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.CITY OF CUPERTINO
.'''%' 'zirF,
BUIL61NG DIVISION PERMIT
CONTRACTOR`INFORMATION
BUILDINGADDRESS:
LINDY ROOFING CO INC
P""T"005070139
7559 BARNHART PL
OWNER'S NAME:
PERMIT ISSUE DATE
LOCK EDMOND D
5554 HARVARD DR
07/22/2005
E:
SANITARY N0, CONTROL NO.
(408)286-9990
ARCHITECTIENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
o
Job Description
Hamed under provisions of Chapter 9 (commencing
I Waffirm rchy arm Nat 1 am Ham
P
with Section 7") of Division 3 of the Business and Professions Code, and my license is
in full force and efrpal._ 21rr81�P
Littnsc class Lie.0
REMOVE EXISTING SHAKE ROOF INSTEAD PYWOOD, FELT
AND INSTALL 38 SQUARES OF A NEW DIMENSIONAL
Date Contracmr
ARGHITECI'S DELLA ON
COMPOSITION SINGLE ROOF
I understand my plans shall W used as public records
Licensed Piumso nal
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from lie Conlractah License Law Our the
following reason. (Section 7131.5, Business and Profemimu Cam: Any city or county
which mit.iru a permit m const, altar, improve, demolish, or term, any slvmum
prior to its issuance, also requites the applicant for such permit to file a signed statement
that W is licensed pursuant n the pmvuimns of the contracture License Law Charter
Sq. Ft. Floor Area
Valuation
(commencing with Section 7(k18) M Division 3 of the Business and Professions Cork) or
b14 OO
Y
that he u exempt therefrom and the basis for de, halleged exemption. Any violation of
APN Number
Occupancy Type
Section 7031.3 by any application for a Permit subjects the applicant W a civil penalty of
not more than Bw hundred della. (15001.
❑ 1, u owner of tW pmpeny, or my employe= with wags u their mlc compenudon,
n
Required Inspections
will de the work. and Na structure is not intended or offered for sale (Sec. 7044, Business'
and Pmfessiov Codc: The Contractor's Licetue Law does not apply to an Owner of
progeny who Wilds or improves thereon, and whodoessuchwmkhimselforthrough hish�mr
ownemployeuiLding ainowli
3TC
wofc mpleeodfoemner,
ri PMWMimpsmldwii owner-
year of mprove
bve
s?Q
4'
frNe
Wilde,.Ne
of pronttssaldeiid our
builder will have Ne burden of proving that he did WI Wild or improve for purpose of
the
sale.).
�Ly
'
❑ 1, as other of the progeny. , B sine s and confessions with licensed mnuaclos U.
i code:) The Contractor's Led
not (Sec. Business and Ptofesny
///yyy
(I rs
���
wh ud
cove Law data not apply je an owner of propcny who W lids or improve thereon, and
room, La des o in
V
��
whence Lace for such projects with a contractor(s) leaved pursuant w the Contranor's
License
.
❑ 1 am exempt under Sec. , B & P C for this mason
exe
Ow r Dau
WORKERS COMPENSATION DECLARATION
by arm unr penalty of perjury One of the following declarations:
1 bemaffirmde
1 have and will maintain, Certificate of Consent self -inure for Worku'sCompen-
mumn, u provided for by Section 3700 of the labor Code, for the peAmmance of the
work for which this permit is issued.
❑ 1 have and will maintain Worker's Compenution Insurance, as requimd by Section
"I of the Labor Code. for de performance or the wile for which this pesmil is issued.
My Worker's Compensatio mnoce canict and Policy numWr am:
Carrier: -(frr^ t "my No.: (SS I� ( 0I
CERTI I ATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Ibu section used not W completed if the permit is formic hundred dollars (SIM)
less.)
I mr-ury that in the performance of the work for which this permit is issued, l shell not
employ any person in any manner so as in become subject to the Worker' Compensation
Laws of California. Dau
'
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
became subject in the Worker's Compensation provisions of thc labor Code, you must
forthwith comply with such Provisions or this Permit shall W deemed muted.
CONSTRUCTION LENDING AGENCY
I hereby affirm Nat there is a construction lending agency for dm Performance of
the work for which this permit is issued (Sec. 3(197, Civ. C.)
Lender's Name
,
Lender's Address
I certify that I have rod this application and sum that the aWw infotmadun is
-
comm. I agrm m comply with all city and county ordin oases and some laws muting in
building construction. and hereby aurhorim tepresenuavv of this City ni enter upon the
above-mentioned properly for inspection purpoxes.
(We) agree to W. indemnify and keep harmless the City of Cupenuoi against
j liabilitia.judgmcnu, casts and cxpcmes which may in any way am. against said City
in eoveguenee of the granting of this permit.
' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date -7 L
SOURCE REGULATIONS.
sl
t.-[ `_�/lige
�— —� 1 • Q �— Yl
Re -roofs f
. Type of Roof
Signm Apple anVC.mrselr Dmr
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building Occupant shim or handle hu:rs material
az defined by do Cupertino Municipal Code. Chapter, 9.12, and the tjeal and Safety
otic, SCcfion 25532(a)? .•�
All roofs shall be inspected prior to any roofing material being installed.
Ycs
WIB front hilum Wildj �u l 1 or devices which
applicant
If a roof is installed without first obtaining an inspection, I agree to remove
thea r vy e
J G pan yuipmcn
..mit harardnus air cenumivnts as find by ft Bay Area Air Quality Mm'li mem
all new materials for inspection.
Diu icl7
❑Ycs Nu
zardous aterials rtqim
(have mIyLMIC ham umenu under Charmr 6.95 of the Califor-
A-�I,
`\^\ \
iia Fksla(ety GmdL.lCetiOns 25585.25533 ara125534.1 undersand Naz iftM Wilding
1
Jos noOily have a ¢rant. that it u my responsibility m notify the .pant of Ne
1�.
cnuwhichmustWmelpdo,toissuanccof.Croulleuof aney.
Si ureofApplicant Date
GSW
All roof coverings to be Class "B" or better
owner 'xed,Pml
m Dam
SIM
CITY OF
OUPEkTINO
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Building Department
JOB ADDRESS:
Yj 55 I-M-Igz:v
PERMIT #
of -076(3 -
OWNER'S NAME: ED doe
PHONE# 406 2-1
GENERAL CONTRACTOR L w.O t%or-iciq
FAX #
I am not using any subcontractors: C>�� ` \ 2210S
Signature Date
Please check applicable subcontractors and complete the following information:
RI
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
U
Owner/ Contractor Signature
Date
a((M
's
4 CITY OF
CUPEkTINO
ft
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Building Department
Subject: Re -roofing policy for the City of Cupertino
Telephone: (408) 777-3228
Fax: (408) 777-3333
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 re -inspection fee must
be paid before another inspection can be scheduled.
IMPORTANT:
1. Flat roofs must have a minimum of 1/4 " 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: ECA Lo Ci'<
Job Site Address: 5 5 turn ka#-4 1'10CS2_,
Roofing Company Name:
Applicant's Signature:
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
M
Date:2 �L_6S
0
Ell
05u+013q
CITY OF CUPERTINO
REROOF
PERMIT APPLICATION FORM
APN # 3 u cD 1 Co 0 -to
Bldg Permit Fees
Date:
Building Address 559 Barr)
%far -4 Pl acQ
Owner's Name: Ci I L U C tC
/ BSEISMICRE
Phone #:
08-`72-I -997-
Contractor: ) lVA dC4MA
BSEISMICOM
License #:
ems`" ) 5 8/
Contact:Cupertino
Loe�L e - Lo8-a8(,0-
R4g0
Business License #:
BUILDING
Type of Roof Covering:
Existing:
Proposed:
❑ Built -Up Roof
❑ Built -Up roof
❑ Asphalt Shingles
Wood Shakes
X Asphalt Shingles
❑ Wood Shakes
❑ Wood Shingles
❑ Wood Shingles
❑ Other (Specify)
❑ Other (Specify)
Number of existing coverings
❑ Provide I.C.B.O. Report k
6k�fo be Removed
❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply
WithCu ertino's Tear Off Polic
job Description: re . rn0t._ �x.s C¢ (bL ,n .lwcw t
M 8i-ct-t.4 38S9vo�S o�c. ne. � otn o tsto��f 0.s 1 �0^ S{ h L¢ IQpo�'
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑
Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project: Type of Construction: Occupancy group:
L1,_L)o CX--)
c- t'co-r S7 c — 0,_S .
Qty. if
Applicable
Fee ID
Fee Descrintion
Mw
Frr (rnnn
{ 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