05070203 (2) CITY OF CUPERTINO
BUIL�ING DIVISION PERMIT C0NTRACT0R INI+;ORMATION a
BUILDING ADDRESS WESTSHORE ROOFING CO PERMIT No.05070203
1124 HUNTERSTON PL
OWNER'S NAME: PERMIT ISSUE DATE
HOU ANDY L AND VIVIAN W 102 OLD ORCHARD DRIVE 07/29/2005
NE: SANITARY NO. CONTROL NO.
(408) 213-3750
7AiRCImECT/ENGINEER' BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
+OLICENSED CONTRACTOR'S DECLARATION lob Description
b1 holy affirm Thal I am licensed under provisions of Chapter 9(commencing PSection 7UM))of Division 3 of Ne Businev aM PmrLssion Code,add my license is
mmummeanaeff t� REROOF-T/O EXISTING .WOOD SHAKE/INSTALL
ammmcl ( - ( co ir- r GERARD STONE COATED STEED--ROOF :SYSTEM
-gyp Dam
"J ARCHITECTSDECLARATION
PI understand my plans shall he used As public meards
s l
5
U.GLicensed PmfeWonal 8
`c< OWNER-BUILDER DECLARATION
<E 1 hereby affirm that I am exempt from the Contractor's License Law for the E 111/
C20 o following mason.(Section 7011.5,Business and Professions Code:Any city Or county
3=� which mquim a permit to construct,alcor.improve,demolish,or repair any Atrucmm PeOi 0 1)h If !."N It r% Is r\
_Z< prior m its issuance,also requires;the applicant for such permit to f to a signed nmemcm rw
that he is licensed Purmanuo NC Pmvisioaufthe Contractor's License LAW(Chapmr9 Sq.F[. Floor Area
Ii In Val11,41y®000
X10 (commencing with Section 7000)of Division 3 of the Business and Professionst�.
Code) R5(J 1f .� �� \} orf
y 3— that he is exempt therefrom and Use basis for the alleged exemption.Any violadon of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil Penalty of APN Number Occupancy Type
not mom Nan five burdmd dollars(kiO(p. 36222028 . 00
❑I,asowner of the property,w my employees with wage a their sole compensation,
willdo Outwork.and theswcwm umtinmmindaroResed forale(SAc.7tua,Businvss Required Inspections
and Professions Code:The Contractor's License es Law donot apply 10 an owner of q P
property who builds or improve thereon,end who coca such work himself or through his
Own employees,provided that such improvements an not irmnded or o@red for We.If,
however,the building or improvement is sold within one year of completion,the owner.
builder will have the burden of proving that he did sol Wild Or improve for purpose of
W.J.
Cl 1,as owner of Ne property,am exclusively connecting with Second commuters to
construct the project(Sec.710414.Business and Professions Code:)The Contractors Li-
ccntt law duel not apply W an Owner or property who builds or impmM3 former.And
who contracts for such pmjecu with a conossmr(s)lieesued pt n um,m the C.m.10r's
License law.
❑I am exempt under Sec. .B&P C for this reason
Owner Dat
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under poahy of perjury osc of the following declarations:
❑I ham and will maintain a CertiOcare of Consent to sclf-insum for Worker's Compcn-
salion,a provided for by Section 3700 of the labor Code,for the performance of Ne
; for which this permit is issued.
1 have and will maintain Workers Compensation Iamransc,as rox,dred by Section
3700 of the labor Code,for the performance of the wort:for which this permit is issued.
My Workers Compensation Tnsinsla carrier and Policy number am:
Cdrrier:�4ThE LPolicy NO: -741U
CA_ I EXEMPTION
FROM" R S'
COMPENSATION INSURANCE
(This section need not necompleted tithe Permit is for one hundred dollars(SI((B
or kas.)
1 cenifv that in the performance of to work for which this Permit 1s issued.I shall not
employ any person in any manner m As in became subject to the Workers Compensation
laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,after making this Ceeificam of Esemplion.you should
become subject to the Worker'a Compensation provisions of the labor Code,you must
,JO fmMwith comply wish such pmvinim.,or do.Permits hall be Accrued mwkcd.
Z CONSTRUCTION LENDING AGENCY
(— Ihereby affirm that Nee is a conauunion lending agency for the Performance of
Ci 7 the work fur which Nis Permit is issued(Soo.3W7,Civ.C.)
pLanders Name
,z Landers Address .
U C) I certify that T have read this application and sum that Ire above information is
w F Cement.I agree to comply with 211 city Add county ordinaMY1 and stak laws elating to
p V building ronswnion,and hereby Authorize representatives or this city to enter upon the
ahovc-mendone-0 property for inspection purposes.
gy (We)agree to save,indemnify and keep harmless the City of Cupertino against
vF„N liabilities.judgmcnu.costs and carouses which may in any way actor,against said City
V Z in consequence of be granting of this permit.
^� APPLICANT UNDERS ,)NOS AND COMPLY WITH ALL NON-POINT Issued by: Date
SOURCEREGUL &
s.../ ��/�-� Re-roofs
Signature of Applinn ontracmr Dale
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building Occupant store or handle hazardous material
as d,fined by One Cupertino Municipal Code,Chapter 9.12.and the Health and Safely
Code,Section 25532(01
0x1 RNe All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or kuium building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit hazardous air contaminants As defined by the Bay Arca Air Quality Management all new materials for inspection.
District,
❑Yes �FfNo
1 have mad the hvardous m atrodsmq.imoeots under Chapter 6.95 of d¢Califor-
iaHealN&Safety Cok,Seetiuns 73505.25533 and 255 .I muleonandtiuifbe building
does not currently here A Tena ITN�p 1 is my mlpeny ly m nrldly 11re q:LYPNt of N[
mquimments which muz con�fiorrm issu eof' cNrmaeof Occupancy. Signature of Applicant Date
�0: All roof coverings to be Class"B"or better
Owner Or au lis rirW agent Date
CITY OF CUPERTINO
em 1 of 1 PERMIT RECEIPT OPERATOR: suem
COPY # 2
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36222028.00
DATE ISSUED. . . . . . . : 07/29/2005
RECEIPT #. . . . . . . . . : 30580
REFERENCE ID # . . . : 05070203
SITE ADDRESS . . . . . : 1124 HUNTERSTON PL
SUBDIVISION . . . . . . .
CITY. . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : HOU ANDY L AND VIVIAN W
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-5069
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
OE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
--------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 19, 000.00 266.76 0.00 266.76 0.00
BSEISMICRE VALUATION 19,000.00 1.90 0.00 1.90 0.00
__________ __________ __________ ----------
TOTAL PERMIT 268.66 0.00 268.66 0.00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ --------_____-----
CHECK 268.66 16701
TOTAL RECEIPT 268.66
e
Community Development
10300 Torre Avenue
3 #✓ Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
OUPEkTINO
Building De artment
JOB ADDRESS: r I tq „'1 I • PERMIT # ,55�� �
OWNER'S NAME: AN 140%4- PHONE # yog -S 6 6 l
GENERAL CONTRACTOR jVe s'3 sok en 1 Mc• FAX # 90 P Z43 - L317
I am not using any subcontractors: �1/V`Y f
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
e
Owner/Contractor Signature Date
Community Development
10300 Torre Avenue
✓ Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
g-UPEkTINO
Building De art , ,-7
JOB ADDRESS: 1 1 2 c1 1_ y , 7 I , PERMIT #'
OWNER'S NAME: /'��of ,) Nc o PHONE # 116, 1
GENERAL CONTRACTOR: j FAX # 'it, )
I am not using'any subcontractors: /– Vll \ � -7
Signature. Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork s.
Cement Finishing
Electrical /
1 Excavation
Fencing
Flooring:.Carpeting
Linoleum/ Wood
Glass/ Glazing
Heating
' - Insulation
— ' Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
F Plumbing ! i 't. �•
Roofing
Septic Tank
Sheet Metal
Sheet Rock j
Tile
1 Y
Owner/Contractor Signature Date
Community Development Department
I Building Division
t
City of Cupertino
• ,/� ~� 10300 Torre Avenue
I J Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
CUPEkTINO
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$176.18. The fee must
be paid before another inspection can be scheduled.
IMPORTANT:
1. Flat roofs must have a minimum of/a" per foot slope and demonstrate
that there is no ponding.
2. An 1.C.B.O. report is required to be on the job site at the time on inspection.
I understand and will comply with the above stated policy on re-roofing.
Homeowner s Name:
Job Site Address: j L9 J' yyttt r 5-1 o r 1' 1•
„rc Qoo{t.
Roofing Company NameVISlS.hlest_M n n1
Applicant's Signature: Date: Lql
Greg Casteel
Building Official
Revised 11/2/04
Rd„tpd nn Recvcled Paper
CITY OF CUPERTINO o
REROOF
UTTbF
CUPERTINO PERMIT APPLICATION FORM
APN # a a� Date:
Building Address:
11214 �v�n�trs•IONA 171.
Owner's Name: Phone#:
�o � y°8 yyL - Sbbl
Contractor: 1, Phone#: License #: —
45a 2 )i—S1S� 719 1/
ZZ- 1
Contact: Phone#: Cupertino Business License #:
(Sa.12r10-1 �p,nnah yo$. 213'3� So 21 '35 "1
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
/0' Wood Shakes -' - ❑ Wood Shakes
❑- Wood Shingles ❑ Wood Shingles
❑ Other(Specify) J2' Other(Specify)
Number of existing coverings �' Provide I.C.B.O.Report# 4 7,3
To be Removed ❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: *7&ftr &fit 2XiS-1i^, wUVtt %r„l S-to-t
Coeried S-fC [I R4#4 S w.
Residential Commercial ❑ _
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project: T e of Construction: Occupancy group:
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