with all sty and county ordinances and sou laws relating he
DU balding judgments.Mitcham exputhor which ayin y of this against id City .��
W shove-mentionW property for inspection purposes
(,y liabilities.e)gore 1.asses Ocxmfy and keep hnmless the City of Cupcmno agmr,
prose which may m COMPLY way ucmc against mid Dry
U z in consequence of the Starting of this Permit.
^ APPLICANT UND RSTANDS AND ILL COMPLY WITH ALL NON-POINT 1 Issued by' Date
SOURCE RE L
6Jc a— � D Re-roofs 1 l v
Signuuq pp icanUCOnuacior
HAZARDOUS MATERIA ISCLOSURE Typo Of ROOF
Will the applicam or room building occupant Mom or handle haca dous material
as defined by the Coleman Municipal Code.Chapter 9.12.and the Health and Safmy
role.Section zssu(,)+ -All roofs shall be inspected prior to any roofing material being installed. -
❑m u
If a roof is installed without first obtaining n inspection,I agree to remove
Will the applicant or f wre buJdmg occupam tau cympmcm art Jevicus which g P g
emit hazardous air conummmus u defined by the Bay Arse All Quality Management all new materials for inspection.
District?
El Ycs
lion row thause.Sc sus 25505.25533 mvimmc 55 unit uduatanb neofthe Calding
it.noth&rently Cade,toram. 00r it yrespo255311 to ii taN nhwcupont building //A /r^O�,
Jose not currently haw a tenan4 that it is my mspomihility m notify the ottupans of the //
mquiremcn wh ma * lunasman .r.eemfiem.f�caparel, SignaYuretofApplicant � Date
r p Dom.nc - - All roof c erings to be Class"Bit or better -
Owner ree Nee a a cm -
Community Development
` 10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPEkTINO
Building Depgtment
JOB ADDRESS: PgIYMIT #
OWNER'S NAME: Rose ,St\tet re icy. PHONE #(k j Z52-- a1z3 .
GENERAL CONTRACTOR FAX # Lot)
I am not using any subcontractors:
Signa a Date
Please check applicable subcontractors and complete the following information:
6d SUBCONTRACTORI BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
• I I Glass / Glazing I I
Heating I
( Insulation I I
Landscaping
Lathing
IMasonry I I
Ornamental Sheet Metal
Painting/ Wallpaper I J
Paving
Plastering
Plumbing
✓I Roofing I
Septic Tank I
Sheet Metal I I I
Sheet Rock I I
•I IT�,ne , I I 1
I�l� It( 11o10 "� ,
Ownelr� ntr for Signature Date
Building Division
10300 Torre Avenue
00 Cupertino,CA 95014-3255
Telephone; (40a)777-3228
Fax: (408)777-3333
CUPEfTINO
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 manufactures specifications on reroofing.
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 reroofing 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) Preinspection and/or tear off approval.
2) In progress inspection approval
3) Final inspection approval.
r 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 that the
proper City inspection can be performed.
IMPORTANT:
1. Flat roofs must have a minimum of V"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 of inspection
We understand the above policy on reroofing and will comply with this policy.
Homeowners Name;
Address: l 1 g \ Y b ro o k e
reroofing Company Name: �� ��s�(}•sly re Ito o �� �� (�c .
Applicants Signature: Date: i 1 l " b (o � .
Joe Antonucci
(Chief Building Official)
&25/01
CITY OF CUPERTINO
REROOF v ( l
�CUPEkTINO PERMIT APPLICATION FORM
APN # A C, 1{ Date: 1 l l ( b I p
Building Address: /
c�cv�roo LcL v,.c_
Owner's Name: Phone#:
((C)%J ZS Z Ol 2.3
Contractor: 1 w (S (V.c- License #:
� s��� 01; 1672,2--1
Contact: Phone #
��6g)Z13 -31SU
Applicant/Contractor: Fax #;
K°g Z+3-1;3 °I �
—
Building Permit Info:
Bldg Elect Plumb Mech
Job Description: wAovt 2 ('31'3 wO°� 0.ti°l y S loll (r't aeN S{�Nt (orit�� Soil IZocrF
Residential: `CeS • Commercial:
Sq.Ft. Floor Area: $/Sq.Ft.:
zs S���,,.�, . J
Architect/Engineer: Valuation:
Type of Construction: Occupancy Group: S -
y ifs
ly
ppl1cA le Fee ID Fee'Description Fee Group
I I BPERMF_EE I Bldg Permit Fees BUILIDNG
! I BENERGY I Energy BUILIDNG I
BSEISMCCRE I Seismic Fee Rees _ _ _ I BUILIDNG
I BSEISMICOM I Seismic Commercial I BUILIDNG
I I I
I BPLANCHK I - I
— ; - I Plan Check Fee j BUILIDNG I
I I BUSLIC I I
I I I Business License I BUILIDNG I
I I I I