08100131 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTQR INI410RMATIQN:'.
BUILDINO AODRES " PERMITNO.
21745 #,ALCAZAR AVE WESTSHORE ROOFTNr TNT' rizi-an 131
OWNER'S NAME: r PERMIT ISSUE DATE
'1814 AIE T-
o �" L'l �'
SA AWO.2�'' CONTROL NO,
TAT D{l
(408) 694-0060
ARCHITEC'VeNGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
A o° LICENSED CONTRACTOR'S DECORATION Job Description
rd 1 hereby affirm Wt 1 am Ikenaed under PeovWOns of Conn.9(mm eam ink P
AAA Section]17170)ofDividon 3 ofNe Bustmas dm Profession Cade,and my liccnm u
? „ in fanrnece,m eci I RE-RF RMV WDSHK INSTIL 15/32" OSBe INSTL
'213 Lim gro Taw end CERTAINTEED PRES CMP SHNGLS CLS A 40SQ
A;mail CTS DECLARATION
�¢< Ise my pldu shall M..MA�Ik mccards
an
g H U111ed Professional
3 OWNER-BUILDER DECLARATION
' f I hereby afrm that i am exempt from the Contractors Uccnu law for IK
p O following mason.(Section]17113,Business sent Pmfessiov Code:Any city ar county
i°m� which"Aim a peril w co meneL alur.impose.demolW.or ropdr any suunure
Z y prim An its fu..A,roquieo the applicant forsuch Permit in fik a signed sdumenl
EiG Natkulmcnud pursuant w the pmvianv of thc ConOacwrs u«nse law(Chipter 9 Sq.Ft.Floor Area Valuation
><1•s (commceuing nth Section 7000)of Divuion 3 of As Business and PVfesaiov Cods)or
5 thd he is exempt therefrom and An basis for the alleged ew 0.Any violation of $19000
Section 71131.5 by any apphant for a permit subjects the apieluanl in a civil Penalty of APN Number Occupancy Type
not mom Bun five hundred dellus(5300).
35719111 . 0 0
❑1,u owner of the ptaperty,m my emplaym with wage u tle4 sole compewdon,
will do Negimis ocke revctoreb ur'sLtdcd ora.1 farss Apply An An Badness - Required Inspections
Ad property who Wallis mimpwwu theroonewommio AM not himsfJ col for eher
howemplayces,provided that such impmsemw t art not ear of c opted n.for Sala.R.
bowevv,Nil building or improvement u told wither ore Wild of completion.p. .of
Wle). will lose An Wmut of proving Net W did not Wild m improve for puepom a(
sole).
0 1,ss owner of the progeny,am ocluumly convecting with licensed rnnan=to
construct the project(Sec.7044,Business and Professions Code:)The Contactors U.
tense law does not apply in an owner of prnpeny who builds m improvo thereon,and
who coned for such projects with a contractor(s)licensed pursuant he the DUOtiactar!
License Law.
O l An exempt under See .B A P C for this rtason
Owner DAM
WORKER'S COMPENSATION DECLARATION
I hereby affirm under Penally of perjury,one of the following declanllov:
0I ham and will mdnuin aCortiEc,u of Covent w xlf-Insure for Worker's Compen.
on ss provided for by Section 3700 of the labor Cade,for the Performance of the
we&for which Nu permit is issued.
z i have and will maintain Work es Compensation Ivurana,u myuired by Section
3700 of the Labor Code,for Ne Performance of Ile work for which this permit is Issued
My Workers Caaaamp���onsutien InAn..ca rose and Policy number Am:
Caner.� Fph.( Polity No.. ^gYaf L
C Fl TE OF Ems'( A PITON FROM WORKERS' ,
COMPENSATION INSURANCE
(This orlon need not Wcempleted Bthe Permit is forme handed dollars nl )
or feu)
I«v[that in du performame of the work for which this Permit is issued.1 shill net
employ any person in my Insurer in u An become subject to the Workers Compmtsadon
Laws of CAr.rina.Date
Andii
NOTICE m APPLICANT:If.after making this Cevfictu of Exemption.you Amid
become subject w n the Worker's Compensation provisio of the Labor Coda you must
Z fmthnth comply with such proviaov or Nu permit real W deemed mokcd.
zo'
[Dti: m CONSTRUCTION LENDING AGENCY
Ihcrtby affirm NUNertuarnvnucunnlending agency
for the Performance of
permit u issued(ice.3097,Ci.
C.I
W^n. Landers Name
,7 Z Landers Adder..
U O T mtify Nal I hate Rod this application W sou Nd the'Wm iNmmauun is
W F cmtmL 1 ague m comply with sit city and county omivnces and a=Ian relating or
0 Ufl Wing construction.and Mrobyauhoeim representatives of NU city w cnur upon du
propen,for ieupecdou Purim e.
F'IV) liabali6mj.dgmcnu.caoruandcxp a whi,hm�yrinmynyeaycmnca'v'vtsdd City
UZ tncoIoneil eafthe granungof NUpeamit.
^
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
souk✓%� 1141011 Re-roofs t
Big art of
HAZARDOUS AppliG �'
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding occupant rwro or Nndk heumav msund
as defined by e Cupenno Mon mpal Code.Chapter
9.13.and the Health and Safety
Cade.Section 235334+ All roofs shall be inspected prior to any roofing material being installed.
OYO 2 No
Will the applicant r future Wddmg occupant one c lid rownt or devices which If a roof is installed without first obtaining an inspection,I agree to remove
tiI hammnus wrconummmis u de0ncd by the Bay Arta Air Qudily Management all new materials for inspection.
vial
0YONU
1haverealthehvamoosmaurialr5533m c55underChapufd.niftheCahfm-
doesnalN&Safetyhawa , L. 25505,75333 and 33334.1undcrnmd Nnddu Wilding
Jots not currently hats•.a anent.Nat it u my rte Uvihility w notify the occupant of N
rtgnirt mw aslhe.111nr .ce .marOceapen Signature of Applicant Date
K a
waerramfat;r="d are� DAM All roof coverings to be Class'W'or better
v ,
CITY OF CUPERTINO
2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35719111 . 00
DATE ISSUED. . . . . . . : 10/21/2008
RECEIPT # . . . . . . . . . : BS000006423
REFERENCE ID # . . . : 08100131
SITE ADDRESS . . . . . : 21745 JOIALCAZAR AVE
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : CHEN CHAO-CHIANG AND CHOW MARY
ADDRESS . . . . . . . . . . : 21745 ALCAZAR AVE
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5929
RECEIVED FROM . . . . : BEN FOWLER
CONTRACTOR . . . . . . . : PAUL FOWLER LIC # 21417
COMPANY . . . . . . . . . . : WESTSHORE ROOFING INC
ADDRESS . . . . . . . . . . : 2814 AIELLO DR C
CITY/STATE/ZIP . . . : SAN JOSE, CA 95111
TELEPHONE . . . . . . . . : (408) 694-0060
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ----2----- ---------- ---------- ----------
1BSEISMICR VALUATION 19, 000 . 00 1 . 90 0 . 00 1 . 90 0 . 00
1REROOFRES SQ FEET 40 . 00 520 . 00 0 . 00 520 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 521 . 90 0 . 00 521 . 90 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 521. 90 MC
---------------
TOTAL RECEIPT 521. 90
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
•
..: Community Development Department
Building Division
L 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 2007 IBC Standards
and manufacturers specifications on re-roofing.All roofs are Class "A"per Cupertino
municipal code 16.04.080.
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 vaid before another insvection can be scheduled.
IMPORTANT:
1. Flat roofs must have a minimum of 1/ "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: ikAYV (,fri O1l�
Job Site Address: 2. I l S A l GA 7-(A V` V
Roofing Company Name: U11 PSt.Sk1C%V 'Q_ F-Dofi on ci .
Applicant's Signature:4�r Date:_LC b_I/ !J
eGreg Casteel /
Building Official
Revised 07/30/08
O / oU/dl
CITY OF CUPERTINO
' a REROOF
•CUPEkTINO PERMIT APPLICATION
APN # Date:
Building Address: Z1 y S G
W t �av A V.
Owner's Name: Y G h Phone #: o � / _ Z$61
Contractor: w QStS�a�� � uo f�� �r1G Phone #: S6 'DZD�
Fax #: S6 " 02_?3
Cupertino Business License M Contractor License #:
Type of Roof Covering:
Existing: Proposed:
• Built-Up Roof ❑ Built-Up roof
• Asphalt Shingles ler Asphalt Shingles
Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other (Specify)
Number of existing coverings 1 ❑ Provide I.C.B.O. Report #
To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description: P-C vyk-Jv,�0 WO J d- 05-6f
O 5fAll ( owy. Sh.;kij )GS
yo �
Residential Commercial ❑
Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if
Green Building Checklist & attach it to the application or if there are any restrictions: ❑
applicable, include in plan set & the sheet index.
Valuation: Iq ' 000
I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
Si tfe
Revised 6/16/08
CITY OF CUPERTINO
r� REROOF
C1 0
CUPEkTINO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1RER00FC0M I Re-roof Commercial B 1COMMLROOF
1 1BSEISMICO Seismic Commercial B
L p O 1RER00FRES Re-roof Residential B 1SFDWLR00F
I 1BSEISMICRE Seismic Residential B
1RER00FMRES Re-roof Multi-Family B 1MFDWLROOF
1BSEISMICRE Seismic Residential B
1BUSLIC Business License B
Revised 6/16/08
•