02090044 CIBUILDING O
f UDN
PERTNO
PERMIT CONTRACTOR INFORMATION:
.BUILDING ADDRESS: PERMIT NO.
10225 ANTHONY PL LINDY ROOFING CO INC 02090044
QB1ySMECHEN 5554 HARVARD DR APPLIC ale?n
002
( PHONE: (408) 269-2025 SANITARY NO. CONTROL NO.
ARCHITECDENGINEER: BUILDING PERMIT INFO
&uU- BLDG ELECT PLUMB MECH
ya
y 2 LICENSED CONTRACT'OR'S DECLARATION
"4- 1� o hereby affirm Net 1 am licensed under provisions ofChapmr 9(commencing REROOF Job Description
F,:1-u with Seiiars7(00)of Division 3of9he Businessind Pmfecondox Cede,and mylicense
_x I<
isI. forte end elittt. ������ �
z a License Class Li,p
3 a U DateContract.,
F LL aARCHITECT'S DECLARATION
�•-� 1 understand my plans shall be used as public records SEP 2 0 20 02
trta.i c Licensed Professional
OWNER-BUILDER DECLARATION
u%+='a I hereby aRrin that I am exempt from the Contractor's License Law for the
following reason.(Section 7031.5.Business and Professions Code:Any city or county
BUILDING14865
c,F❑ which requires a permit to construct,alter,iniprose,demolish,or repair any structure
i 3 0. prior to its issuance.also requirestheapplicant for such Permit t file statement
rak,a,�
that b k,licensed punam 10 the-provisions of the Correctors License L (Chapter 9 ,,_ •'••34•py.GtO gIQoClgSya.a'p 4 '^ - Valuation
(commend,with Star 70!1))of Division 3 of be Burn. ndI' f .ions Cadet t s. ,a la,ate: sy rTs
or that he 1$exempt therefrom and the basis for the alleged esdripdrn Any violation '
of Section 70315 by any applicant for a pennit subjects the applicant to a civil penalty'
,of am marc Nan Eve hundred di.q .S50o). 3 0 5 APN p4dWp}E ! <v;. :.t Occupancy Type
111.as owner of the Property.orm'y employees with u ages as their sale compen.aeon, 307 - INSULATION_r]:�
-'wit[do the work,and the structure 6!
is not offered far (See:70 ,' { yT�l
Budiumi,and'Professiom 601 — ROOF TEA
Code:The Contractor License Taw does not apply to an Re f'(1 Ins eet10HS t'• "
Owner of progeny Who builds m improves thereon,and who does such work himself 602 - ROOF PLYWOOD NAI L
or through his own employees.Provided that such improvements are not intended or
...aReRdTOFI.lelEnoweve r,tbeWJdingorimpm.mmtntIisaId_%_irhinone ymar or --- -----603. _ ROOF-..BATTENS.....----_... --------'-----..._..---'completion,Ne ow.r-hilder will have the burden of proving that he did not build or - ly -- '''r'•' a
improve for purpo.caf.alc.). 604 - ROOF IN-PROGRESS
Ol:a e, he Po the propenY nm excBusiness mal contracting C I:)Th Coun ors m "`""-'-'
License, the projttl(Sec.70Ja,Busmen and s,my who
Code:)The Contmam•s ,:.1: : •, '.,I•.
Liccnse Law does not apply man owner th a.coni woo builds or scimproves thereon,
_arW who contracts !Law. h.projtt¢wiN.a.cammnorts).liceosed Pursuant.m.Ihe -._.._._....____-_.._.__-__.___.-___..-- _._._..___
Conuactors License Law.. ._-...-._._ __........-.._—.___--
_ ❑lam exempt under Sec:" „Bi&P C for this nation Ii;it
Owner: .. ,,.. ..' Date'„ r.
_ WORKER'S COMPENSATION DECLARATION,
! Thereby mann under pcwity of perjury suI ofthefollowingdmlamtturn:
.al ❑ 1 have'and'wilf mmonln'o Certificateal"Conzent to self-insure for Worker's
Compensation, as provided for by Section 37W of the Labor Code, for the
performance of im',ml,for which Nis permit is issued.; .
❑I h d' ill'mu" m W k r C pe t I ' turned by Section
37W f ih L'IedC d 'far the perGmnance of the work fof which this permit is
ismcCrime s I �{.�L' don "*pie m J Policy robe arc:"
d My W k s
r':ft . viPrl rNa.. f. }:, 1 . 'i' a r x't Zet ` tIt,.t- t n
A
FICTION OF.EXEs1P1'ION FROM WORKERS t,M t�,
' COMPENSATION INSURANCE"'-p r"
"coon tiecJ out he cumplemJ if the pemtit iz for one hundred dollars r�'r'' s•1'• .'._ it 1 ' l'
(SI001 Icss.l
;I rt fy that in the pert nn - which
-.. - .. .... ..1.., «.:...,�. ,. _._ ...«.., ..._. ..,
coo t mploy my person n any manohti k f h h N pe t ss d 1
mann so as to become subject to he Workers'
Compensation laws of Coliform..Dale"'
Applicant.:.. ..: :� ... ...:. :. . . .... _ '
NOTICE TO APPLIC
ANT.If. B mak,g old'Crnf roof Exemption,y M1UIJ _ - - --- - - - -- -_..-__
Z ma s ecomply
the Worker C taper t 'pro of the lame Cod you du
fort"Nthis
Q 0 focomply'wiN such props ons or Permit shall bed red revoked. ,
C > 1 n ny.Rim Nm NOR .,const a 1 a ng age ey ro m perrormanee' „ a r .
rr of Ne work for wfi ch th s perms a lssucd IScc.3097,Civ.C.1 `;_' - '
.7`,'L
L.
V 0p I c n fy Nat I h e rcaJ N pphcat and sot th uh bo of rtn ran is
kl �. cotrea 1 gree tp c mply th II eD nJ ntY d' c d t to mining
Q_V mertswin
�„'(r] Nc bo c m Y n-d pct pony f in.p„t s p ry
F'W linblt(W ) g t.s i eemn fy dkceph mlesN Cty fC pens 'gainst
) dgmems, st nd pe s¢ h h m
z y,in any y me ags
C.3 City co q ncc ofN g m g hM1i p i '� aid aid
TPPLICA�T UNDERSTANDS AND WILL CObIPLY wTTH ALL NON-POINT ' Issued by, Dale
SOURCE REGUCATIbNS ,( „
S,g t of Applcum/Conraam ”' j oat. Re-roofs
I,. HAZARDOUS MATERIALS DISCLOSURE
,;. Will Nc ppl cat f t rt bu'IJng uc p t x15 hmJle hazardou. mat nal .T e of Roof _
as def dby the Cpen aMun 'pal CodChapter912 and theHealth and Safety Ty
Cod S t n 25532(a)? 7 ( .,
A1Lroofsshal] be inspected pnor.to any roofing material being.installed.
,.worn applicant rfuture buldngacpnt seequipment devices wnch If a roof is installed'withoutfirstobtainin art ins ection;la fee'to'remove
ithazardousit comm t as defined by theBay Aria Air Quality Mmagement
DigrmL. g P g
- • a ore. , . . "ON. ;c:',". '= _ .. tats for,inspec[ion_ Applicantpnderstands_and will comply with_,
_ I new mater
• all non-point source regulations
I ha c mad she h z d meals requ remcnn and Chaps r 6.95 of he
Calf Health IN&Safety Code.Salons 25R15.15533 and 25534 I understand Nat
dike baldngd not cu dY havea¢n r that ts m rtspo' bltyt Defy Nd - '- -- - - - -- - -- __ _
occupant of N- quirtme t. 'Inch'must be mei p r mss of C nificum of ',,a �
the pancy s
Signature c pplica _ _ Da-(
' ownerar. adree.ge Date All roof coverings to be Class "B"or.better
�'�'. ...W:A ...... ._ :. 1.
OFFICE
Building Division
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
&CITYO Fax: (408)777-3333
CUPERT]NO
Building Deparitnent
Subject: Reroofing policy for the City of Cupertino.
I. 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 withoutfirst 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:
I. Flat roofs must have a minimum of W 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 inspection.
We understand the above policy on reroofing and will comply with this policy.
Homeowners Name:
Address:
Reroofing Company Name:
Applicants Signature Date:
Joe Antonucci
(Chief Building Official)
6/25/01