04080256 CITY OF CUPERTINO
BUILDING DIVISION PERMIT �sCONTRACTOWINFORMATION a
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BUILDINGADDRESS: LINDY ROOFING CO INC PERMITNo04080256
21702 CQI,lIMPTTq AW
OWNER'S NAME: PERMIT ISSUE DATE
BRYAN MIL
ONE:
SANITARY o CONTROL NO,
7-� LQ-,
CHITECTrENGINEEI: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LLICENSED CONTRACTOR'S DECLARATION
1 nemby afnrm wt 1.m It it anderppmvisions of Chode. 9(commencing Job Descrip[ion�f� n ��� p�
ties Of111)ufDivision 3oftht BusineLfand Profcssiunx Code.and mylittnu is II1P IIII w{I 1'�}
mu and error!. l REROOF W/ HEAVY SHAKES
ense C ns 3 9 Lic.N
u ��_��ARCHITECTS DEC RATION J1
C undcrwnJ my plans shall W acted u Punlic mcnrds SEP 6 2004
)yU
3 u Licensed Professional
,uct 3 OWNER BUILDER DECLARATION D � 11 A ®� �, 11 /�
u'i S 1 Wrchy alBnn that I am exempt from de Conuscur's License Law for the U Ih�- 111111 uV11 f\t\�—f/
x O o following reason.(Section 7031.5,Business and Profesvum Code:Any city nr county
K m E! which mquima a permit to construct,slur.improve,demolish,or mpair any asucmm
prior m its issuance.also mquims the applicator for such Permit to file a signed summcnt
2?G then he is licensed pursuant to out provisions of NC Comcaomr's License Law(Chapter 9 Sq.Ft. Floor Area Valu [Ion
a�F (commencing with Section 7000)of Division 3 of the Business and Professions Crude)or
i $ that he is exempt thertfrom and IW hnis for rhe elicged exemption.Any violation of
Section 7031.3 by any applicant for a permit orbiters the applicant to a civil penalty of 3MN9,0"ero0 Occupancy Type
not mom than r.n hundred dollao(Stip).
❑Lnowner afore property,or my employees wida weges uthcir sole eompewtion.
will da the wank end Ne swctme is not intended oroRued Russia(Sec.71144,Business
and Pmessiom code:The Communes License nae Law donot apply to,a mvoa,or Required Inspections
pmpeny who builds or in,movestimixturritrod who does such work himsel(or though his
own employces,provided that such impmvemems she notimmndW or offered for We.If.
however.the building or ireprow thou is mrd within He year of completion,he ow Mo.
builder will have the burden of proving that he did nm build or improve(or pm me of
sale.).
❑1,as owner of the property,am exclusively contracting with licensed commctors m
conswe the project(Sec.7064,Business and Professions Code:)The Contractor's Li.
more,taw does not apply in an owner of property who Wilds or improves daemon,and
who contracts for such pmjeeta wim a contractor(s)licensed pursuant in the Contractors
License law.
❑I am esempt an&,Sea .B&P C for oris moon
Own r Dau
WORKER'S COMPENSATION DECLARATION
I hemby affirm under penalty of perjury oue of the following declarations:
1 have and will maintain a Ccuifieau o(Conum to self-insure for Worker'sCumpcn-
sation,an provided for by Section 3700 of the Labor Code,for the Performance of the
work for which this permit is issued
❑1 have and will maintain Worker's Compensation Insurance,n mquimd by Section
3700 of the labor Code.for the amformvnec of the work for which this permit is issued.
My Warke s CompamWi Igsamnce canc..up liry number am:
G I D PolicWORKERS'
COMPENSATION
✓ RIIFl COMPEN ATION ON M WORKERS'
COMPENSATION INSURANCE
musseetion need tort W complemd ifft permit is formic M1undmd dollars($li(f)
,it lea,.)
1 certify that in dac performance of the work for which his Permit is issued.I shall not
employ any person in any manner m as to become subject o the Workers'Compensation
Laws of California.Dale
Applicam
NOTICE TO APPLICANT:If,after making this Cenifium of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code you most
.JO forhwm idr comply with such pmvisioor on,permit shall W deemed mvnked.
Z CONSTRUCTION LENDING AGENCY
(r I hereby anon that them is a eonwctinn lending agency for the performance of
he work fur which oris permit u issued(Sec.3097.Co.G)
W 0Under's Name
,z0. Lender's Address
O Q 1 ccnlfy that I have read thio application and sou mat the above information is
D.f correct.I agree to comply with all city and county ordinances and slate laws relming to
0(J building construction,and hereby aumame¢pmsenotives of his city to enter upon thc
above-mentioned property for inspection purposea
Fy (We)eg.to save,indemnify and me,harmless WCity of Cupertino against
fA liabilides,judgmcnts.costs and cape"vs which may in any wayacemeagaiesrsvit City
fJ Z in consequence of he granting of this Permit. 'Z,
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Dateq/3
s Rc_egEculp7mNs /� eyLy�`�� Re-roofs
Signature ,(� o Mwttm E rL 'd Dam
HAZARDOU MATERIALS DISCLOSURE. Type of Roof
Will the applicant or future building occupant store or handle hazardous material
az defrncd by the Cupertino Municipal Coda.Chapter 9.12,and the HcoW and Safcty
Lac.8Ycs 25532(a)? aa-,,((,, All roofs shall be inspected prior to any roofing material being installed.
Will thea Imant fir I Wilding t useequipment ardcvices whin If a roof is installed without first obtaining an inspection,I agree to remove
w gaccapan
mit hazardous air conlamitWn az defined by tW Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes
I have mad the havardous materials mquirem res under Chapter 6.95 of the CalifaP
ala Hcalth&Safcty CWc,Scctiom 25N15.25533 and25534.1 unWrsund motif Ilse Wilding
dos not currently haW a unapt,Out it is my MSNMihiliry m nudl'y he oaupent of the , fY' A'• ^>
rcyuimmcn w rant atPnrr inti accrdficacafOccapanc. Signatureo�lic=7 Date
Owner ar aurhmvcil ap pati All roof coverings to be Class "B" or better
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
JIUPEkTINO
Building De artment
JOB ADDRESS: PERMIT #
yi Co/u o
OWNER'S NAME: PHONE #
GENERAL CONTRACTOR/ 1 ' FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
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
OWP�Frcl
onir or ature Date
Community Development Department
r. Building Division
4 s City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax(408)777-3333
UPEkTINO
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 there-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.
r
Homeowners Name: '{Tj�le4c-
Job Site Address: /D� �o/man za
Roofing Company Name: L iti (IFI e2 `e i a7n Lb
A plicanYs Signature:
Greg teel
Building Official
Revised 1/30/03
Printed an fiecyded Paper
CITY OF CUPERTINO
aw��,
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN # Date:
i
Building Address:
Owner's Name: Phone
i� r e
Contractor: r Phone#: /1 Off- License #:
C' r 6,
Contact: hone#: yp� Cupertino Business License#:
Z1,17 l �v
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof Cl Built-Up roof
❑ Asphalt Shingles Cl Asphalt Shingles
X Wood Shakes I-e Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ 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: ��[vDr/2 SLa�ps , 4,66 Ze kf 4C
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with PI rt�DOptf
there are any res ctions: LJ
Cost of Protect: Type of Const do Occupancy up:
y, if
cable 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
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