06090106 CITY OF'CUPERTINO ° +~< tea. '' �yi`� �"-"yy�,�
BUILDING DIVISION PERMIT `'•w��I 14�. GRIN ,I<uY11��Q1\ ".
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Byl1.DINGADDRESS: LINDY ROOFING CO INC PERMITNO.06090106
20967 FAIRWOODS CT
OWNER'S NAME: PERMIT ISSUE DATE
AEk GRELLI VINCENT S AND SANDRA L5554 HARVARD
NE: SANITARY NO. CONTROL NO.
(408) 286-9990
ARCHITECT/ENGINEER: BUILDING PERMITINFO
BLDG EO PLO MEOCH
Top LICENSED CONTRACTORS DECLARATION - Job Description
FF 1 hereby affirm that 1 am li emrd muler prodaima of Chapter 9(mmmercing
;Zusf with Section TOOO)of Division 3ofthc Busincesand Profession Coderandmylicensc is
in full force andeffu _ ZIP Bilk REROOF- REMOVE EXISTING WOOD SHAKE ROOF, INSTAL
'8z Dow. Cl. Lia- 1/211 OSB, 30# FELT & 32 SQUARES OF NEW LIFETIME
Da. Conus nor
££ HITECTSDECLARATION COMP. CLASS A
i N I undenund my piens shall he anti as puhlk records
iU
G
Licensed Professional
OWNER-BUILDER DECLARATION
I n I 1 hereby alum that 1 1. exempt from tie ComfeLtio s Code:
censeAny C Law for the
•o a following reosmn. emdon 7ro construct.
Business and Pmfde oli Code:Any city ar mumy
5$ which its i su o permit ns cnmwcL alas,impmsu dcmalHh or repair any wruebm
.Zi pther wiuiensedpdsu rtgoiMe the ipplMofMeut for Commch ent's
Iia
thatonflan cgwitpunuan,7 N)ofDiaiomofthe Mo Bud.
Licensefaw(,Code)9 Sq.Ft. Floor Area Valuation
!� (commencing with5.sion7I100)ofDimufon3oftheBadnmandProfrssimmCnde)u $13000
$
at he u exempt therefrom and Use,bsais for the alleged exemption.Any violation of
Section 70313 by wry applicant far a permit mbiccu the.ppikmi m a dvil pmalty of APN Number Occupancy Type
not more than rim hundred dollars($500).
❑1,as ownu offt Property.m my amplayua with wages as their sok compensation,
will do the week.and lhednecwre ianaimendedorafked Po,ate(Sre.7044,Business Required Ins ections
and Profevdom Code:The Cmmuacmr`s License Law Clam ml apply b an own.of 9 P
property who but Ids or ion poem,thereon,and who docs such work himsel f m through his
mwn.nployem,prodded Nat Inch improvements sum not intended oroRued f.sak.If.
however the building or improvement b sold whom dm yew of mmpretion,the owner.
builder MB haw that buNen of proving Nat h did ant hNW u improve for purpose of /
sak.).
❑Los owner of We property.am exclusivelyelsand Profession
with Ilmhed mnuacbss U. ll//
coma Lawepmk.pplyb Bm,n�mdPy,who mDmd<,TheD.themon,and,
6 /
came Law da,not appy c m owner of property,who m builds oident M ss thereon,and L
whoLacu for such projems with econuacmr(s)Hemmed president b We Convactoh Q�
0
Lie..on Law.
❑Tom exempt undo Sea .08 PC far th4 season
Owner Data
WORKERS COMPENSATION DECLARATION
I hereby affirm under penalty,of perjury arc often following declaradom:
1 ham and will maintain aCeNfimre of Co..lto self-mune f.WorkVi Co mpen•
serum,sa provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑1 haw and will maintain Worker`s Compensation Insurance,an required by Section
3700 of the Lain,Code,for Ne perfarma..of the weak fu when this permit is leaned.
My Worker`s Comperes lon I ce, '.end Policy nu at� .2
Carrier. E Policy No.:
CERTIF E OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(rhh steam need Out becomplued if me permit H free=hundred dollar($Im)
nr less.)
1 certify drat in the performance of the work for which this permit is issued.I shall not
employ any person in any manner so a Or become subject to the Workeri Compemadon
Laws of Califamia.Date
Applicant
NOTICE TO APPLICANT:If,after making this Cer ificam of Exemption.you should
become subject be rhe Wohch Compensadon provisions of the labor Code.you moor
.,O forthwith comply with such proveom w this permit"I h doomed mak d.
Z� CONSTRUCTION LENDING AGENCY
[••t (hereby alrmn that Were H a construction lending gency for the performance of
CYi 7 the weak for which tiffs permit is hsmd(Sm.3097.Civ,C.)
W Q Undeh Name
Z I<ndce Add,.
U f) I certify that I have mad this application and sure that the above information is
U. Fcorrect.ligrm to comply with all city and county nNinanc, ws and sum latesting to
U building consuuction.and hereby authorim representatives of this city to enter upon the
N RWi .Hume-mentioned property for inspection purposes.
(We)agree to son,indemnify and keep harmless the City of Copenino against
fA Iiddlidce.judgmenu.cosu and expemu which may in any way accrue against said City
U Z in comequenoe ufthe Stenting of this permit. C�/y GL
AEP_LICANT UNDERSTANDS AND WILL COMPLY WITH ALL ON-P INT Issued by: Date 7 4 _
SOU EGU TIONS. N`/ t
Re-roofs
Sig ApplicanVOmmcIor If Dow
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or forum building necupenttome or handle harandom mabHal
as deRsed by the Cupertino Mumci 1 Coder Cho as 9.12-and tie Health and Safety
Code,Section 8332(a)' All roofs shall be inspected prior to any roofing material being installed.
❑Y, a
wn tite appliwnt lama building aceupam uxc esryipmmr or Devices which If a roof is installed without first obtaining an inspection,I agree to remove
emithm0!d1 airedam nsnu, fined by the Bay Area Air Quality Management all new materials for inspection.
District?
C]Yes Nu
Ihowmad Wehr Nws 25505.2553 immcnuunder Chaprer6.95ofthe Calding �` •—��
ria H,lth&Safety Cade,Srdem,Me503,my ono u1LSS34.1 undcrwM thwifthe Wilding v�
r Currently hew a knmh Net it h my rcaponsiMlity m notify Wo pcCupm f Nc
rcyuim wmenxmelpdara,iwawlmmrac.arreareareu1({sar SighattdeofApplicant Date
✓i --�"
Ow thomedagcm Date All roof coverings to be Class°B°or better
CITY OF CUPERTINO
�m 1 of 2 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 35913114 . 00
DATE ISSUED. . . . . . . : 09/14/2006
RECEIPT # . . . . . . . . . : 36049
REFERENCE ID # . . . : 06090106
SITE ADDRESS . . . . . : 20967 FAIRWOODS CT
SUBDIVISION .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : GRELLI VINCENT S AND SANDRA L
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 13 , 000 . 00 201 . 96 0 . 00 201 . 96 0 . 00
BSEISMICRE VALUATION 13 , 000 . 00 1 . 30 0 . 00 1 . 30 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 203 . 26 0 . 00 203 . 26 0 . 00
•
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Cln [)F telephone: (408) 777-3228.
CUPEkTINO 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 coveruigs shall not be applied without first obtaining all inspection
and written approval from the building uispector. 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 uistallation.
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 minimwm 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: V Grel I 1
)ob Site Address: a0 R(o 7�1 F�n'r W �S �(—
Roofing Company Name: 1—t nd tC Uon �D .
Applicant's Signature: Date:9. o�
• Greg Casteel
Building Official
Revised 11/2/04
Primed on Recycled Piper
CITY OF CUPERTINO CV010i
REROOF
• CUPERTINO PERMIT APPLICATION FORM
APN# 3 1 _ Date-
Building Address:
of U9 (a�- �4 trwcxxQ S CT-
Owner's
TOwner's Name- Ph on #:
V �VICQ� .� Sanc2 6rCA-. -,k bg a ?� b7 So
Contractor: , LioLicense#:
Contact: L 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 ❑ Provide I.C.B.O.Report#
�7 To be Removed ❑ Provide Mfgr.Installation Specs.
ALI I Have Read, Understand and Will Comply With Cu ertino's ar Off Polic ❑
Job Description: remouwoocA TeKtce r oo • in5
s are d"sA
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning D_pt. if
there are anrestrictions: [
Cost of Project: Type of Construction: Occupancy group:
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