06090107Z4
CITY QF CUPERTINO
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'1CR�S.C.�' (IR T1V '0 0I
BUILDING' DIVISION PERMIT
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BUILDING ADDRESS:
LINDY ROOFING CO INC
06090107
20957
OW NEWS NAME:
PERMIT SUE DATE
ANAT KEMER
5554 HARVARD DR
...0.911412006
NE:
SANITARY N0. CONTROL NO.
(408)286-9990
ARCHITECffENGINEER:
BUILDING PERMITINFO
BLDGO ELECT PLUMB MISCH
l� D l�
LICENSED CONTRACTORS DECLARATION
Job Description
P
Mrtby atf im that I am licensed under provisions of Chapter 9 (com rmcing
wild Smiden 70W)of Division 3 of eudnm ofessiuN tlmylicansci.
In full rorc.miletfet ��)'
REROOF- REMOVE EXISTING WOOD SHAKE ROOF, INSTAL
Lkena a Lk. N
Dat C.gDECr
1/2" OSB, 30# FELT & 32 SQUARES�OF�NEW LIFETIME
DECLARATION
CHll
COMP. CLASS A
W used
1 understood my plans .hall W dad u public mcnrd
fj
LI¢naed Professional
OWNER -BUILDER DECLARATION
1 bozehy .(Sinn that 11. exempt from the Contractors License Law for the
Any c
Coda: Any city or county
o L5, Business and P o
following reason. (Section
(�
demob
which requires • permit re construct. alley. Wprave, demolish, or repair any .Vadum
co
`
the applicant far such Dermic m film a signed atatemem
alsont
PH. Or its unsed License law
Sq. Ft. Floor Area
Valuation
of (Chapter9
Natal is licensed pursuant to the provitiona of Ne Contmdurb
p to the
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
$13000
that he Is exempt Wemfram uW We basis for the alleged comae on. My Walmion of
APN Number
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
ma mare Lou five hundred dollars (SSW).
❑ 1, as owner of dm property, or my employm with wages as dee it sok compensation,
359±31tj. 00
wired Inspections
will d the work and the structure I. rot Intended araffertd for salc(Sec. 7064. BusinessRe
and prafeWON Cade: The Contractor's LiRNC Law does WE apply W an PA•Mf of
q P
pmpemy who bu ild s or i m pros¢, summational who dao suc h work himxclf or through his
awn employees. provided thosmh improvements art notintendd nraaered for sale. U.
however, me Wilding ar Impro•.errom u sold within arc year of completion, me owner,
builder will love dee When of proving mat M did mi build or improve for poop ea of
ale.).
❑ 1, as armser of the pmpcny, am exclusively contracting with licensed condxcmrs to
constnmt the pmjm (Sea 7044, Businw and Protest= Cad:) The Contractors Li-
morm law does a., apply to an awNr of property who Wilda or improves Wetmn, and.
who contracts for soh pmkcs, Mm a Contractor(s) licensed punsu lm me Convxclors
License Law.
❑m I aasempt under See. ,8&PC for this moron
Owner Date
WORKER'S COMPENSATION DECLARATION
10 I hereby affirm under penalty of perjury, oro of the following aeclaradaN:
❑ 1 have and will maintain a CeniBesmof Consent m self-INum fmWarkcrs Cast
salon, u Dmvided for by Section 37W of the Labor Cod, for the perforromm of the
-
work for which this permit is Issued.
❑ I have and will maintain Workers Compensation Infromoa, as oxidized by Section
37W of the Mbar Coda, for tiro performance of the work for which this permit is issued.
My Waskera CC permission 1 cyto/p cr and Policy nu W
tj
Carder. .> s�Z 1 V/A't/as Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
a COMPENSATION INSURANCE
(Thisaction mN mtbocmplemd if me Permit is furan hundred dollars (51001
N Ica)
1 comfy that in the performance of the work for which this permit is issued. I aNll not
employ any person in any manoran u m became subject W tite Workesa' Compeuation
'
Laws of California. Data
'-
Applicant
NOTICE TO APPLICANM If, after making mu CenfOcate of Exemption, you World
become subject to the Worker, Compensation provisions of the Labor Cade you mem
forthwith comply with such provisions or this permit shall W damcE invoked.
CONSTRUCTION LENDING AGENCY
1 herby la a construction lending agemy, Inn me PCftamlLlCe of
thi mat mi
which i 3D
' the work for which Thu permit u u,md (Sm. 3097, Cis. C.).
fenders Name
Lcnaera Aadeu
i I certify the I have Mad this application and state that the above information is
' torten. 1 agree to comply with all city and county and lmmms and aside laws relating to
building cons"ction, and hereby authorize representatives of this city to enter upon the
I aheve-mentioned property for insPcedon purposes.
(We) agree to save, indcmni fy and keep harmless the City of Cupertino against
j liabilities, judgmenu, costs and expenses which may in any way me= against mid City
in Wronupm of the granting of this permit,
,v
i APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date v' Y
SOURCE REGULATIONS. q Nl
1
�— ✓`—
Re -roofs
Type of Roof
a
gig ADDIItantlCanRDOU Date
HAZARDOUS MATERIALS DISCLOSURE
Will ft carforumWilding smrcor handle
Health andimandous
e,occupant
Safety
Cupertino Cade. Chapter 9.13, and the Health and Safety
u dfiod by tite Cupert/ful.
Cod, Section 255324)7
All roofs shall be inspected to any roofing material being installed.
❑ Yu
prior
If a roof is installed without first obtaining an inspection, I agree to remove
w.1 theappfit ding ocoupsnt as equipment or drica which
emit hutaNnns alrtontaminanu as fined by the Bay Ma Air Quality Management
all new materials for inspection.
District?
❑Yes Nu
tm5534.1 Chapted"ifthe Califon
I ban maul thehe.S=6s
I
nicer Safety Cad. Scodats25t
255D5.25533 undtuand thmiftle Wilding
ma,u
dao not curtentlY has a taanl 0th h u my zespanslhility m ratify the oavP., of dm
It b;m responsibility
myu' muRWmetpdormiuuaoeotaCrnifsateafOcapan 14
Z'..^—'��
' of Applicant Date
All roof coverings to be Class "B" or better
Owner or tat orvcd agent Date
om 2 of 2
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 35913113.00
DATE ISSUED.......: 09/14/2006
RECEIPT #.........: 36049
REFERENCE ID # ...: 06090107
SITE ADDRESS .....: 20957 FAIRWOODS CT
SUBDIVISION .......
CITY CUPERTINO
IMPACT AREA .......
OWNER ............: ANAT KEMER
ADDRESS ..........:
CITY/STATE/ZIP ...: ,
OPERATOR: amyw
COPY # : 2
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
-=-------- ------------- ----------
BPERMFEE VALUATION 13,000.00
BSEISMICRE VALUATION 13,000.00
Itilivillm Dr u?w
METHOD OF PAYMENT
-----------------
CHECK
TOTAL RECEIPT :
0
AMOUNT
-----
406.52
406.52
AMOUNT
PD -TO -DT
THIS REC
NEW BAL
----------
201.96
----------
0.00
----------
201.96
----------
0.00
1.30
0.00
1.30
0.00
----------
203.26
----------
0.00
----------
203.26
----------
0.00
NUMBER
------------------
2260
•
PJ
CITY OF
CUPEkTINO
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Building Department
Subject: Re -roofing policy for the City of Cupertino
'telephone: (408) 777-3228
Far: (408)777-3333
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 andthe 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: 1'7),04 ( eraser—
job Site Address: a DR S---7-F4`r-W0_x)5 CST-'•
Roofing Company Name: Nat{ R -O
Applicant's Signature: Q —rl : f JLC Date:
Greg Casteel
Building Official
Revised 11/2/04
Prinlod on Recycled Pgper
/
CITY OF CUPERTINO�� I 01
REROOF
PERMIT APPLICATION FORM
APN,#
Bldg Permit Fees
BUILDING
BENERGY
Energy
BUILDING
Building Address: �7
Owner's Name: Phone #:
GSI 9ePhone#:
mer-
Contractor: / Phone #: License #:
yo
Contact: Phone #: Cupertino Business License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built -Up Roof ❑ Built -Up roof
❑ Asphalt Shingles Asphalt Shingles
T
;%::�* Wood Shakes Wood Shakes
O Wood Shingles ❑ Wood Shingles
❑ Other (Specify) ❑ Other (Specify)
Number of existing coverings ❑ Provide I.C.B.O. Report #
,,�Y' To be Removed ❑ Provide Mfgr. Installation Specs,
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: El—
Job Description:C-rv%Ou1rl5 X,54,- wGc&ShaiG¢ ruo , res 1r5
1 S6 o44:�_t4 o rd_ n,, CC nPos-r-h o -i
esidential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project: Type of Construction: Occupancy group:
(3/000 ree_ -oo-P . ,Soh (4 -
Qty. if
Annlicahle
Fee M
BPERMFEE
Bldg Permit Fees
BUILDING
BENERGY
Energy
BUILDING
BSEISIvIICRE
Seismic Fee Res
BUILDING
BSEISMICOM
Seismic Commercial
BUILDING
BPLANCHK
Plan Check Fee
BUILDING
BUSLIC
Business License
BUILDING