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03050084 ..rCITY OF CUPERTINO BUILDING DIVISION PERMIT A�CUNm=RGUR TNUiM TO r teg.'c .,7 < A f3. „.: 4.Eta4k"hh ze`. 3A Y "Sep 9uILDINGADDRESS: LINDY ROOFING CO INC IM�"x'03050084 Q2.14 CAMARnA ("T OWNER'S NAME: 5554 HARVARD DR PERMIT L951jEAA}$ 9/2003 OPELS DAVID U7� 1 NE: (4 08) 269—2 025 SANITARY NO. CONTROL NO, ARCHITECTIENGINBER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH p +I OZO LICENSED CONTRACTOR'S DECLARATION Job Description 1 hereby affirm that 1.Ilanmd under provision of Chapter 9(Commencing P ^� 1.1ull f torte a0!ycl. Nsion Sof the Buoi andProfessian Code.And myllcewk REROOF ��®W�9gi,'beY�C® ante w uc.N 3Q D ARCHITECTS DECCAa_TION ty7 Iundcuundmyplmeahallheused aePgpRtFecmda MAY 2 7 2003 Lmmsed Pmfeuionel OWNER-BUILDER DECLARATION p� E 1 hereby of im,that I am exempt from the Confranoes License Lew for the BUILDING 0 o following reason.(Sinden 7031.5,Business and Profnsdans Code:Any city or county $ which requires a permit to construct.Blur.W prow,demultsh,or repair my atnruterc ire pdor k its Issuance,spm requires applicantfarsah permit m file signed esteem thathaislicensed pursuant todteprovisions ofthe Canttactm'aLicense U6 Law Sq.Ft.Floor ,sa ton 5$ (commencing with SeNon7oh(fiof Divulon 5 offle wm Busind Professions Code)on 3 that he is axempt therefrom and the buss for tM alleged exemption.Any Hohdon of Section 7071.5 by any applicant fa a permit subjects the appliam h,•civil penalty of 3 AR79dQ Mel 0 0 Occupancy Type not mem than Ow hundred doll.($507. p L u owtur of tie proparty,"my employm with wage u Uetr Ink emnpewdon, willdoshework,andthestrumurelarmtinundcdm-ff-Wfaaok(SM.70M,BusinuE Re aired Ins actions and Profession Code:The Conuumrs Licew Law dm not apply w an owner of P property whobuilds orimprows durem,andwho doessuchw"khtmselforthroughhle 307 - INSULAT ON own employment,provided that such Improvements.her Intended or offered tarok,If. 601 — ROOF TEAR OFF however,the building or Improvemant Is mid within oro year of completion,the Owner. border will hove the burden of proving Net he did not Wild or Improve for purpose or 602 - ROOF PLYWOOD NAIL tele')' 603 - ROOF BATTENS p 1,a awour of the property am exclusively coumacMg with licensed contnmom to construct the project(Sec.7W,Business and Pretensions Code:)The Contractor's Ll- 604 — ROOF IN-PROGRESS caw Law dean net apply m an owner of property who Wilds or Improves thereon.and, who Contract,for such pmjecto with a eommou(s)licensed pursuant to the Cm.etoes Lice.Taw. p 1.exempt under Sm, .B&P C for this reason OwnerDew 'S WORKERCOMPENSTnON—DECLARATION I hereby&Man under penalty of perjury oro of the following deci.tiene 1 raw and will mainWn a CerdRate ofCawnt to sepFimm for Worker's Comfort. notion,an provided for by Section 570 of the Labor Cade,fm don perf rrmaw of she work for which this permit Is Issued. ❑1 haw and will maintain Wortmes Compenoiion Inatoanm,u requited by Semon 3700 of the LAImrCodc,M Workar'Compewtim the performance a16�fyothdp,, fswher sm: permltkkaved. t CEirnFICATEOFE%EMPnON WOR 3' COMPENSATION INSURANCE (ITksmlim need an[W completed time permit I.foram hundred dollars(s100) mkss) 1 anify that in me Performance of the work for which this permit is Issued.I shall not employ myperron in any counter an u w hecomesubject to dru Workers'Cempanmdon . Law.of C hhm, .Dow Applicant NOTICE 7O APPLICANT If,after meting this Cenll cae of Exemption,you should become suhjecflat M Worked Compensation provisions of tiru Labor Code.yen muss �0 foMwith comply with such provision or this pemdr.IWl be deemed remised. �O that LENDING AGENCY [.w IWmby.M,m that drum is a cotuvucOrm lending agency for du performance of Ni> the work for which this permit Is lasued(Sec.3097.Civ.C.) W Q Undoes Name a Z Lommes Address U Q I=try shot i haw rend this application and sum than the show Information is tT. Corm.l agree to comply with all city and county ordinates and was law relating In O building eonstmctlon,and hereby auth"irn repremmmum of this city to offer upon the W ahove-mentioned property for hupeedoa purposes. pp ty, (We)agree in use.indemnify and loop hemi.the City of Cupertino against /S / G'a V) Ilabllitlea,judgmcnu.eau and expense,which may In any way came against mid City I J U In APPL CANT UNDERSTANDStAND WILL COMPLY WITH ALL NON-POINT Issued by: Date rZfi. PAULATIONS. Re-roofs pptw r f Dte H US IAL9 DISCLOSURE Type of Roof theapplicmtor no=Wilding accupant star"handle haardous macNai y the Cupertino Municipal Code.Chapter 9.15,and the Health and Safety u5324)? All roofs shall be inspected prior to any roofing material being installed. the applicant or fumrc Wilding aceupent um equipment m dcvlcea whichIf a roof is installed without first obtaining an inspection,I agree to remove eus air Commitnants u dented by the Bay Arco Alt Quality Management all new materials for inspection. yy��'es d0o I have Food the Imanh mmawdalarmulremenu underCNpur6.95 oftie Colif e. a[CHealth&SatmyCodc,Scnlora25505.25555 md2553/.I undctwd Lunglfthe building dm not currently haw a board,that It a my responlailhy in roti the aaupanf of d requirement, fiIg1lA,ar be s dura ssuanceo Ccrdfeate of cupem`� Sig—nature of Appligint �'VV_ ate own" mharlxN. nt Da All roof coverings to be Class"B"Or better Community Development Department I Building Division City of Cupertino 10300 Torre Avenue CITY OF Telephone: (408)777-3228 U P E IST I N O 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. 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: a,4 &d2 .t kr �6IC //// n� Job Site Address: _ ;2 2 ice/ — D�./���,� 4ggZ ( f Roofing Company Name: L i�ri�o� � ( O A plicant s Signature: r Date: – • Greg eel Building Official Revised 1/30/03 Printed an Recycled Paper CITY OF CUPERTINO O 3 0 a REROOF CUP4ERINO PERMIT APPLICATION FORM APN# Date: © -O tlding Add s: o /� D / 67 Owner's e: Phone#- &4 X CU Contractor: Phone#: License#: L ' - s Contact: t Phone#: Cupertino Business License#: Type of Roof Covering: Existing: Proposed: Cl Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles � Asphalt Shingles XWood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other(Specify) ❑ Other(Specify) �,/Number of existing coverings El Provide I.C.B.O.Report# n To be Removed ❑ Provide Mfgr.Installation Specs. • I Have Read, Understand and Will Corpply With Cu ertino's Tear Off Policy: Job Description: 12 B k�'e- SX- 4e S Residential Co ercial ❑ Fire Zone: Yes ❑ No Confirmed with Planning Dept. if there are anrestrictions: L5 ost,o f Project: o� Type of Constructio OccupancyArcypq Qty. if Applica6le Fee ID 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 z� s� 7 '27 7 `'