06090012 ------------
CITY OF CUPERTINOa,,wyyw tt +f'�°
BUILDING DIVISION PERMIT � col! 1j AC e Tt T1
BUILDING ADDRESS: LINDY ROOFING CO INC n_ PERMIT No.O6O9OO ZZ
10366 HENEY CREEK P
OWNER'S NAME: FERMITLSSUEDATE
FEN CHOI 5554 HARVARD DR 09/01/2nn6
NE: SANITARY NO. CONTROL NO.
(408) 286-9990
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
o p LICENSED CONTRACTOR'S DECLARATION lob Description
b 1 heroby affirm that 1 an licensed under Pro small of Causal (commencing
with Section 70M)al'Division 3 often Business and Profeaiav Code,aro my license is
,�„ Inraliracewder RE-ROOF - REMOVING EXISITING SHAKE ROOF, ISTALL
Z Lice Clsss Lle. �� ��
!�� oafe��ca�,aca 1/2" OSB WITH RADIANT BARRIER, 30LB FELT & LIFT
I understand my plug shall
Aused ss Public mcnNr
n shall he seuDEC mnON DIMENSIONAL COMP SHINGLES CLASS A
��<
myU
�ij Licensed Professional
OWNER-BUILDER DECLARATION
i0 1ft hereby
,zy farm that 1 efrom Communes Law far he
•Oo following mea..(Section7m1.4 Business ad R ewc:My Cly Of county
$onwhich require•permito musical,alloy,i -demolish,lir cash rwthe
priormiuiasmncc.alwfcquirestheapplieutforsuschpcmi(to0leasgnedsulemen'
Valuation
< that he is licensed paac
ment to due provisions of the Contractor's License Law(Cluper9 Sq.F[.Floor Area
js a (commencing with Section 7010)of Division 3 of the Business and Preamm"Cnde)or $17000
15. that he u attempt dica chroln and the basis for the alleged eemptart Any vl.1=)a(
Secdw 7031.5 by any applicant far a pewit subiccu the applicant to a civil penalty Of APN Number Occupancy Type
not more than five hundred dollar,($300).
❑L,ummusrafte Property,or my employm with wagesss theirsoleeampewtion,
wiildoLhe"6.�tasnwtumiswtintewedarmreadfofame(SW.70".Bumas Required Inspections
ad P cfeasae Code:The Conuactara LKena LJw does Ml apply M sm Owner of 9
property who builds or improv thecon,and who does awh wolk himulf or trough his
own employed,provided that such improvements ss at mucaded araaered fors le.IL
however,the building or haprovement is told within ane Sear ofcompieuon.ons owner.
builder all have the burden of proving tat he did w,build or improve fur Purpee of
oak.).
❑1,as owner of the property an exclusively celfrct its with Ikensed contactors to
construct the Project(sec.7044.Business and Professions Cade:)The Comome rs U.
came Law dean not apply man owner of propertY-W WilEs ar improv thefcan,and,
who contacts for such projects with a conumetor(s)licensed pursuant to the Comractoh
L'aense Law.
❑1 an exempt under Sec. .B At P C far the wan
ownerData
W ORKER'S COMPENSATION DECLARATION
I hereby aBhm penally ally of Palms,one of flue fallowing dalaram.:d
I
have mal will maintain a Certificate of Counsel to self-inwm for Workers Compcn-
adan,u provided for by Secuan 3700 of the labor Code.far to perforassnce of the
were for which this Permit is issued.
1 have rod all maintain Waiters Compensation Iruaruce,as squired by Semon
3701 of dle labor Cast.for tat performance of the wart forwhich this Permit as Issued.
My Wark1ces Compensation Insurance artier and Politynumber sc:
........7ng•Y-C 4:11),10 Policy No.:!%S4 ZB�9'-0.6
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
('Thu awed need nothccompleued if robe permit is fosse hunamsdallm($10)
or less)
1 certify that in the pefa..me of the work far which this pewlt is innucd,I shall nem
employ any person in any muneru as m became subject to do WortrrY Compensation
U.of C.Mifomis Data
Applicant
NOTICE TO APPLICANT:If.after making this Centfiam of Exemption,you should
becalm subject to the Worheh Cumpntsadon provisions of due labor Cade,you most
.J Q foMwith comply with such provisions or the Permit Nall he accrued ranked.
z tiCONSTRUCTION LENDING AGENCY
(-n Iheabyaifnm Nal them u a cemmfuctlnn lendingageney far the periarmuweuf
IY> due work ser which the permit is entad(sea 3097.Civ.C.)
W�tj lenders Names
z Loaders Added
U Q I anify that 1 lane read this appliate aro ruse that oc Obote infomudun I-
U
Uf P correct.l agree to comply with all city and county ordinance and stale tan coming to
0 U buildiagconswction,awhecbyautho6mfcpnuenulivof Nischyloenlarupnnoe
a above-mentioned property for inspect.purposes.
(We)agce to U. indemnify and trop harrnlrss the City of Cupertino against
,F-m r/1 liabiliuesjodgments.costs awexpensu which may in any way morose 1,10.1 aid City
,'Z
U in consequence of the granting of this permit. l
,..i APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS. )
'ln I S`–a.— - - C� Q—l-(�o Re-roofs
Saingund of AppliantlCoolractor ale
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building=put stme,orhudle hmaadou material
as de0rued by sue Cupertino Municipal Code.Chapter 9.1;and tit Health and Safety
Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes A)4 No
a cuwIf a roof is installed without first obtaining an inspection,I agree to remove
Will the applices,or fugue,building ,at use opm m,a devices whim
.mit IwaNne air cmumiwu at defmcd by the Bay Acs Air Quality Mwgcmet all new materials for inspection.
District?
❑ye a-$N.
1 here fcwd the hnardouammdae cquimrucnu underCMpuer6.95 ofthe Cdifor.
ne Health&SafetyCade.Seetiens ZS5o5,25533aod25534.1udsmaodthatlfthe Wiloing
does not cascOy haw a memos,tat it is my responsibility to notify sue occupant of due
mequicmenus which must be met pilar to issuance of a Ccrefcsse of Ocwpanry, (_ Signature of Applicant Date
G' -! All roof coverings to be Class"B"or better
O uihofvued a,cnt Dam
7'
Community Development
10300 Torre Avenue
aClOF
Cupertino CA 95014
Telephone(408)777-3228
Fax(408)777-3333
toUPEI�TINO
Building De artment
JOB ADDRESS: 1 03 6 G en QY Cc-4,c tc K. PERMIT#
O
OWNER'S NAME: G o r PHONE # qQ tr-,;IL86 -F97(0
GENERAL CONTRACTOR: c ' o ri FAX #
I am not using any subcontractors: _C�
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 felephone: (408) 777-3228
CUPEkTINO Far: (405) 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 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 utstallation.
11 plywood is unstalled, a plywood nail inspection is re,uirLd.
6. Any roofing which is applied without first obtaining an uspection,
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 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: te^
lob Site Address:
Roofing Company Name: LI��C/i U?7i�iGr
Applicant's Signaturef J � c Date: `d�
' Greg Casteel
Building Official
Revised 11/2/04
Ponloo on Racycled PVer
CITY OF CUPERTINO
�m 2 of 2 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 34248032 . 00
DATE ISSUED. . . . . . . : 09/01/2006
RECEIPT # . . . . . . . . . : 35888
REFERENCE ID # . . . : 06090012
SITE ADDRESS . . . . . : 10366 HENEY CREEK PL
SUBDIVISION . . . . . . :
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . :
OWNER . . . . . . . . . . . . : FEN CHOI
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 17, 000 . 00 245 . 16 0 . 00 245 . 16 0 . 00
BSEISMICRE VALUATION 17, 000 . 00 1 . 70 0 . 00 1 . 70 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 246 . 86 0 . 00 246 . 86 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 406 . 52 2215
TOTAL RECEIPT 406 . 52
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