08060166 CITY OF CUPERTINO
BUILDING'DIVISION• PERT rCONTRACTpR INI~ORMATION
N,�" �.j., i�i'.LL Y.• .4
PERMIT NO.
eulL(.)Igcy,ADpRE$$.E PALMA IN LINDY ROOFING CO INC 08060166
OWN�EWSVNASME: l) PERMIT ISSUE DATE
KAREN PAI 5554 HARVARD DR 06/24/2008
lipNE: SANITARY NO, CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
RE—RF RMV EXTNG WDRF& BLDG ELECT PLUMB MECH
0 0 0 0
u o o LICENSED CONTRACTOR'S DECLARATION _
uF 1 hereby affirm that I am liamand made,mavilme of Chapter 9(anmmcMmg Job Description
mW with Scction7t )ofDiviaion]of Ute Bminessand Profcesiun Code andmylicenanis
^<.Om in full force and afffta—'3 LicI
og z Licence Ins L.
b,9 Oaa TECTOS= N
44 an Hll W u S DECLARATION
W I understand my plans shall be used u public records
sW
o Licensed Pmfcmoml
3 OWNER-camap,RDE DECLARATION
f 1 bcmhy.(Sofrom that 11. uonn Pram the Congas Co Lima.c Law for the
❑O following.damn.permit
t Lo I.S,Bonn.and ve.dcoam Code:Any city os county
K$ which requires o permit re cures tn,ape,impmsu deeO1W,ri ream,arty stmcmrt
priorb its Waitrequiresto to thovisio antsof for ft Contra
ch mitmfileasigaw statement
Ego (mans rcess,wpmemite.mthe of Division3OftheBusinessand �l.onsCode,9 ,Sq.Ft. Floor Area Valuation
yle- that hesinemiNSeaioed and of Divisionr ofalleganessand Professions Cade)of
Y•j$ Bt+l IY.•l]eaempl BVJefrem and BC IlaeR for Use allCgfd Clte,tlpllaR Any Vlolldett of
Section 7031.5 by any applicant for a permit subjects Ute applicant to a civil penalty of APN Number Occupancy Type
ret name Nan five hundred dollars(M). P Y YP
I,as owner of the property,or my ctnplones with wage as their In monpoomt an,
will do the work and the structure N trot intended or offered for sale(See.7044,Business
and Profession Code:The Contnctofa Liar a Law does ret apply at an owner of Required Inspections
property who Wild,or improves thereon,and who does such work himself or through his
awn employeel provided that each improvements are not intended oroffered fursale.R,
however.the building or improvement issold within one year of completion.are owner,
builder will have the burden of proving that he did wt build Or improve for purpose of
ask.).
❑L as owner of the property am"elusively contracting with licensed cenuanora to
construct the project(Sec.7044.Beinces and Professions Cade:)The Contractor's U.
cense law data not apply m an owner of property who builds or improve thereon.and.
who contracts for such projects with acom user(s)licensed pu mons to the ConuactaYs
lima taw.
❑I am exempt under Sec ,B&P C for this reason
Owner Date
WORKERS COMPENSATION DECLARATION
I hereby affirm under pmaity of perjury aro of the fallowing declarations:
1 haw and will maintain a Certificate ofCommm to self immm for Waftescompen-
7c,
tion.as provided far by Section 77011 of the labor Code.far Ne perfofmanca of the
rk for which Nis permit is meed.
1 have and will maintain Wmixes Compconties Insurance,as requred by Senior
00 ofthe lahmCode.far Ne performance ofthe roes for which Nu pemtit is issued.
y Workes Cra,sedan Insurattrycanie and Policy numrrier: A C_/G1/r�_Lf/ Policy No.; Oy
CERTIFICATE OF EXEMPTION FROM ORKERS'
COMPENSATION INSURANCE
rMisanefian need not he completed lithe permit is fosse hundred dollars($IOW)
or less)
I modify that in the performance of the work far which this permit Or issued.I shall not
employ any person in any mamter an as to became subject at the Worlmn'Compwmet,
laws of califomia.Date
Applicant
NOTICE TO APPLICANT:1f.after making this Cettificam of Eumption.you should -
became subject an the uom e s Cmopemadon provisimts of the tahm Cade you mire -
.J Z forthwith comply with such proridom or Nu permit shall he daemon resakcd.
'Z O CONSTRUCnON LENDING AGENCY
[•+ I hereby affirm that inert is•construction leading far Nc
pesformaraceof
!Yi the roes fur which tins permit is issued(Sec.J09],Civ.C.)
G A
Lxn&es Name ,
n z UI<nrelcedefs Add.
V Q 1 certify that 1 have read this application and mare that the above informadun is
II.V correct.tailed ro comply with all city and county ordinamta and state laws relating to
.O building mnsuuction,and hereby autbodre representatives of this city m C(am"pnn the
LI) aW.-Famdoncd Property for inspection purposes
LL (We)agree to an.indemnify and keep harmless Oe City of Cupertino against
h liabilide,judgments.costs and expense which may in any way accrue against said City
[)Z in consequence of On granting of this permit
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL ON-P NT Issued by: Date
REGULAAMONS.
Re-roofs
si o pplicanUContractor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building c.0taotvom2.and tie ha'rallom material
C defined by tic Cupertino Municipal ode,Chapter 9.n.and Ute HW N and Sa(ety
Code.Sued.usJZ(a)7 All roofs shall be inspected prior to any roofing material being installed.
Ye
If a roof is installed without first obtainingan inspection,I agree to remove
Will the mplic or fu Euilding Occupant use,equipment or devices which P
e0ms�lssvudnm vie co mi u e defined by the Bay Area Air Quality Management all new materials for inspection.
❑Yas r]NO
IhewmaAtheh.udd.mamd+Ismquimmcnuunder Chapted6ai theWilding
ria HcalI h&e read! heIstemit.acunU5,195JJ amt ras under
mndthu ifUtc building
does amt currently ban a comms Nn It is my ampomthility,m nodfy the mcupmt of the
requiremc uatbcm�`ortoinuanccafaC " tare of Occupancy. Signature of Applicant Date
Owner or Dam' All roof coverings to be Class'n'or better
CITY OF CUPERTINO
• 2 ITEMS OF 4 PERMIT RECEIPT OPERATOR: pdtg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36932055 . 01
DATE ISSUED. . . . . . . : 06/24/2008
RECEIPT 4 . . . . . . . . . : BS000005199
REFERENCE ID # . . . : 08060166
SITE ADDRESS . . . . . : 20035 DE PALMA IN
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER KAREN PAI
ADDRESS . . . . . . . . . . : 20035 DE PALMA IN
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : LINDY ROOFING CO IN
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
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 11, 000 . 00 1 . 10 0 . 00 1 . 10 0 . 00
1REROOFRES SQ FEET 28 . 00 364 . 00 0 . 00 364 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 365 . 10 0 . 00 365 . 10 0 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
11)90 o c�
-
CITY,OF, CUPERTINO:.
REROOE
�CUPEkTINO PERMIT APPLICATION
0 Date:
Building Address:
-2U-o 3s L
Owner's Name: Phone #:
Contractor: Phone #: L�6 p_ gQ�j
�«d i26 -5?
Fax #:_ b -a
Cupertino Business icen5e #: D!. Contractor License #:
Type of Roof Covering:
Existing: Proposed:-
❑ Built-Up Roof ❑ Built-Up roof.
El Asphalt Shingles Asphalt Shingles
--Q'—Wood Shakes ❑- Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings / ❑ Piovide I.C.B.O. Report#
/KT L3 be Removed ❑ Provide Mfgr.Installation.Specs.
Job Description: r'ernC) Ll e>4s ty,
30 �cE s�uc,�Ies
Residential Commercial
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
Valuation:
there are anrestrictions: u
/ l 060
I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
Signat
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.
Homeowners Name: 0 r-er) 10CL4
job Site Address:
Roofing Company Name:
Applicant's Signature: 1_ Date: Le�'`b c`t)
• Greg Casteel
Building Official
Revised 11/2/04
_ Community Development
I
f, 10300 Torre Avenue
Cupertino CA 95014
:.. Telephone(408) 777-3228
CITY OF Fax(408)777-3333
VUPERTINO
Building Department
JOB ADDRESS: Q 0 3 S �� /04 (mcg ✓1 PERMIT *
C2Aoc O
OWNER'S NAME: are,1 41 PHONE # C(V $—3 -6 za
GENERAL CONTRACTOR iridU 06 ,f FAX #
I am not using any subcontractors: Z o
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
Owner/Contractor Signature Date