03050062 CITY OF CUPERTINO * '.
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION ,.;
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BUILDING ADDRESS: WESTSHORE ROOFING CO P RMITND03050062
10156 PENINSITIA BLVD
OWNER'S NAME: 5869 WINFIELD BLV PE SSb'° 14/2003
BERT NGO & SU DANICA
IFINE: (408) 629-2100 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
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LOp LICENSED CONTRACTOR'S DECLARATION Job Description
m 1 hemby affirm that I am lianard under powidons of Chapter 9(commencing
V with$ation fDividon7of NCB end Profcssmm Cmir wdmylio.maris ��
imm�fom�-
L
1Vyf REROOF NALE
qts LKenwGD�' DemC'SD s RATION MAY2 0 2003
I uused public teemds
�yV
;a)n LiccnuO Professional
3 OWNER-BUILDER DECLARATIONin
BUILDING
V Ifl�gtg�
1 Wrthy affirm that 1 am Csempt Gum the Caow
nwN LAecmac Law for tW v
00 following mason.(Section 7031.5.Business and Profession Cade:My city at County
which mid.•permit to enm0ua.alma improve,demolish,or repair any structure
rZi pdefm its iiwom,Mau mgalma the applicant far such Petit w file a signed statmorm
£ < tbar heislicensed puorwomanthe pmvisionsordreConnector's U.Law(Chapter9 Sq. Ft. Floor Area $4)�49tion
of RF$ (commencing with Scc&n7")of Division Sof be Busincssmnd Pmfcunins Cm4)or
— Samba 703x(5 by any arnin pp ant fm a pennthe harais y�jecu Ne epplied ncant w a chkilatfun of
at at Penalty of
Occupancy Type
not mom than BK hundred dmhns 8300). er0 0
❑1,as owner of the pmp My,of my employees with wages as theb wit compensation.
will&este wodc sad the aauerarel,amiammded Ordlfered heard.(Sac.nw.Bush. d Ins ections
and PmRssiom Cade:The Committees License Law dao.1 apply w w dome,of 307 - I NSULA'1'1V" p
property who builds or improves thereon,and who does such work Infractor through his
Own employees.prodded that such improrcmenu am not ntended ord0cred for Mile.If. 601 — ROOF TEAR OFF
however,Ne building or imPnwandent is said within mm year of cmplNw,the owner-
WBJerwill how,Met burden of proving that he did not Wild orImpactor,for purpose of 602 — ROOF PLYWOOD NAIL
sale') 603 - ROOF BATTENS
I.re mom,of the property,am exclusively contracting with licensed cna.rdn to 604 - ROOF IN-PROGRESS
construct the project(Sec.711,4,Business am Pronounces Code:)The Conuwtor's Li
nose Law dors not apply to an owner of property who Wilds or improve thereon,and
who counsel,for such projects with a conamewar(s)licensed puruam w the Committees
License L, .
1 am exempt under Sec .B&P C for this moon
Owner Dale
WORKER'S COMPENSATION DECLARATION
I hereby aRrm under penalty of perjury one of the following declarations:
I haw and will maintain a Ceniftamof Comen to self-imomfmWarketsCompcn-
73700
ion,u provided for by Section 3700 of the LSWf Code,for the performana of the
rk for which this permit is issued.
1 have and will maintain Worker's Compensation Insurance,u mquirtd by Section
of the Inbar Code,for the performance of the work for which Nis permit is issued.
yWorkers Co em 'on lnwnna ca d Policy numberamme No.: O IOD I(�
CERTIFlCA EX POM WORKERS'
COMPENSATION INSURANCE
(Thu accuw need not W completed lithe permit is rordne hundred&Ilan(5100)
or less)
1 canary that in be performance of the work for which this permit u issued.1 shall not
chad,any person in any mwnerso as to Wcdme subject to ave Worker'Compensation
Laws of C.Hrannia.Dart
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption•you should
become subject w me Worker's Cofrpemauen previsions of the Labor Cade.you muss
2, Forthwith Comply will Such pmvisiom of this Permit shall W domed rewired.
Z O CONSTRUCTION LENDING AGENCY
I hereby alErm that them is a consonance lending agency,for the performance of
> the walk(ser which this permit is issued(Sec.309,,Civ.C.)
Iz7 0 Lender's Name
d Landels Addreas
U► 1 certify that 1 have mad this applicationIW
and sate Nat wow information is
U. P cancer.I ogres to comply with all city and county on inwces and mart laws misting to
0U Wilding construction.and hereby suthmsbe reprmenlativea of this city to enter upon the
C. aWve-mentioned proPcny fmimnify sot keep ea.
C.W (we)agree to cave,indemnify end keep harmless the City o(Cupcnino egaimt
rn liabilities judgments.cress and expenses which may in wy way acerae against mid City
U z IAPPLIICCANTCof the UN ERSTANDSodding of th ND WILL COMPLY WITH All NON-P01 Issued by: Date
SOURC REGUL ONS.
f N Re-roofs
SI nature ofA licam/Crathis o e_ Data
HAZARDOUS MATERIALS DISCLOSURial Type of Roof
Will the applicant or forum Wilding occupant Mort in handle la ar ous material
as refined by the Cupertino Municipal Code.Chapter 9.12, the Heald sa
d the Safety
o&.Section 25532(.)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes 6VO
If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant ase equipment of&vies which
mit hoaamous air comnminanm as defined by the Bay Area Air Quality Management all new materials for inspection.
Disuier7 l
[]You tBr°
I have mad the turn duus minerals requirements under Chapter 6.95 of the Calirm,
ria Health&Safely Cock,Sections 25505.25533 and 25534.1 undersand dot if be Wilding
does nm eunemly hoot a not.thou it u my rapamihility w IwtifY IW accuPwr of IW
m mcntswhmnmu mntpuorwissuwcCdfaCcrtificate Occa cy Signature ofApplican[ Date
All roof coverings to be Class "B" or better
Owner w aullodu.d agent Dam
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
I Telephone: (408)777-3228
CITY OF
4UPEkTINO 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.
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: (k U \ 11� ' ��/✓�
Job Site Address: 0 1
Roofing Company Name: ve o
A plicant's Signature: G7' Date _ 3
\A/'61/ODL�
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
I
CITY OF CUPERTINO G v
REROOF a 3 6
CUPEkTiNO PERMIT APPLICATION FORM
APN# f 6 Date:
� t-f U 3
Building Address:
S
Ow ' u v ,,/I , Phone #:H-51
rtcl
Contractor: I Phone#: License#:
ljue-,,A�ILA re J c C/v'J to,�C/—,'too
Contact: I e__ Phone#: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
t� Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles W�Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles Cl 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: ❑
Job Description: — r
\�tyf- o�-� C� (�(JT Ce—(UOQ Q.��s fr11�� C�(J�l�
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Det. if
there are anrestrictions: [e
Cost of Project: Type of Constructio ) Occupancy group:
mo U fe - V-b d N
Qty. if
A le 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
Zt y'�.