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05100013w LL�J ,y FUF 0 OS �OCoC tmt� yZ> EFo 1 CITY OF CUPERTINO ,$ 7 QLender's � f" U W G Ir. z, «a'4 •ice�°'`� INFORMATIONNNN BUILDING DIVISION PERMIT p'CONTRACTOR BUILDING ADDRESS: LINDY ROOFING CO INC PERMIT NO. 05100013 4 OWNER'S NAME: PERMIT ISSUEDATE FULTON & KELLY CHEN 5554 HARVARD NE: SANITARY NO. CONTROL NO. (408)286-9990 ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 LICENSED CONTRACTOR'S DECLARATION Job Description P I hereby a(@m that I am licensed under provisions of Chapter 9 (commencing with Section 90!X1) ofMAMMA sof NC Busing and Prof�cs,t�, .andmylieemcis Imm�rnmeaoderr Z.IJ'b n ' - REROOF-T/O SHAKE, INSTALL COMP. License Clan Dam Contractee ITECfS DECLARA ION 1 I understan my plans shall be used as public ¢cords Y 1•/� " "I �l (j)� /� F� Licensed Professional OWNER -BUILDER DECLARATION 1 hreaso a(finm that 11. cttcmpl from the Commm.h LiAnyCLaw for Nc frF R mann. ]owls, Business and into Cafe: Any city ancounty.M. / w. do AT pair armature which ho a permit W Cnn improve, which 29ui perm, t (/ }j n v "�(!86000 ed em aisions of for th. Yehper1.111aicense aw(Chapt ant su s the applicant It Monit t a tprior hat het iiaiensed lChapmr9 Mel licensedpursuant1.theofDiviomofthe Sq. Ft. Floor Area {fj� / .-y �' rept- Valuation p.alanreyuirie n3 nflMexeand Professions CM,lc)tar me Section ]f ndof the Business ndPmcosi ,t7 s ppri.0 that he examith basisalleged gumption. Any= of tlmmfrom and Ne burs for the Nn H and Olx�paney Type objects ifi Senion]Osls by any applicant for apermit sublccu the applicant macivil penally of io 31.5 b not mom Than five hundred dollars ($SW). ❑ I. As owner of Ne property, army employees with wages as lhcirsoleeompensation, Required Inspections will do the work.and the suuclum is not intended or oRcred permit,(Sec. 7W, Business and Pmressi.na Cox: The Cnnnaeml: came Law does nm apply m A. aware or q P property who builds or improves Neuron, and who does such work himself or through his awn employees, provided that such improvements art not intended or offered for sale. If. however. the building or improvement is sold within mm year of completion. the owner - builder will have the burden of proving that he did not build or improve for purpose of . sato.). ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to eonstruct the project (Sec. 7004, Business and Professions Cade:)MM Contractor's Li - mem raw dors not Apply,. tet owner of property who builds or Improves Merton, and who eMoracu for such projecu with A x0mrseta(s) licensed pursuant m the CMUTICmra Lic— Law. 0 1 am Attempt under See. . B A, P C for this taxon Owner Date COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury mm of the following declarations: 1 have and will maintain a Cenifieme of Consent m selfdnsum for Worker's Compen- on, a provided far by Seeim. s]00 of the labor Code, for the o fiarrom. of to rk for which this permit is issued. 13071WORKER'S 1 have and will maintain Worker's Compemadon Ine urana, As pointed by Schon Wof the labor Code, far th= performance or Ne work far which Nis pearl is issued. Work¢eerr�, -Cmn,Mzma 1 unn¢ carrier and Policy number a rrie,. vt LMA. Bnlicy No.: I 1 L l S CERTIFI ATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thu our. recd at W complcWd it Ne permit is rano. hundred d.11onflitBn) tar less) 1 aAmIV Nat in Ne p,rform4nco of Me work for which this permit u viewed. 1 shall not employ any person in any manner so as m become subjecua the Workers' Compensation Laws of California. Date Applicant NOTICE TO APPLICANT: If, after making this Ccnifcme of Exemption, you should become subject m the Worker's C.mpcpmallan previsions of the tabor Code, you must forthwith comply with such provisions or Nis pormt.hall be deemed revoked. CONSm ON LENDING AGENCY 1 M1is a c lending agercy for dm perfotmmmc of thi that Nem is e or which d (See. 0 the work for which this petnil is issued (Sec. 709], Civ. C.) s ' de Name , 1-ena=riAmrae�e I certify that 1 have read this application and state that Ne above infotmmion is correct. 1 agree to comply with all city and county ordinances and slate I.Ws relating m building construction, and hereby authorise representatives of Nis city to caste upon lM ahove-rami onod property roe impaction purposes (We) agree m save, indemnify and keep harmless Ne City of Capetian .gaunt liabilities, judgmenu, casts and expo••• which may in any way accrue against said City tocmeact,uence of Na gaming of this penmiL LICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date SOUR E ULATIONS. `� 10 4(0- - a u---'� Re -roofs Type of Roof SigMMTFe of Applicmt/C.M.tm Tom HAZARDOUS MATERIALS DISCLOSURE Will the, applicant or future building oecupanumm or handle hantdous matcrial , MAipal Code. Chapter 9.13, and the Health and Safety as defined by the Caperton1'.!� .de, Section zss72(a] All roofs shall be inspected prior to any roofing material being installed. Yes If a roof is installed without first obtaining an inspection, I agree to remove Will thea lies buildin acs. ant me e t or devices whim ppa p equipment tit w.atdnua air ecnmminan6 a recd by the Bay Area Air Quality Management all new materials for inspection. Uialriel'! ❑Yes Nu nix HmlIhaw mail uehannitiau2550als requirementsLh Wilding Ihavemad Neha.aNtionsZ rialsmyuitcmc 5u 1.Iu Chnpmal Loca rNc Waldron. { W dors .1 currendy have A tenant Nat it is my tespomibility, to notify do occupant of em nLx whim mum be met print to issut,ae of a cwficaw or a.upan y. �Tig nature of Applicant Date 1l7 � All roof coverings to be Class "B" or better Ownm-Or authoriucd ngcn, „e S,00 CITY 0, UPEI�TINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS: PERMIT # s OWNER'S NAME: Pj l [&-c t Chest PHONE # 3Z - GENERAL CONTRACTOR: c:�CSS. FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: -Owner/Contractor Signature15ate 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 Signature15ate 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: F!" i; -A�n Job Site Address: L070 %U[ v Roofing Company Name: Li r1 dq �0 —n r-) Co. Applicants Signature In Date: L"65 Greg Casteel Building Official Revised 11/2/04 Printed on Recycled Paper 1 (I, as - - C, or CUPEI�TINO CITY OF CUPERTINO REROOF PERMIT APPLICATION FORM U Sr/ °-0� APN # I?/ � } I 6 / Bldg Permit Fees Date: Building Address: !o '0 �r Cl Owner's Name: V '�� I e--�ll chemo Phone #: Phon o 8-738- s Contractor: ko : - Lin d(4 -MO DPg- 6 hone #;,License>S - 5� Contact: Phone #: Cupertino Business License #: BUILDING Type of Roof Covering: Existing: Proposed: ❑ Built -Up Roof ❑ Built -Up roof ❑ Asphalt Shingles , ]� Asphalt Shingles Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other (Specify) Number of existing coverings ❑ Other (Specify) ❑ Provide I.C.B.O. Report # To be Removed ❑ Provide Mfgr. Installation Specs. I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: Job Description: rerAO - ey-t 5 - 5 6hccKe_- roo-r, i ✓i c"e-c i VC pS6 30 4 vhe4l f l OSoL'Y) Residential Commercial ❑ Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if there are any restrictions: ❑ Cost of Project:4 Type of Construction: Occupancy group: (0�00� Q,ai-Do-9 cSip] (e. 2asa Qty. if Applicable Fee ID u Fee Description Fee Group 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