05080238 CITYOFCUPERTINO
BUILDING DIVISION PERMIT C()N RACTORINF'URMATIOi `
.x, r j ",�", d»,• sS ,r3., c-A,fpw;.na'
Bu1LDINGADDRESS: LINDY ROOFING CO INC FFRMITNO.05080238
0917 PATPWnnng CT
OW NEWS NAME: PERMIT ISSUE DATE
NE: SANITARY NO. CONTROL NO.
(408) 286-9990 .
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BO ELECT PLUM MECH
O
LI ow LICENSED CONIRACIOR'S DECLARATION Job Description
I busby afRnn that 1 ant Ikxnsed under provision of Chapter 9(mmmcncing
with Section 7000)afDivWon 3 of the Business and Pnefes�a earMmyli.e.
^ in full force and cf _
�?
Lt.... Lk.N d REROOF-T/O SHAKE, INSTALL PLYWOOD DECK,
Date�Contrmur H FELT COMP. PRESIDENTIAL TL
A HITECTs DECLARATION
1 understand my plan shall W used as public menrds
LLU
O
Licensed Pmfcuianal
OWNER-BUILDER DECLARATION
I I M1rome M.on I am exempt from site Contractors e:My
law for the
i O O following noon.(Section RO Ls,Business andvedc.professions Cade:My city or roomy
$0, which mquLus a permit re cnrmnc4 ale,n improv,drecall,sur repair my dcame t
y priormits issusnet,almntto amres thovisios offwsochpewi,m file a censeLw(he,mcm IBQ 000
< (co me ccenxeJ pursuantto )pro vision of the a Buutoh License Law(Chapter9 Sq.Ft.FIOOI Area Valu'
$ that W Incing with emerms and of We basis n 3for th al eged essaxe and t proon.My
Code)of
du,m h attempt therefrom anti the bow for du alleged exemption.My viols1lon of
Section 7031.5 by any applicant for a permit subjects the applicant m a civil penally of APN Number Occupancy
a.,man wan five hundred dollars(M).
35913111 . 00
P y TyPe
❑1,u wmerof the Properry,m mY tmployw wW wgca u tie,w ante cmnpenution,
will do thework.and the skuctum is notine,nded or offered formic(Sec.7044,Business a aired Inspections
and Professioy who ns Cade:Dee Conumtah Lune Law don ant apply h an owner of q P I'��
mumProemploy=,les ProorimProwsch Improvements
da nauchwmkhimnifar through his /..� ru.Lwa�
however.the Wildingorimvided msuchimprovemmts osmole of cmo0ercd realistic.er. '� t� �•�1 Ikti7fa,—a,
however.theWildingthe
orlmprovemcnngthat did Out build
of cprove for the Owner. 77 '^��1's"
builder will have Ou WNen of proving Nn m did ant hrild or Improve for purpose of °' .t`'
tele.).
❑I.O w'ner create property am exclusively contnming with licensed conuactms h SEP 'V 1006
construct the project(See.7044,Business and Professions Cade:)The Cantrmhh U. U
cone taw don not apply to an owner of property who builds Or Improves thereon,and
who contracts far such pmjeeu with a contractual)licensed pursuant to the Comm-mu r't 7
Law,
018. gvC
Iwexempt under Sm S .Bk PCfor this noon Ft . 40;9 I{�pf7 mrt•.,
Owner Dan
WORKER'S COMPENSATION DECLARATION
I hereby afaren under penalty of perjury one of tin following decanu onr.
1 baro and will maintain a Cer00cate of Consent to relfdnum fm Workers Compem
Ion,u provided for by Smdon 3700 of the Labor Code.for the perfmmance of tan
woh for which this permit is issued.
❑f have and will maintain Workers Compenatlon Inman,as required by Section
3700 of the Lemur Cade,for the perfowmce of the work for which this permit is Www
My Workeet C,okm,.peena_tion��ncees 5OPolicyJ`num rm `
CaMtr. k CE'alftllFl 1 O LEXEMIIOOPn1V0/N FAOM WORKE0.5'
COMPENSATION INSURANCE
Mar section reed notbecomplemd if tan permit is fmonc hundred dulim(SIM)
or IOU
1 certify that in the performance of lite work for which this pumit is issued,I shall not
employ any person In my mummer an as at become subject to dh Workers'Compensation
Lavas of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Onalmaw of Exemption,you should
becmne mbien ro the Workers Compensation provision of tan latter Code.you mute
.,O forthwith comply with such provision or flus permit shall be deemed mwked.
r tiCONSTRUCTION LENDING AGENCY
[—r
1 hereby affirm that there it.couwctinn lendinpgemy for the pmfurmamo or
(Yi> the work for which this perotit Is issued(Sts.3097,Civ.C.)
tp Q Lender.Name
z U.,kes Mdreu
V Q I certify that I haw mad this application and sure that the a Wve information is
ft. correct.1 agme to comply with all city and county oNlnanen and shot laws misting to
Q building convection,and hereby suNorix representatives of this city to enter upnn the
W mew-O ndootd propmy for Inspection purpose.
LL (We)agree to wave,indemnify and keep harmless the City a!CuPMOO against
h liabilities judgments.toss W eapeum which may In my way weme again,NdCity
in consequence Of the
U 4 AP RCCANT UNDERSTANDS ANDrahling of WILLWILL COMPLY WITH ALL N N�POINT Issued by: Date
URC UTA ONS.
Re-roofs
Sig t Applica bConvutor Card
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant m future building occupant Rom arhandle ha>smovs material
u defined by tie,Cupertino Municipal Code,Chapter 9.13,and the Hnith and Salcey
C
ode.socbon 2ss3z(r)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes Na
Will the applicant or future building occupant use equipment m&—A=which If a roof is installed without first obtaining an inspection,I agree to remove
it ha>aremus air canteminnu u d by the Bay Ane Air Quality Mangement all new materials for inspection.
strict'?
❑Yca No
I haw real the hazardous manriaw requirements under Chapmr6.95 olthe Califon
.lth&SafuyCodc,SoW=25505.25533au125534.lwi&nLWthaifthe Wilding
no,cuncntly haw a tenant,that h h my responsibility h no ry the up. of the
renents which must be me,prior h issuance of a Certificate,a! Slg t fApplicant - Date
wners ri>ed.en, Date All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
;It
Cupertino CA 95014
11 Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPEkTINO
Building De artment
JOB AD�DOR SSf 7 I" F 1 Qt.ID000Q . C j ,. PERMTT
CC
OWNER'S NAME: CCf—t C I!. —t-` PHONE # - 7 70
GENERAL CONTRACTOR: 1 ^p I 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
Owner/Contractor Signature Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
kUPEkTINO 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
d id-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.
Homeowner's Name: 'S C () G�"r 6CL(--
Job Site Address: ?20q37 t^t K uiecJ C1
Roofing Company Name: Li " &)D r—L,
Applicant's Signature: Date:
Greg Casteel
Building Official
Revised 11/2/04
Printed an Recycled Paper
CITY OF CUPERTINO
A DO REROOF �S� 9z 2-
CUPEINO PERMIT APPLICATION FORM
APN# r Date:
J g a5-US
Building Address:
c;�Q 9 3-7 FG rwcvvds C:--T'.
Owner's Name: Phone#:
CO•-1+ � SUS a r) e7O - 7-O%(P�
Contractor:Ll�� �C)(J�� Co License#-
C;)/ 59/<o
Contact: /l Cupertino Business License #:
Type of Roof Covering:
Existing: Proposed:
O Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles < Asphalt Shingles
V�' Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O. Report#
YTo be Removed O Provide Mfgr.Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: renoue..e), Q rt� rva �v15 �t y�x�xA r
a CL 6 s c�)a r�-_ 6-r co/npw fion 200F= H_eslc_r,7�7 z / 774
Residenti'al
K Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: u
Cost o Project: Type of Cons tion: Occupancy group:
oZQ CJS
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