04090015 .I CITY OF CUPERTINO .
CONTRACTOR R -.-F:..'°r»"rn-.*.' s:=r°:•<c
BUILDING DIVISION PERMIT INFORMATION":,,, .
BUILDING ADDRESS: LINDY ROOFING CO INC PERMIT NO 04090015
1 S T S Ann7nT(=TnNT ("T - - -
0 O OWNER'S NAME. PERMIT ISSUE DATE
RUBY SFT0 FC;n WZSVITyinn no na
ONE: SANITARY NO. —CONTROL NO.
(408) 269-2025
ARCHITELTIENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
"66 LIm tat I a CONTRA under S DECLARATION I l l s V
to 1 Mmby affirm Inn 1 am lice¢d under provrsiom of Chapter Y(commencing Job Desc
<W with on 7000)af Division 3ofdWB�and Professions Cade.shod my blame infu^I,� deffe�/ LKIa �-� G REROOF W/COMP. SHINGLES
�'J` ARCHnECCI'aSa1DLCa�RATION y
Dale 1 understand my s shall he used as public records f �00Z ���
J \
u LlccnuI erelly net ® � N
='03 OWNER-BUILDER DECLARATION
F 1 mastr.s it shin 1 1. exempt from the Contractors License y c Law for the
no following moon.(Season 71D L5,Buslncss and Professon'CaJC:Any city dr county
x S wInch rtqulres a Permit m cnnaemel,Blur.Impmvs,demolish,o roper any suattura h t ]O n n
Ha poor is issuance,also requires she applicant(orsuch peroiuo Bic a signed statement _ _ _ _
inshot Wis licensed pursua ntlnlMprovian.oftoCmarlewe,liaa.Law(Chapter 9 Sq. Ft. Floor Area Valuitton
~S (commencing wish Section 7")of Down.3 of NC Business and Profesions Cwh,)ur
shat he Is uempt therefrom and she beau far the alleged�eapdm.Any violation of rrAA nnwwiT�wLa� bb�� TfT�I,,,,ricy not on 70ot by any red doll fora perms subjects one appincane to a civil penally of 3 MI9 2b[ er Q 0 �O u� Type
not more Nan five hundred dollar r a per. BaVry'■
❑I,as owns of she propeny,omy uvployaawM wagesss Heir sole wmpensalion, iKBp`Y
willdo the work,and the stmttare r not imandedor offered far sale(Sec.71%4,Business I Required Ins tl�s ,
and Profession'Code:The Contractor's License Law does not apply to an owner of
q P
property who In ildsorrmpoves thcson,and whodossuch wok himself or through AU I,
own employees,provided shat such nmpmsementsm not intended or offered far aide.If. SEP ,� Z�U4
however,the building or improvement s sold within one year of complwon.the owner- s
Wilder wig love de burden of proving°tar he did nos Wild o Impmw far purpose of_
male.) BUILING
C3 1.u owner of the property am reclusively contracting with Itcen'ed conuacmn to
construct La she paled(Sec.706x,Business and property who Code:)The Contractor's Lid
area Law dos not apply an owner of property who Wilds or improves sksom,and
woomntraw. for such Iacocca;wish acansracsor(s)licensed purwane to the Conuattofs
0 1 sear taw.
❑I am exempt undo Sec. .B&P C for Nu reason I
Owner Data
WORKERS COMPENSATION DECLARATION
1 hereby of orn under penalty of pequity ore:of the following declinations:
1 have and will maintain a Certificate of Conum to elf-insure for Worker's Compan-
uch,to provided far by Sccuon 3700 of the Labor Code.far the padcorronm of she
work for which Nn permit s nssuW.
1 kw and will maintain Worker's Complication Insurance,ss required by Section
3700 of the Labor Colo.far the pciformanm of she for which this lc.I,sassed. ;
My Worker's Cmrpamtgan inyanncpymegrp(I'�,YP.o.li nl�..(Wram: y� J
art's T/:�✓CL Polnry o.:a
rERTIFlCATE OF EXEMPII OM WORKERS'
COMPENSATIO SURANCE
m ssecuon need net k complcud if be Permit is for arc hundred dollar(SIM)
ar Ice.)
I comfy that in the purfarromen of ek work for which this perenn is mount I shall not
employ any person in any mannerso to In keome subject to to,Workers''Compensation
Laws of California.Da,^
Applicant
NOTICE TO APPLICANT.If,after making this Certificate of Exemption,you should
become subfecl m the WOReri Campcnsauon Provisions of she Lano Cnde.you muse
.JZ foMwuh comply with such provisions or this permit shall k decmcd ranked.
ZO CONSTRUCTION LENDING AGENCY
P:V; hereby affirm that them is a construction lending agcnry lot the performance of
a the work fur which this permit u treed(Sec.3097.Ctv C.) t
t[3 Q Lender's N.-=z Lender's Addm•
V 0 I cenify that I have tad this applicnian and sou That Lk above information u �
u.F coMn.1 agree to comply will all City and county callowness and sure laws slating to
0 V building construction.and
acts hereby
it yaushonw repsumamrs ofy..tomtu upon NC
N G akvcmemmoed pmpany for iospemon purposes
(We)agree to save,mdcamfy and keep harmless the City of Cupertino aguun
� to liabilidu.judgmcns,cosand cxpmves wnreh mayor any way aceme against said City
V z APLICANT of Ina R87A granting of this D WIl. pM I N /
APPLICANT UNDERSTANDS AND WILL C PLY WITH ALL NON-POINT Issued by: Date
SOURCE R�cUL ONS. //Y// _
�. !```_ /1-..� C�� Re-roofs Q
gnaeure orAp HAZARDOU AT'ERIALS DISCLOSURE✓ Date Type of Roof l
Will the applicam or forum building oceupanutore or handle hvudous maunal
as dc0ned by she Collett Municipal Code.Chapter 9.12,and the Health and Safety
m e.Scc Yes 23532(a1'
Ayesa All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining n inspection,I agree to remove
Will Inc applicant or tutus budding occupant sou Area Air a or devices which g P g
Disu cenu air conterminous al Jchncd by du Bay Arita Air Quality Management all new materials for inspection.
❑Yu Ig Na
I live&Seel tkde.Seeress mquacennes 25u Ire Cnapur695 of the lading O�
nu HCot cur Safely Cade.mnamuomiti 2myrosorrohn 1 understand tithe ifthc Wddthe /A-/ C /// �,G/y/ /) /
Jos not creamily how•unank Nn n is my mspon'nM1dny o 1mulY she mcupanl of the \ /� �
syut s�na- real Ietp t ccafaCCmOCau cuypanry�y/� ignatureofA�hi3nt ✓ "bate
`Ownetat,a,krt, gmI - All roof coverings to be Class "B"or better
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
WUPEkTINO
Building Department
JOB ADDRESS- �/J PERMIT #
/Ova Cyr- (I /<
OWNER'S NAME: S,,ye�p PHONE #
GENERAL CONTRACT R: FAX #
I am not using any subcontractors:
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
iLandscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
�( I Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
I
Le
Owner/ or-tGactor Signature Date
a' Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
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
Js 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 LC.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: `R/" y SP_f0
Job Site Address: *a/4'/<'
Roofing Company Name: z I 1
A plicant's Signature: � `v� -%r.,Z �x Dater-01
\�lJK1R1DC�c1
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO a 5
REROOF
= CUPER INO PERMIT APPLICATION FORM
APN # �,6 , ).Z �, 6�� Date: - Oy
Building Address:
Owner's Name: / Phone#:
22 /7 5`ef4 (r"_� U/
Contractor: / Phone#: Lic�n'se#:
_999,.,
Contact: Phone#k: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed: .
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles X Asphalt Shingles
XWood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings / ❑ Provide I.C.B.O.Report#
XTo be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read, Understand and Will Comply With Cupertino's Tear Off Policy: ❑
Job Description: Zep.,Ov-e- -0,eAe,5: —lrt,;- �K// S ' e'SQ S`�yVL
Residential Commercial ❑'
Fire Zone: Yes ❑ No ❑ Con med with Planning Dept. if J
t re aze a�ty restrictions: LJ J
Cost of Project P� Type of Constructio tl'-. Occupangrouj
Qt . if
A a e Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING J
BENERGY Energy BUILDING
I /�/' h BSEISMICRE I Seismic Fee Res BUILDING
BSEISMICOM _ I Seismic Commercial I BUILDING
BPLANCHK Plan Check Fee I BUILDING
BUSLIC I Business License BUILDING
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