06090236 CITY OF CUPERTINO , a O wrN,,u-n.;7f + �` • • ""
BUILDING DIVISION PERMITC+CSIVRA.CC)RINF' 17.tMTTt3I '
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r 1` :.an&�a �z ,:M.;. SR. r.a :, Ida •Ln+. q
BUILDING ADDRESS: LNG CO INC PERMIT NO.06090236
11555 EVENING SPRING CT
OWNER'S NAME: PERMIT SUE DATE
GEE LUBIN 5554 HARVARD DR 09/25/2006
NE: SANITARY NO. CONTROL NO.
(408) 286-9990
ARCHI EC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
;off LICENSED CONTRACTOR'S DECLARATION lob n
Descr) on
m I Mrtb affirm Nat 1 w licensed under provisions of Chapter 9(commencing P
(V with SeNon 7IXX7)of Oivlshon3of Ne Busiest and of ahhd mylmense is
'or
force and `� REROOF- REMOVE EXISTING WOOD SHAKE ROOF, INSTAL
L'eem�Lk'" ; 1/2" OSB 30# FELT AND 50 YR DIMENSIONAL COMP, 1
f Dam AR allWusSOECLARATION a SQUARES, CLASS A
I uhMentsnJ my plans Mall M1c used a public records
5yU
u G Licensed Professional
OWNER-BUILDER DECLARATION
I hereby aRrm
that 1 am exempt from the Committees LILenS law for the
.00 following reason.(Section RD I.S.Business and Prolamines Code:My city or county
e S which tequMa a permit to commuc4 alter,Wpmw,demolish.Or repair my Mature
�itra prior m its issuance.aim requires Ute applicant for such permit m file a signed Ststemcm
< that he is licensed permanent to ft provisions of Um Conumemes license Law(chapter 9 Sq.FL FloorArea Valuation
S $ (commencing with Secdon 7000)of Div4ion3af ase Business and Profenions Code)or 5000
u�.. that W is eumpa therefrom and the basis for the alleged aaemption.Any violation of
Secdon 7031.3 by Amy applicant far a permit subjects the applicant to a mull penalty of .APN Number Occupancy Type
at more than On hundred dolWs(55007.
❑1,u ownu of die proPeny,a my empbym with ages u them ale comPenssUa. 16652022 GO
and dothewmk.maim she Contrshmrmmmedwaw dine,-1a(Sec.US SoOasiwaa Required Inspections
PmPand Professions Cade:The Cont eas arms,am Um he Law due tet apply m m owner is Ll P
onmywhas,predrimpat Such
doessuI.,. rimaelfwthroughhu
own em.line h,provided that ower impronmrnts see not inteeded woResed far sok.IL
howesr,thebuilding Orden of pmmnkhathwithinoa year of c pecom,forrm,dte use of
SaleI. will hart the WNcn of proving Nn M did rot build w improv Iw WTae of
exit.).
❑1,as Owner of the Property,am=elusively conmaming with licensed canvhaun m
contract ase project(Sec.7W,Business am Profession,Cade:)The Cm=wes U.
cam law dace nut apply an an owner of psoperty who builds or improws the cu n,and
who contracts for Such projects with a eommetWS)licensed pursuant to the ContraMs's
License Law.
rl 1 am exempt under S.C. ,B At P C for this rtasan
OwnerDate
WORKER'S COMPENSATION DECLARATION
Uncraby affirm under pnalty,of Perjury Oa of the following declammul:
ban and will maintain a Certificate of Consent to self-iasme for WOrkersCOmpen-
ation,uprovided fm by Section 3700 of the Labor Cade.(Or the Pedarmmce Of the
wort f whiN asts Permit is issued,
have and will maintain Worker's Compensation Insurance,u sequired by Section
700 of the,labor Code,for the pdomsma class arms,far which this Permit IS Issued.
My Worker's Compensation Inmryme tarts and Policy n�orh(tppe�amort:Li) �{ O
Cartier. 'S'r to��PoI'tey No.: �•`� d
CERTIFICATE OF EXEMPDON MOM WORKERS
COMPENSATION INSURANCE '
(Ibis section need not be completed lithe Permit IS(moot hundred dollen(5100)
or leu)
I cert%that in the Performance of the work fw which this Permit IS Wood.l"I nue
employ any person In my manneran as an become subject to to Workers'Compeaatan
Laws of GIUOmIA.Dam
APPlicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you simuhl
become subject to the Worker's Compensation provisions of Ne labor Cede,you mu"
.,O forthwith comply with Such provisions or this permit he dwmed m n aid.
rACONSTRUCTION LENDING AGENCY
[r I hereby affirm that them Is a construction lending agency for the Performance of
tai the work for which this permit is issued(Sec.3091,Civ.C.)
W�Q Lenders Nurse
a 2 Loader's Address
U Q I ttrify that I ban need this application and Sate asµthe above Information is
ly„ T-' correct.l agree to comply with all city and county ordinances and sum laws rtladng to
C) SU^ building construction.and hereby authorize reprucnmins of this city m enter upon the
W above-mentioned property for impaction purposes.
(We)agree to an.indemnify and trop humku Ju City of Cupertino spins,
r'4 liabilities,judgments.costs and expenses which may in my my accrue against mid City
U Z in consequence of the granting of this permit.
.. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NyN-AINT ssued by: Date
SOURCE REGULATIONS— ` a�lzL/ Z
- `- Ere-roofs
SipµYm e( romancer Date
AZAADOUS MATERIALS DISCLOSURE Type of Roof
WIII theappli mt Or fuuuc building oceupam a(m an handle hazardous material
as defiad by the Cupertino Municipal Code.Chapter 9.11.and the Health and Safety
Cale,Section 755324)1 All roofs shall be inspected prior to any roofing material being installed.
❑Ym ❑N
Win the applicmt uwro building eccupam esu equipment or Jcvitss which
If a roof is installed without first obtaining an inspection,I agree to remove
emit hayardous dr mans u dc0ad by the Bay Area Air Quality Management all new materials for inspection.
Distrle0
❑Yes
Ihanroad Utehu nus materhlsmyulremenu underChapter 6.95 a(the CSlifor \ .� N— ••�-
maHealth&SafetyCode,Sections 25505.25533 and 25534.1 understand thatlftho building \
dues oat cumently ban a tenant,thin It la my responsibility laundry U7c aeupmt of ase
requirements which muse W metpdorluisSUMMOla CerUOcatr�(l0tcu�p nuc /� Signa, Applicant Date
Owner,er mm!i.d agent Dam All roof coverings to be Class"B"or better
CITY OF CUPERTINO
!m 3 of 3 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 36652022 . 00
DATE ISSUED. . . . . . . : 09/25/2006
RECEIPT # . . . . . . . . . : 36196
REFERENCE ID # . . . : 06090236
SITE ADDRESS . . . . . : 11555 EVENING SPRING CT
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : GEE LUBIN
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
�EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 5, 000 . 00 115 . 56 0 . 00 115 . 56 0 . 00
BSEISMICRE VALUATION 5, 000 . 00 0 . 50 0 . 00 0 . 50 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 116 . 06 0 . 00 116 . 06 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
- ---------------- ---------- -- ------------------
CHECK 611 . 87 2281
TOTAL RECEIPT 611 . 87
•
Community Development Department
Building Division
1 City of Cupertino
10300 Torre Avenue
• CITY�F Telephone: (408) 777-3228
CUPEI�TINO 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 inspecdon 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 mininnum of I/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:
Job Site Address: i I SSS_ CVS t e\c\ 5 Pr,
Roofing Company Name: L\n Rc3a4n� �-
Applicant'sSignatut�--iate:Cf —aS'
rr
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled PV er
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPEkTINO
Building Department
JOB ADDRESS:116515 ��i PERMIT#CAVC
OWNER'S NAME: :J LL i PHONE # —
GENERAL CONTRACTOR FAX #
not using any subcontractors:
v 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
CITY OF CUPERTINO 0oCq 044 1SU
REROOF
• CUPEII;TINO PERMIT APPLICATION FORM
APIC# Date:
R - a5,o
Building Address: 11555 �/en, , slOr, "
Owner's Name: Phone#:
Contractor: �-, -R Phone#: License #:
21 58
Contact: Phone#: Cupertino Business License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
W Asphalt Shingles W Asphalt Shingles
❑ Wood Shakes ❑ • 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 Polic
Job Description: yenwue, P-�b-a:.� cow p ruo , /n3-JLa C/ G 01%�
19 S .-e -r' 11C4,3 SO ear r a Q. Co o s
Residential 2 Com ercial ❑
Fire Zone: Yes ❑ No o., Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project: Type of Construction: Occupancy group:
cs0� rz —rvv� Sri
Qty. if
Applicable 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