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BUILDING DIVISION PERMIT
CONQn TRACTOR INFORMATION
BUrLDINGADDRESS:
0480 RAYWOOD DR
LINDY ROOFING CO INC
PERMIT NO. 05090039
OWNER'S NAME:
PERMIT LSSUE DATE
STEVE
5
NE:
SANITARY NO. CONTROL NO.
408)286-9990
ARCHITEC ffiNGINEER:
BUILDING PERMIT INFO
BLDG ELECrPLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
Job Description
1 hereby affirm that I am licensed under provision of Chapter 9 (commencing
p
with Scciian 7000) of Division Sof the Businem and Prafcssimox Cpm. and my license is
fm�reeander�l.
Lt 3 teg 21j j�W
Cam Comndnr Nom'
REROOF--T/O SHAKE, INSTADL SHINGLES
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�
DECLARATION
Asguill
111111
use
I undcrstanJ my plans shall he used az Public mcnrds
/& ry005
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Licensed Profcasomal
OWNER -BUILDER DECLARATION
1 hereby affirm this 11. cxcmpt from Nr Contractor's Law for the
Any
: c
following 1ificuirca A (S..tion Zconsumer. les di. info Cad,: inor s y o trisew y
which mauimu improve, nr repair any
permit mpuirothe
s�w� p(nI aa p fpm ^s
17C6'I POP )I p ,tlp 14 O
,ape ,
n h Permit t tattmum
prior to its issuance, also nt to Me IM applicant for such Permit m rile License signed summ,m
thathe the Camrumr aProf Law (ChapterCode)
Sq. F[. Floor Area IJL)u(SVIiH
�l Valuation
mencinwith Semanun0) of Diviomaf
(commencing with Section )BBB) of Division J of the Business and Professions Cmm) ser
that he or exempt M.mfrom and M, beau for the alleged exemption. Any violation of
.3 A09r
Occupancy Type
Section 7031.3 by any applicant for a permit subjects Ne applicant to a civil penally of
not more Nan five hundred dollars (5500).
❑ I, as owner or Ne propcny, or my employees with wages az Meir sole compensation,
will do Me wok. end Me structum is not intended oroRercd (orale (See.7(u,L Business
Required Inspections
and Profession Cade: The Co metorf Licartse Law does not apply to an Owner or
pmpeny who builds or imports. Ministrant! who does each work himself ar Mmugh his
Own employees, provided that such impravemenu arc not intended craffued for We. IL
.
however. Me building or improvement is mid within one year of completion, the owner.
builder will has the human of proving Mat he did not build or improve for puryou of
sal..).
❑ h as owner of the property; am exclusively contracting with licensed contractors to
...stN.l the project (5... 7W. Business Bad ProfeSawns Cade:) The COaVacbr'a LI
can= law does not apply w an Owner of property who builds or improves themon. end
who contracts for such projects with a contractor(s) licensed pursuant o Me Contractor's
License taw,
O l am aempr under Sec. ,B&PC far Mia mann
Owner Data
WORKER'S COMPENSATION DECLARATION
1 bemby afrm under penalty of perjury one of the fallowing dadantions:
1 hove and will maintain a Certificate of Consent to ael6lnaum for WorkcesCompen-
mium, as provided for by Section 37W of Me Labor Code, for Me perAMUMe of the
work for which Mia permit is issued.
❑ 1 have and will maintain Worker's Compenaumn Insurance, as Ieyuired by Section
32W of Me tabor Code, for the performance of the work for which this pemak is issued.
My WorkefsxCompensaion l'�°nce caner and Policy Monte, arc:
Cartier: S 1 sI a e r -9WL -t ✓�TBcy Na: IS 100010
CERTIFICATEPr10N FROM WORKERS'
COMPENSATION INSURANCE
(Thu union Iced nol b, cumplcmd if the permit is formic hundred dollars(1100)
,it his.)
1 certify Mea in in. p.rforman.. of the work for which Mia pefmia or ismed, 1 shall not
cmptoy any person in any manrtcr An az in become subject a M, Workers' Compensuian
Laws of California. Data
Applicant
NOTICE TO APPLICANT: If, after making this Cenifeate of Exemption, you should
become subject to Me Worker's Compermuon previsions of Me Labor Code, you muse
forthwith comply wit such provision or this permit snail be deemed invoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm Mat dem is a convection lending agency I'nr Me performance of
Me work (or which Mi. Permit or issued (Sec. 3091. Civ. C.)
lender's Name
Lenders Addm-ss
'
1 certify Mn 1 have nod Mix application and sure Mat the above informative u
emm.l 1 agree to comply with all city and county ordinances a W sum laws relamli to
building construction, and hereby authoriaa reprcunutisea of Nis city to enter upon the
ahow-mentioned property for inspection purposes
(We) agree to save, indemnify and keep harmless Me City of Cupertino against
liabilities, judgments, costs and expenses which may in any way ac.mc against mid City
in consequence of Me graming of this Permit.
ICANr UNDERSTANDS AND WILL COMPLY WITHAL N N -POINT
Issued by: Date �r— 7 -71 (r—
SOUR REGULATIONS.
Re -roofs f —A-
Type of Roof
h k .-�--L�. .ice—
Q
_
9 am o Appls HAZARDOUS MATERIALS DISCLOSURE AnCommactor am
tn
Will Me applicant or future building Occupant store or handle havardous material
as defined by the Cu,mm. Municipal Code. Chapter 9. 12, entl the Health and Safety
Z. Section25532(x)?
All roofs shall be inspected to any roofing material being installed.
0
prior
will
If a roof is installed without first obtaining an inspection, I agree to remove
the applicantfuwm building occupant use equipment or devices which
it harzmnux air contentts fined by Mc Bay Area Air Quality Management
all new materials for inspection.
islrict?
❑Yes Nu
Ih&S.mt Meh amnusmam
mail Me Califon-
reg3amenta underC.rsmntl
\ \ V/\. �—
duandour 255Uals
ria Health&e 5,25quimmcnMuntkrdha.b.95ofthc
Mot ifthc buiCalling
�f✓�'
deet n t romendy haw a tenant. Nat it is my Marti m redly the Iieet.11AM of Me
cuts which be metpnmtoismanccofa Certifcamof Qct rtnr. o
Sign to (Applicant Date
Ow cis ter a thorind agensnt Date
All roof coverings to be Class "B" or better
I
t
LAIC
Please check applicable subcontractors and complete the following information:
Owner/ Contractor Signature
Date
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
Owner/ Contractor Signature
Date
ffia
�CITY OF
UPE TING
11
Community Development Department
Building Division
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 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: E 1� st11 N Z
Job Site Address:
Roofing Company N
Applicant's Signature:
Greg Casteel
Building Official
w_740'00 _7480 8 �
L
Revised 71/2/04
Printed on Recycled Paper
C`
Date: q/0 716
•
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CUPERTINO
CITY OF CUPERTINO
REROOF
PERMIT APPLICATION FORM
v S -n ? 3
APN #
Bldg Permit Fees
BUILDING
BENERGY
Energy
BUILDING
Building Address:
Seismic Fee Res
Owner's Name:
BSEISMICOM
Phone #:
Contractor:
BPLANCHK
License
Contact: U
2- 2(o
BUSLIC
Cupertino Business License #:
Type of Roof Covering:
Existing:
Proposed:
❑ Built -Up Roof
❑ Built -Up roof
❑ Asphalt Shingles
jam' Asphalt Shingles
M�,_Wood Shakes
❑ Wood Shakes
❑ Wood Shingles
❑ Wood Shingles
❑ Other (Specify)
❑ Other (Specify)
Number of existing coverings /
❑ Provide I.C.B.O. Report #
V --To be Removed
❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu
erlmo's Tear Off Policy:
Job Description: (ernes-� X15 ^� C�1 �G� row ns l psg3 ��c er a�n�e
OWrK 28 hires o�c PrrScCLe,,i1,A,TL.
�.1-''l,n.lo5
Residential Commercial . ❑
Fire Zone: Yes ❑ No ❑
Confirmed with Planning Dept. if
there are any restrictions: u
Cost of Project: Type of Constructi(Occupancy group:
\ LN --o re.--roo Z, S C,q_
Qty. if
Anolicable
Fee ID
FPP r)eccrintinn
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
43<<,-�y
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