02100050CITY OF CUPER,rINO
BUILDING DIVISION PERMIT
CONTRACTOR INF *ORMATION
Buse 11< I EsALMADEN CL
LINDY ROOFING CO INC
PERMITN(C 2 10 0 0 5 0
Ow RRIT: BRUCE T AND JOAN T TRUS
ESS54 HARVARD DR
APPLICATITI�I?rt1Y2002
77 ��'' //
IONIi:
4OS 269 -2025
SANITARY N0. CONTROL NO,
ARCHITECTIENGINT:ER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MP.CH
0 0 0 0
LICENSED CONnRd made,SDECLARATION
1 hereby aflirmtbar 1am BJ underprovisionsofsCote, 9
Job Description
P
REROOF
me my license is
with Section ]1MMB of Uivisiun 3 ..f the Business and Pmfasinns CtWC, and my license is
In Ibrtc mA cffcc-
Liccnroll u ' rare Lic �ZZ F�
ualc Contraflor
ARCHITECTS DECLA MON
1 understand my plans shall W used as Public c rec or mds
Llce.ud Pnd'croonal
OWNER - BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the
$12000
following reason. (Section 7031.5. Business and Professions Cute: Any city or county
which requires a permit,, conuruct, alter, improve, demolish, of repair any suucom
poor to its issuance, also requires the applicant for such permit to rile a signed statement
that he is licensed purs am to the provisions of the Commus's Liccnu law(Chaprof 9
Valuation
(commencing with Section 7000) of Division 3 of the Business and Professions Cafe) or
that k u exempt therefrom and the basis for the alleged exemption. Any violation of
Section 703 L5 by any applicant for a permit subjects the applicant to a civil penally of
than fvcWndreddollars
-
NN
Occupancy Type
P y yp
not mom (SS0(y.
307 INSULATION
I, as owner of the PmNny. Or my employees with verges a their sale compensation,
will do the work, and the structure is not intended or offered for We (Sec. 701C, Business
and Professions Code: The Conomfors License Law does not apply to an owner of
602 - ROOF P nsqfc�tns
property who builds or improves mcrcon, and who does such work himself m through his
own employees, provided that such improvements are not intended or offered for salc.If.
603 — ROOF BATTENS
however, me building of improvement is sold within one year of completion. Use owner-
604 ROOF
the
huJtcr will have burden of proving mat he did not build or improve for purpose of
— IN— PROGRESS
sale.).
❑ I, as owner of the property, am exclusively contracting with licensed contractors to
mstrict the project (See 7(W, Business and Prmcssions Code:) The Contractor's Li-
01•IOW01
see Law does not apply ,, ea ownm of property who Wilds or improves thereon, and
�
w
who contracts for such projects with a comoretor(s) licensed pursuant to the Contractor's
License Law.
la am exempt under Sea ,B &PC for this reason
^^T I
U
Owner Date
Q
WORKER'S COMPENSATIONDECLARATION
1 hereby afBlto under penally of perjury one of the following declarations:
11
° • _ 011VG
V
I have and will maintain a Certificate, ofconscnu o self -made rte Worker's Campen-
sstion, as Provided for by Semion 37M of the Labor CMe, far me perfomance of the
work for which Oil permit is issued.
I have and will maintain Worker's Compensation Insurance, as required by Section
370tl of me labor Cole, fur me pefOfmance of the work for which this Permit is issued.
My Work�er's C/////nJJJJ/mpensatinn torero rate Cartier and Policy number are :
CarticT./�_ Policy N.4 ~
C RTIFICATF.OF %EMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This sect... need not W completed If me permit is for one hundred dollars ($lol)
rlr lea'.)
I [edify that in the p1lorri ante of the work for which this permit is issued, I shall not
employ any person in any manner so as m become subject o the Workers Compensation
Laws of California. Date
Applicant
NOTICE TO APPLICANT: 11: her making this Cenilicate of Exemption, you should
become subject to the Workers Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this Permit shall W deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby affirm chat mere is a construction lending agency for the performance of
the work for which this permit is issued (See. 3197, Co, C.)
Lender's Name
Lenders Address
1 certify that I have read this application and state that the shove information is
correct. 1 agree in Comply with all city and county ominances and sum laws relating to
building Construction and thereby a thoriu mpreunutiws of mix city to cater upon the
shove- ms.judg d for expenses purposes.
(we,) to indemnify keep
agree save. and harmless the City of Cupcnin, against
judgments, su
in Consequence thecosuand expenses which may in any way acrncagamu said City
roLICANcc of oft his permit
UNDERSTANDS
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by. Date I
SOURCE REGULATIONS.
Re -roofs
Signature of ApplicundConractor Date
I IAZARDOU S MATERIALS DISCLOSU RE
Type of Roof
WilI me applicant nr future huilding Occupsn score or handle M1aiallous material
as defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety
Cudc. Scion 25532(x)'/
❑YesNt,
All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building Occupant use equipment or devices which
Imit
If a roof is installed without first obtaining an inspection, I agree to remove
hasardous air conuminanss is defined by the Bay Area Air Quality Management
all new materials for inspection.
p
District/
❑Yes
1XNo
I have read the hvallous ma erialsrcquirements under Chapter 695 of me Califof-
iallealmkSafetyCOle , a,x 255t I dmmifllc Wilding
lb.mmyd tatifftntnlme
�a
to notify
rocs nor au Oyhart.tenam,maitis55rapnmbi.
Raw, thin $I My
An / -
/o_
rcwiicment.wptttmasthe IN,Ktoissnanceof cca of�l/a/YUp,7y
4
Signature ofApplica t Date
All roof coverings to be Class "B" or better
owrrerma" m..rtaedag .t 7�"�''0;,�
r
LI
Building Division
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: (408) 777 -3228
Fax: (408)777 -3333.
Building Department
Subject: Reroofing policy for the City of Cupertino.
1. Prior to permit issuance, you must agree to comply with 1997 UBC Standards
and manufactures specifications on reroofing.
2
New roof coverings shall not be applied without first obtaining all inspection
Wand written approval from the building inspector. A final inspection and
approval shall be obtained from the building inspector when the reroofing 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) Preinspection 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 that the
proper City inspection can be performed.
IMPORTANT:
1. Flat roofs must have a minimum of V4" 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 of inspectidrL
We understand the above policy on reroofing and will comply with this policy.
Homeowners Name:,:.
Address: /_rl'7�
reroofing Company Name: P112 47,- i
Applicants Signature:
Date:
Joe Antonuccd
(Chief Building Official)
6,125101