06120013 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CC1N3T'RA.GTOR INk'QRMATION
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BUILDING ADDRESS: LI OOFING CO INC PEILMIT"x.06120013
21876 CORTE MADERA LA
OWNER'S NAME: PERMrr ISSUE DATE
JERRY FIGUEROA 5554 HARVARD DR 12/04/2006
NE: SANITARY NO. CONTROL N0.
(408) 286-9990
ARCHITEC tENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
l0G LICENSED CONIRACfOR'S DECLARATION - Job D05COP000
w FC 1 hereby affirm Met I am licensed under provisions of Chapter 9(commencing
:iW with Section 7")of Division 3ofMc Business and Pro(cssiuv Cade.aM my license is '
t<n. in full forceandefree 215 O REROOF- REMOVE EXISTING WOOD SHAKE, INSTALLING
License Class `i`'" 1/211 'CSB 30# FELT AND 29 SQUARES OF LIFETIME
Dale Contractor
IundcrsundmyplansmalllheusedasspLARRTIO� PREMIUM SHINGLES
idu
G y
Licensed Professional
OWNER-BUILDER DECLARATION
Cono ION
no I hereby.(Tipp on 1 1. exempt from tPi Can nim,Cmc:censeA.,c taw for the
p o following mason(Scotian 703 1.5,Business and improve.
co ions Codc:Any city or county
�$�
which requires a pumit m cannm0.alms improm,dcmnitsh,or repair anY structure
prior to its issuance.also rryuires the applicant for such permit to file a signed sutement
Sq.F[.Floor Area Valuation
that he is licensed Pursuant to the provisions of the Ciouacuter Licettm Law(Chapter9
(commencing with Section 7")of Division 3 of Me Business and Professions Code)or $11000
— Nal W is exempt therefrom and the basis for Bre alleged exemption.Any violadon of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
per...than five hundred dollars(S500). P Y YP
1,as owner of Ne pmpmy,in my emi with wages as their mlc compensation, 32645039 . 9
will da Mewofk,and dmam.hom is mat Nteread W offered In,sac(Soc.7041,lium S{ Required Iections
and Professions Code:The composer Licenm Law don pat apply m an manic,ofp
property who builds or improve thereon,and whodoessuchwork himselfar through his
awn employee,provided that such improvements am trot imeMed aroffereel fmsale.If,
bawevcr,the building or improvement is mid within ane year of completion,Ne awned
builder will have Ne burden of proving that he did not Wild or improve for purpose of
sale).
❑1.as owner of the property,a.exclusively...m miag with licensed commicurn m
coomenct the poij."(Sec.7014,Business and Pm(cssiaes Code:)M Contrscmr's Li"
come,law dna not apply in an owner of property who build.or improves thereon,and
who contracts for such projects with a comfore or(s)licensed pursuant in dm Comosc.r's
Lk.law.
❑I am exempt under Sec ,B&P C for this mason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby.Rum under penalty of scojury ane of tK following declarations-
1 ham and will maintain fsam m
a Ceo of Consent self-inm.for Workers Compere
smite,a provided for Seby ction 3700 of the Labor Code.for the Performance of the
work for which this permit is issued.
0 I have and will maintain Workeh Compemariop Inwrartce,as po uired by Senton
3700 of Ne labor Code,for the performance of the work for which this permit is issued
My Worker's Campensalio Ire me JaJrtier and Poliry num�,p,�(r ate.(/ p�
Cartier. eS� A.�l Poliry No.: I✓�
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE .
(Thkmetion product be completed i(the permit is foranc hundred dollars(SIM)
or les-)
1 cenifv Nat in the performance of the work for which this Permit is issued,I shall not
employ any permn in any manner so as to become wbject m the Workers'Compensation
Laws of Califtrmia.Dam
Applicant
NOTICE TO APPLICANT:IL a(mr making Nu Certificate,of EmmpOon.you should
become subject in the W.rkei s Compensation provisions of the Labor Code,you most
.J z feMwidt comply with such provisions of Nu permit shall W deemed revoked.
z O CONSTRUCTION LENDING AGENCY
(•" I hereby affirm that them its co pure n lending agency for the performance of
Be wish far which this permit is armed(Sec 3097.Civ.C.)
C Q lender's Name
] z lender's Add.
U 0 1 certify But 1 have tad this application and sum this the above ter..Win is
If. correct.)agree to comply with all city and county i mitat.,and ren laws plating to
V building construction.and hereby aushorim mpaeaenutives of this city to enter upon the
uhovome judgments,
property fur inspenlon purposes. .
H y (We)ague to ave,indemnify and keep harmless gu City of Cupertino against
ern in consonance
Standing of this
may in any way accme against mid City
UZ in eosuequencc of the granting a(thu pewit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SqURCER,EGULAMONS. /
signu pplt'avtUContracwr Dare
t I_/� Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant score or handk heramous material
az defined by Om Cupertino Municipal Code.Chapter 9.13,and the Health and Safety
Code.Section x5532(.)7t�7/�^ All roofs shall be inspected prior to any roofing material being installed.
ElYu O
If a roof is installed without first obtainingan inspection,I agree o remove
Will Ne applicant or future building aecupanl sett equipment or desacs which ret
P g '
,.it hi.mntts air conumirunu n defncd by the Bay Area Air Quality M.......t all new materials for inspection.
District?
Yu N.
I have read the herandous materials n:qui.mem under Chapturii.95 ofthe Calif"r.
nice Health&SafctYCede,Sections 25505,M533 and 25534.1 undcn.M tlutifde Wilding
dor not comody ham a tenant.Nat it is my responsibility to notify the nxupenl of Nc
t ntswinch mustbemet prior missuanceoraCcrdGamofoccu SI n ureofA Applicant Dat
�r� 1 �,_k-� IIL 4 0(r g PP e
Own auth"rigid agent Da All roof coverings to be Class"B"or better
Community Development Department
Building Division
1 City of Cupertino
10300 Torre Avenue
' CITY OF relephone: (408) 777-3228
CU.PEkTINO 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 unstallation.
' 6. 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 andthe job is not ready,
you will be charged a re-inspection fee of$176.18. The re-inspection fee must
be Raid 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: �IGt�r��-7't
Job Site Address: �?12:2(Q
Roofing Company Name: s COQ
G
Applicant's Signator
Greg Casteel
Building Official
Revised 11/2/04
Prinlod on Recycled PVer
CITY OF CUPERTINO
om 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32645039 . 00
DATE ISSUED. . . . . . . : 12/04/2006
RECEIPT # : . . . . . . . . : 36949
REFERENCE ID # . . . : 06120013
SITE ADDRESS . . . . . : 21876 CORTE MADERA LA
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : JERRY FIGUEROA
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP' . . . : ,
RECEIVED FROM . . . . : LINDY ROOFING
CONTRACTOR . . . . . . . : RUMFORD, LINDY LIC # 3921
COMPANY . . . . . . . . . . : LINDY ROOFING CO INC
ADDRESS . . . . . . . . . . : 5554 HARVARD DR
CITY/STATE/ZIP . . . : SAN JOSE, CA 95118
TELEPHONE . . . . . . . . : (408) 286-9990
•FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ----- ----- ---------- ---------- ----------
BPERMFEE VALUATION 11, 000 . 00 180 . 36 0 . 00 180 . 36 0 . 00
BSEISMICRE VALUATION 11, 000 . 00 1 . 10 0 . 00 1 . 10 0 . 00
---------- ---------- --- ------- ----------
TOTAL PERMIT 181 . 46 0 . 00 181 .46 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 181 . 46 2344
TOTAL RECEIPT 181 . 46
•
b Community Development
10300 Torre Avenue
3/ Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
%UPERTINO
Building Department
JOB ADDRESS: a 1 87& CO M PERMIT #
G ool�
OWNER'S NAME:j �' �� PHONE # p _ 7
GENERAL CONTRACTO FAX # (a
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
ha 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
CITY OF CUPERTINO
REROOF
CUPERTINO PERMIT APPLICATION FORM
APIC# 32U J ,t,� _ 02q Date:
Building Address: 'j J//��1 _
l -7
Owner's Name: Phone#:
- YV9- D 7 S
Contractor r d Phone #: License #:
ego as8.
Contact: Phone#: Cupertino Business License #:
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) ❑ Other(Specify)
Number of existing coverings L3Provide I.C.B.O.Report#
X—To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Polic
Job Description: nGNiUu ems ti.< waUrJ� S6u�lL�
� S / ^S7�'�Irnq t J2r� p$d
e ^-F
Lc cr l {rrn
Residential Commercial ❑
Fire Zone: Yes ❑ No Q Confirmed with Planning Dept. if
there are an restrictions: LJ
Cost ofProj�� Type of nstruuchion: Occu anc
p y group:
rn —3
Qty. if
A licable Fee ID Fee Descri tion
BPERMFEEFee Grou
Bld Permit Fees BUILDING
BENERGY Ener BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial
BP CHK Plan Check Fee BUILDING
BUSLICBUILDING
Business License BUILDING