05070057 LA�'NERS
ITY OF CUPERI'tN0 17 " n '-
BUILDiNGDIVISION PERMIT CONTRACTOR`INFORMATIQN
LDING ADDRESS: LINDY ROOFING CO INC PERMIT"b5070057
U
NAME: PERMIT ISSUE DATE
1 JOHANSON ROBERT
ONE: SANITARY NO, CONTROL NO,
(408) 286-9990
ARCHITECT/ENGINEEK: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
moo LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that L Am liecnsOd under provisions ofChader 9(commencing Job Description
i� withSeed..YUtlo)of Division Sof the Businesswq Pafessi...Cadgandmylicenmia
in mumrceanIt if e GAS REMOVE EXISTING COMP. ROOF AND INSTALL A NEW
q
� z Lieenx elan_ Lie« pRESIDENTIAL TL COMP ROOF, 20 SQUARES WITH NEW
rp Dalc TSDECr
Y J jai
ARCHITECTSDECLARAT101 FELT UNDERLAYMENT
m 1 understand my Inns snail heA.
used u public records
ic G Licensed Prolimakinal'i
< OWNER-BUILDER DECLARATION
yI hereby alLfm that I am exempt form the Contractors License Law for the
%'0 following mune.(Section 7M 1.5.B.O.and Pmfcssiuns Code:Any city In aunty
i$ which requires a permit to construct alcor.improve,demolish,or repair any structure
Lori prior tar its issuance,alsu"does the applicant for such permit w rile a signed statement
££ <
that he is licensed pursuant mthe pmvisiomofthe Contractor's 1-mmscLaw(Chapter 9 Sq. Ft. FIOorArea Valuation
y~$ (commencing with Section 7000)of Division 3 of the Business and Professions Coik)or
k`;_ that he u exempt th defrtm and the basis for dm alleged exemption.Any violation of $9000
Section 7031.5 by Any Applicant for A permit subjecu the applicant o a civil penalty of APN Number Occupancy Type
not more Nan five hundred della.($500). y n fit
Q I,As owner of the proper,or my employca with wages As their sole eampenee0on. 1
will do the work,and Ne stucture is not intended or offered for age(See.7060,Business
and Pm@uiom he Code:TComoremn License Law it=not apply to an owear of Required InspectionLices, 11
progeny who builds or improves themon,andwho donsauch work himxlf or through his
own empioyma.provided that such improvements are not intended or offered for sale.If.
however,the building or improvement is sold within one year of completion,the owner.
builder will haw the burden of proving that he did not Wild or improve for purpose of
sale.).
[_)1,as owner of the properly am exclusively contracting with licensed contacted,m l I�1( I \t 11 I
construct the project(Sec.70X4,Business and Poefcxsiotu Codc:)The Conerenori Li- r IUIff^�..�1�1 Nil f(/^
cense law does on,apply to sin owner of properly who Wilda or improvus thereon,And li L� t �it
who contracts for such projects with a eonvactor(s)licensed pursuant o the Convector's
Licenselaw.
1 am exempt under Sec. .B&P C for this reason
no, Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury ane of the following declarmiom:
1 have and will maintain aCenificate of Comment to self insure for WorkersCompen-
sation,az provided for by Section 3700 of the labor Code,for the performance of on
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance.As rcquimd by Section
37009(the Labour Code,for the pdrimm mcc of the work for which Nis permit is issmd.
My Worbert&:pmPensation lmirGsimYe carrier Policy number am-
cm
'4'N7t)dkA.'G ✓' poliOyNa.: ISSID0�o3o
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the Permit is for one hundred dollars(5100)
In lets)
I cest(v Not in Use performance of the work for which this permit is issued,I shall not
employ any person in any manner an As to become subject to the Workera Compcmation
Laws of California.Dare
Applicant
NOTICE TO APPLICANT:If.after making this Cenifica¢of Exemption,you should
become subject to the Worker's Compensation provisions of the labor Codc,you must
wJ O foMwith comply with such provisions or Nu Permit shall he deemed revoked.
Z"� CONSTRUCTION LENDING AGENCY
I-+ .�. Ihcmh affmm Nat Nerc is a conswcting lending for the Performance of
Y .C.) 'r
C> the de work fear warn wa Permit u torten(se..3897.Civ.ca
Lenders Nam.
_z Lenders Add.
U O 1 certify Nat 1 haw read this application and sum that the above information is
lL F correct 1 agree to comply with all city and county mJinantes and sum laws relating to
pU building consWftioi and hereby Andorra repeaebutraa of this city to Other upon the
a alcove-mcationou proper for inspection purposes.
(We)agree to saw,indemnify and keep harmless the City of Cupcnino.1gral
F"Tq Liabilities,judgments,costs and expenses which may in any wry serve against said City
U Z in consequence of Ne grand ng of this Permit.
^ APP ANT UNDERSTANDS AND WILL COMPLY WITH AliL N N-POINT Issued by:91toDate
S RC EGy�,ATIONS. -
' kms. �(,71� .
Re-roofs
Sign Appli HAZARDOUS MATERIALS DISCLOSURE Dam Type of Roof
Will the apphemn or future building Occupant slam or handle humdous material
u defined by the Cupertino Municipal Code,Chapter 9.13•and the Health and Safety '
OYe tion 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
Will the applicantor fuwrc building acupam use equipment or Jcvicea which If a roof is installed without first obtaining an inspection,I agree to remove
I
tharafdoes air contaminants u cfixed by the Bay Arca Air Quality Management all new materials for inspection.
ctT
❑Yes No
I have ma)the luraidma materials requirements undo ClUmO,6.95 of Ne Cslifot
ealth&Safely Code.Scions 25%5,25533 and 25536.1 understand Nu if the building
not currently haw a moan,that it is my responsibility to nadfy the Occupant Of the h must he met Normnamanceofa ccnifm f cuancy._ a"P tit Sign of Applicant Date
ow .r uthorizcd.,101 Date All roof coverings to be Class"Brum or better
Community Development
10300 Torre Avenue
1 Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPEt�TINO
Building De artment !
JOB .AIDDRE S: PERMIT # I
01 a; ' i 1-h b I ,S L L)S GT <7S07oo�t >
OWNER'S NAME: v SO PHONE
GENERAL CONTRACTOR: Zftio. FAX #
I am not using any subcontractors:
61- Signature Date
Please check applicable subcontractors and complete the followinginformation
60 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
U P E IST I N O 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 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
iththe above stated policy on re-roofing.
Homeowner's Name: ^O pC�rT JJ Q/ n 50(1
Job Site Address: c1 9 C 71 �IBJ CT.
Roofing Company Name: I -W C[U ROO�Rt`tti CO.
Applicant's Signature: ���.l�Q � Date: —0
Greg Casteel
It Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF
ZINO\ -
�CUPEkTINO PERMIT APPLICATION FORM
APN # Date:
-0 - oa - 0.97 v5
Building Address:
aavq 4blscu.s CT.
sContOwner's Name: �C)der / – —0 � SO/ 7 Pone
T V v - ?3 6-/a 75-
Contractor:
ractor: h r'UO Q Phone #: L/��a�C�C License #: a �8`/
Contact: /� Phone#: ! / Cupertino Business License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
�i< Asphalt Shingles N<' 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 Policy:
Job Desc tion• re_h+o
Pre-s d�.' .'� Corn rvoF o2D�/S/ware Snug/.1 u� e�lfnlin�C Pr lc q�nw.n�
Residential f Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: L 1
Cost of Project: Type of Construn: Occupancy gr p:
e,-rcn
Qty. if
Applicable Fee ID Fee Description Fee Grou
/ 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