03060079 (2) CITY OF CUPERTINO �"- ~ �€<n'7 �,s
r BUILDING DIVISION PERMIT �c N'TRACTdRANFORMATION�
BUILDING ADURES& WESTSHORE ROOFING CO PERMIT"x.03060079
nqA
OWNBRMrr
ER'S NAME: 5869 WINFIELD BLV PLss(dMO/2003
NE: (408) 629-2100 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
Op
LICENSED CONTRACTOR'S DECLARATION
V 1 on 7 affirm that I am lived under provusiov of chapter Y(commencing Job Description
with Section]Bj10)afDivision3of NC Bu and Professions CoM,andmyliccveia �q
n y L one soE eRa A REROOF FORMALS®
License r✓ l_ R
ax C
A0. HIiECI'g LARATION
w �a �Ian.�.11b aspahbemgad JUL 0 9 2003
s G� Lice tlFrofessional
i3 OWN�LDER DECLARATION BUILDING
�f I hereby affirm Nal 1 are exempt from the Contractor's License Law for On
❑O following mason.(Section 7001.5.Business and Profession Cade:Any City or county
5 g 1 which requires a permit In construct.alar,borrow,dcmolLch.or repair any structure
-I j, prior ill its Issuance.esu reptiles the applicant foruch permit m rile a signed statement
££ o Nat be is licensed puruanttoOnprovisionoftheContractor's licenseLaw(chapter 9 Sq. Ft. Floor Area $l(ygl9#on
3 0 (commencing with Section 7000)of Division 3 of lW Business and Professions Cadc)or
Nat he u exempt therefrom and the hues for the alleged esrmpuon.Any violation of
Section 7031.5 by my applicant fore permit subjects the seldo e,x.civil penalty of 31'3E18 LIf1t�fleT 0 0
net mom than five hundred dollars(M). Occupancy Type
❑I,u owner of theproperty,ar my employees withwages u their sola a mpevadon,
willdo the work.end thestrucure u not intended or offered forme(See.7044,Business _ FRAME
and Professions Cade:The Contracmes Lianm law don,not apply m an Owner of 3 O 7 - I N S ULA'I��u8[jd Inspections
property who builds orimprovu lhereon,and whodaessuch workhimulrorthmugh his N
own employee,provided Nal such impmaemenu son not intended oroRernd for We.If, 6O1 - ROOF TEAR OFF
howewu,Ne building at iMPICA mut isoldwithinmrYearofcomplcuon.therwner-
builder will have the burden of proving that W did not build or impmwn for puryOu of 602 - ROOF PLYWOOD NAIL
01. 603 - ROOF BATTENS
❑I.u Owner of the pec.704.Businem telyand crowning wind:)The
ronoanom m
Came La does
(Sec.oan Guinessendrly who Wilds
Cage:)Thews thermal,
U. 604 — ROOF IN—PROGRESS
nerve law don,not epplr men owner of property who builds is improve Norton,tad
who contracts frrsuch projects with a contrxmr(s)licensed puissant m IheConvector's
0 l oasOrr Lew.
❑Ion eunpl under Sec. ,fid PC far this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the fallown,datlanuom
I have and will maintain a Cerdficaa of Covent m self--imum far WorircrsCampen-
7370M
er.u provided for by Section 37M of the Labor Code,far the performance Of the
h for which this permit u island.
1 haw tad will meinlaal Workers Crmpevsuon Ivuranc.......req meet by Section
of Nc lobar Cade,for the performance of Ng work forwhich Nis permit u issued.
WorkCes Compenuua Insurance atria tad Polity numberam:
e�iT✓a�-8P U+O tJJ' CERTIFICATE OF MEMPMN FROM WORKERS'
COMPENSATION INSURANCE
(Thu section need trot W completediphe Permit s forane hundred dollars(5100)
Us kis)
I Certify Nat in the perfawanc a of the work for which this permit is issued.10.11 nut -
employ any perun in any manners,u le become subject r On Wrfkem'COmper cation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If,MCI making this Colorer of Facmption,you should
become subicct In the Workers Compensation provisions of the L oWr Cade,you must
70 rit N comply with such provisions or this pemol shill W decimalrewkcd.
z h CONSTRUCTION LENDING AGENCY
1 hereby affirm Lou them is a Covwction lending agency for the perfurmucc Of
Y. the work far which this permit Is issund(Sec.3097,Ci,C.)
37 0 Lenders Name
3.
=Z Lenders Addem
J 0 I Certify that 1 have read this application and sea that the above information relang is
y (-' wrong l agree m comply wind all city and county mnaws or and sea lows relating t e
V
building roentl hereby mutation rtpreunutive of this city mcntm upon the
U.1 shove-menudgm property far inspection which may
a
C ns
(we)agree Io sate,indemnify tad keep harmless the City of Cupertlna!pawl
lZIZ inconses,jnec,Of On grinding
expenses which mryin anyway aceve agaiw aid City �JY
J z inconsequence of Ne granting o(Nis permit. 111
APPLICANT UN ERSTAN AND
/y4LL CpK7pL,y WITH ALL NON-POINT Issued by: Date
SOURC QEGs\fUL ONS. s/-1
S noise a� pp�on�K IA p-5 Re-roofs 07
HAZAROO S MATERIALS DISCLOS E Type of Roof
Will the applicant ar fano Wilding oceuPent score ar bangle hvardous material
u defined by the Cupertino Municipal Code.Charm,9.13,and the Health and Safety
aglode.Section 35313(a)? / All roofs shall be inspected prior to any roofing material being installed.
❑Yrs r'1 Nr
will the applicant a/r r`name Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it livardau it Contaminannd as Unlined by the Bay Area Air Quality Management all new materials ❑SpeCtlOn.
it ict?
C Yes IbN.
(hawse read Neb mdtmsm=6alsmquimmenuunder Chapar6.95ofthe Califon
nie Hcal"SolctyCode.Sccdm 5505.35333mdn534.1undemtend Nnifthe building I/l O
Ban,wl cureml baso s te 1.that it i))) y reapovih.1. m nnuly the occupant of the ll
reWulk,'n(p ndwh hmuzb Ipriort6 is once ofe Crnifcaa f Copan e,
v Y�IIVv f j Q A6 Signature of Applicant Date
Q .1mmthorircdagcol .� Date All roof coverings to be Class "B" or better
Community Development Department
Building Division
it: City of Cupertino
10300 Torre Avenue
r CITY OF Telephone: (408)777-3228
L U P E kT]N O 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 Y4" 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: &P,(-Y CH U
Job Site Address: _10MS kULrLACE
Roofing Company Name: wcr co I N C
A plicant' Signature: ��— Date: b 0 j
�� \�IJ�SlJl1�C�C1
Greg teel
Building Official
Revised 1/30/03
- - _. -. Prinfad nn ParvrinN Pe
CITY OF CUPERTIN0 o3 o6 o cD7�
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN # Z , G Date:
Z, bI00j
Building Address:
Owner's Name: / Phone#
Contractor: Phone#: License#:
W�s�sHo2� ��6)6t,5
Contact: Phone#: op Cupertino Business License#:
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: ❑
Job Description: �- e 11 /
Y o� crost-t r6U C 1/Qr1j T Vw4 tv,S c_I� 6 6S�sH.ea'C� n.� o.ri�
Residential Commercial ❑ , ivo%�
Fire Zone: Yes ❑ No ❑ Confirmed anning Det. if
there anrestrictions: LJ
Cost of Projec 101 S Uv _ Type of Construct ^ J Occ p group;
Qty. if
A lic 1 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