05100219z
CITY OF CUPERTINO
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BUILDING DIVISION PERMITdCONTRACT,ORINFORMATION.
BUILDING ADDRESS:
20667 CRAIG ("T
WESTSHORE ROOFING CO
PE M rNo.05100219
" NER'S NAME:
PERMIT ISSUE DATE
XIAOFAN ZHOU
102 OL
ONE:
SANITARY NO. CONTROL NO,
408)213-3750
ARCHITELTENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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LICENSED CONTRACTOR'S DECLARATION
JOS DCSCiIpUOn
1 kreby affirm That 1 ten licensed under provisions of Chapter 9 (commencing
with Section 70IBB or Division 3 of Ne Business and Pro asiom GoM. mylicens<u
in Bre forceff=L
REMOVEWOOD SHAKE/INS �S ING
Li<anha Cl. Uc. a'
Dm cont, ter -
LANDMARK
LANDMARK TL COMP
ARCHITECTS DECLAR
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I undcrwnJ my Plans dull k used ss public records
Maoist
NOV
Licensed Professional
OWNER -BUILDER DECLARATION
2005
1 hereby afire that 1 am exempt from the Convacmrs License Law for Ik
following mamn. (Section 7031.5. Business and Pmin ews Cole: Any city or county
t :°✓,w i4
which mquira a permit to cnnswcl, almn improve, demolish. or repair any structure
S' „ y s 'I
prior at itskoomlee. also RGuirea the appliCLll for men pemlil to file a Signed statement
that he is licomed putwam to the pmvisians of the Contractor's Lice= law (Chapter 9
Sq. Ft. Floor Area
1 y
1{Valu ill 0 0 0
s�'JI'
(commencing with Scetion 70001 of Division 3 of the Business and Professions Coale) or
LME M is exempt therefrom and de baso for the alleged exemption. Any violation of
APN Number
Occupancy Type
Sccuon 7031.5 by any appliam for a permit emit the applkanu. a civil porosity of
an, mom dram Bvo hundred dollar (sSBo).
35915017.00
the contended with wag=ssoe(hale compewtion,
ido
Required Inspections
a, work, th....[we us omi Or offered
Chdac
s .1 ,Iy to an
he C.O Law does rot apply lf an owner
and Codc: The
and Prehosaiwa Lie
q P
bu his
and who doesamhwate himself is
progeny wha Wildsad m mocha on, and
Property
edthrough
Unit st ch unpr are not inteMcd eofferW fmsale. f.
awn c Nat tech im
rp. tho WiOrovikd
,-
howeaer, the Wilding or Lnprovemmn u halt widiin arc year of mmplcdo the owner -
is sold a4d
r
builder will kve dte Wrdcn of proving that k did Out Wild or improve for Putposc of
salt.).
0 1, as manar of the progeny. am =elusively contracting with licensed contraCmrs b
construct the pmjem (Sea 7064. Business and Professions Code:) The Co mseners Li.
i,mu, law docs not apply man owner of propenywho Wilds or imphav=Nveoo. and.
w W contracts for such prejeeu with a contractor(s) licensed pursuant m the Contractor's
License Law.
I am exempt under See . B & P C for Nis reason
Data
WORKERS COMPENSATION DECLARATION
1 hereby affirm under pevlay of perjury am of the following declamations:
Q I ham and will maintain a Ccrufiate of Cement m self -insure for Workers Compen.
sedan, u provi l d for by Seeuan 3700 of the Labor Code, fm the performerme of the
wort for which this pctmit is issued.
1 have and will maintain Wori Compensation Insurance, ss mquircd by Senlao
3700or the Labor Code. for the pefmcuraceaf the wort far which this pmmi, is issued
'
My Workers Compete on Lou ec carie and Policy nu�mbe
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Cartier. Policy No.: 2 L
ETIFICATE OF EXEMPTION FROM WORKERS'
-
COMPENSATIONINSURANCE
(flissmian wed not k completed Base parent u rmanc hundred dollars (SI00)
m less)
I cerufv that in the perforrmanee of the work for which this permit u issued, I shall net
employ any person in any manner m sa m become subject to the Workeri Compemauon
,
Laws of Califomia. Date
Applicant
NOTICE TO APPLICANT: If, after making this Cenificate of &cmpaion, you should
become subject m the Wotkr's Com,twetion provision of the Tahor Coda you most
foMwoh comply with such pmvisiom w Nis Permit shall be dwmed mvokd.
-
CONSTRUCTION LENDING AGENCY
1 kr thi that then u s agency for the performmaz of
which 7. Cm
e work for which Nis permit u usucd (Sec. J091, Civ. CJ
ed (Sec.
Name
Lender's Add.
eae
I certify that 1 hale mad this application and state Nm Ne akve information is
correct, l agree m comply with all city and county =Nim <s and state laws relming m
Wilding constmcuon. and botchy wthonxe rtprtmnuatier or lhucity mcnmr upon the
ibow-menuowd property for imiNction purposes
(We) agree I. sale, indemnify and keep harmless the City ar Cupertino against
'
liabiliticajudgmenu.<mts and expenses which may in any way accrue agaimisaid City
in consegmncc of the graming of Nis permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -PINT
Issued by: Date lO 27 -va'
AT'I
SOURCE REGUL)NS.
Re-roofsZZTt
t�\ I
Signature of Anglican Contractor Date
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will de applicant m (more Wilding acupe nt nam or handle hzaardpns material
u defined by Ik CuPenino Municipal Code. Chapter 9.11, and the Health and Safety
Section 35531(0)?
All roofs shall be inspected prior to an roofing material beim
P P Y g being installed.
❑Ya 1 ❑Na
IF*
If a roof is installed without first obtaining an inspection, I agree to remove
Will to applicant or future building occupant ore equipment or Jcviess which
emit hxvarmus air <anuminants ss defined by the Bay Arta Air Quality Management
all new materials for inspection.
District?
❑Ya ON.
1 have mad dte Wardmasmatedals requiremenuunder Chapter6.95 of the Caliror
ria Health &Safely Cade, Seevons 255U5. 35533 and 15534. I understand! thmifthc Witting
does not cuncolly hast s tenant. Naz it u my resp insihili, m nauly The ne'lu�p,'mt of the
regain tswinmastbemctptiormissaan«arac<mir<layf�'pah<)'.S�
Signature of Applicant Date
L(
All roof coverings to be Class "B" or better
Owwro
authorisd agent Dote'
CITY OF CUPERTINO
Ile, 1 of 1 PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN' ........: 35915017.00
DATE ISSUED.......: 10/27/2005
RECEIPT 4.........: 31762
REFERENCE ID # ...: 05100219
SITE ADDRESS .....: 20667 CRAIG CT
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OPERATOR: suem
COPY # : 1
OWNER ............: XIAOFAN ZHOU
ADDRESS ..........:
CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-2903
METHOD OF PAYMENT
-----------------
CHECK
TOTAL RECEIPT :
AMOUNT NUMBER
------------ ------------------
181.46 16960
------------
181.46
RECEIVED FROM ....:
WESTSHORE ROOFING
CONTRACTOR .......:
PAUL FOWLER LIC # 21357
COMPANY ..........:
WESTSHORE ROOFING CO
ADDRESS ..........:
102 OLD ORCHARD DRIVE
CITY/STATE/ZIP ...:
LOS GATOS, CA 95032
TELEPHONE ........:
(408)213-3750
•
FEE ID
UNIT QUANTITY
AMOUNT PD -TO -DT THIS REC
NEW. BAL
BPERMFEE
VALUATION 11,000.00
180.36 0.00 180.36
0.00
HSEISMICRE
VALUATION 11,000.00
1.10 0.00 1.10
0.00
TOTAL PERMIT
---------- ---------- ----------
181.46 0.00 181.46
----------
0.00
METHOD OF PAYMENT
-----------------
CHECK
TOTAL RECEIPT :
AMOUNT NUMBER
------------ ------------------
181.46 16960
------------
181.46
CITY OF
�UPEkTINO
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax(408)777-3333
Building Department
JOB ADDRESS:y0fouq
GCMio G�
J
PERI f,#. / 6 a 2 1
OWNER'S NAME: ado
2—t�,p .
PHONE # 'a L3-3,-1&0
GENERAL CONTRACTOR:
SV,Oj
FAX # Z — Z3
a
I am not using any subcontractors:
Signature
Please
Please check applicable subcontractors and complete the following information:
U� Z
Date
A,
—IVOwner/Contractor Signature
[012,7101)
Date
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
A,
—IVOwner/Contractor Signature
[012,7101)
Date
CMof
�UPERTINO
CITY OF CUPERTINO
PERMIT APPLICATION FORM
D 5i6E%2/y
APN # —Date:
559 /s"
Bldg Permit Fees
Building Address: 2,O wN Coo,
ra C
,
Owner's Name: Z y \Ou
BSEISMICRE
Phone #:
Contractor: ` ` C1_ ^ p Phone #:
IOW �V�-
2A3>-3;MO
License #: ^I .�Z
�g l
Contact:`cU&k �� ` ^� Phone #:
VG
BPLANCHK
Cupertigoj us s� License #:
j
Type of Roof Covering:
Existing:
Proposed:
❑ Built -Up Roof
❑ Built -Up roof
❑ Asphalt Shingles
X Asphalt Shingles
Wood Shakes
❑ Wood Shakes
❑ Wood Shingles
❑ Wood Shingles
❑ Other (Specify)
❑ Other (Specify)
Number of existing coverings
❑ Provide I.C.B.O. Report #
❑ To be Removed
❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
7OeDMesa�rtiopOlT�S�O� 1��1 s r TL wry
Residential Commercial ❑
Fire Zone: Yes ❑ No Z1_
Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Pro'ect: T e of Construction: Occupancy group:
�� o00 �- r0oX
SP .
Qty. if
Applicable
Fee ID
Fee Description
Fee Group
BPERMFEE
Bldg Permit Fees
BUILDING
BENERGY
Energy
BUILDING
BSEISMICRE
Seismic Fee Res
BUILDING
BSEISMICOM
Seismic Commercial
BUILDING
BPLANCHK
Plan Check Fee
BUILDING
BUSLIC
Business License
BUILDING
CITY OF
CUPERTINO
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408) 777-3228
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 $176.18. The re -inspection fee must
be paid before another inspection can be scheduled.
IMPORTANT:
1. Flat roofs must have a minimum of 1/4 " per foot slope and demonstrate
that there is no ponding.
2. An I.C.B.O. report is required to be on the job site at the time on inspection.
I understand and will comply with the above stated policy on re -roofing.
Homeowners Name:
Job Site Address: 2_0W1 Cra�� COQ✓t
Roofing Company Name: QV�estt$�Ci
Applicant's Signature: �1 �� Date:
® Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper