06030062 'CITY OF CUPERTINO
BUILDING DIVISION PERMIT ON'TI�CTUR IN1P'URM,4'CIUI
W4 x*'i.€'f 'x^al3+t ', -t arxl3tu�`.Y.vrtt^rk$t
BUILDING ADDRESS: LINDY ROOFING CO INC PERMIT NO.06030062
208
OWNER'S NAME: PERMIT ISSUE DATE
HARRAH ROBERT C ET AL 5554 HARVARD D 06
NE: SANITARY NO. CONTROL NO.
(408) 286-9990
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0
uo0 LICENSED CONTRACTOR'S DECLARATION JobDescri tion
vlZ F I hereby Mm Net 1 un licensed under provisions of Chapter 9(commencing P
n< wkh Section 7").f Division 3oftha Enamored and Fmfentmu Code,and my liceme ie
D< nfullfnrceondc 21S6(1p REMOVING EXISTING SHAKE ROOF, INSTALLING 1/2 OS
> z Licenacl". tic.« 30# FELT AND LIFETIME DIMENSIONAL COMP. SHINGLE
.Dao Conlnctor n-a oAi
A .1mall use DECLARATION^' CLASS A �� ���®
I understood my VA1C he used"public rectands
DECLARATION
iQ Licensed Pmf=ionat
OWNER-BUILDER DECLARATION
I hereby.(stem Net 11. exempt from the Cssions o e:my c Law for IK
`o O following mama.(Section 711313, s alter, and ove.demolish,doll Code:Any city st aunty A/Bp I/le? 2006
a$ whichits isuae.a,titreuiresteLahar,improve, emittrte a sig ed ewount
z� rlormslimme applicant (Chamant
< mat he ie llaued runvanttothe pmvialom of the Contramre'slave law(Charar9 Sq.Ft.Floor Area valuation
x€� (commenclnS with Section 7000)of Division 3 of the Businessand Professions CoEe)or - 18000
e 5— that he Is exempt therefrom and the basis for the alleged eamption,Any umbdion of
rilh—
Section 7031.5 by any applicant for a permit subjects me applicant to a civil penalty of APN Number y Type
not more than ism hundred dollen(1500)
❑1,u ownu of the pmpeny,or my employee with vngm u tM4 mlo c=penadon.
will do the work.and thesaunum is noti anded moff cd for.ale(Sec.7044,Bun=s 35925642 . 0. Required Inspections
and Profamlom Code:The Conummrs License Law does ret apply to an owner of q P
property who builds or impluws theme,and who does curd work himself or through his
.employ=,provided that such Improv menuve notimeMed voBared forsale.IL
however.to building or improwmant Is sold within one year of impletion,the owner.
builds will have the bmdm of proving that he did it build or improve for peop act of
tile.).
❑I,at owner a the property,ma eaclusively contracting with licensed contractors he
construct the project(Sec 7004,Buinev and Prefudou Code)The Contractor's U.
cense law d=not apply to an owner of property who builds or improve meson.and
who contracts for such projects with a controtonO licensed pursuant to the Contranors
License Law.
❑1 am exempt under Sm. .B d P C for this moon
Owner Dow
WORKERS COMPENSATION DECLARATION'
I hereby.fRrm under penalty of perjury arc of the following deelarNmu:
1 have and will maintain.Ca dfnte of consent to alf-loom for woriers compen- '
"lion,as provided for by Section 3700 of the labor Code,for the perfmmason of the
work for which this permit is issued.
❑1 have and will maintain Workces Compematlon Insurance,as required by Section
37011 of the Labor Co�drrreaaa,dddfor the performance of the work for which this permit is Issued.
My Workers C.Cmpaygati Insurance envier and Polley number O:
Corner. �: Poliry No.: O�V
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE '
Trio section mad not becomplead lime permit is feroahunNeddollus(SIM)
Or leas)
1 cenify that In the performance of the work for which this permit is issued.I shall net
employ any person in my summer an tato become subject to the Workerf Compeuathon
Laws of C lifomin.Dae
Applicant
NOTICE TO APPLICANT:If,afar making this CartlRum of Exemption.you should
become subject to the Worker's Compensation provislom of me labor Code,you mum
,J O forthwith comply with such pmviatons or this Permit small M domed rcwsed.
Z� CONSTRUCTION LENDING AGENCY
EI barony a.ren mem Its co.tinn lending agony for the performance of
�; the wish for which this;permit is issued(See 3097,Civ,C.)
UJ Q Undoes Name
r7 Z Lender>`Addm" .
(„)Q I certify that I haw read this application and state that Oa above information Is
F'
comet.I agree to comply with all city and county ordinances and sea laws relating to
OU Wilding convection.and hereby authorize representotiws of this city to enter upon the
W ahovmme tioned plurally for impaction purposes.
(We)agree ro sow,indemnify and keep harmless the City of Cupertino against
'rrAA IlablihieLjudgmenes,could and expenses which may in my my am.against saidCity
in
Of the
U�+ APPLICANTeUN ERSTANDS ANartiOf this DMIL
WILL COMPLY WITH AL NON-POINT Issued by: - Date
UR GULATIONS. 3 !J
j Re-roofs
Sig uurt pplient/Conuator
Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant mom or handle hvardo"material
or defined by me CupertiXMO.ic1 Code.Chapter9.Ix,tib the Health and Safety
case, Oyu xss3x(a)7All roofs shall be inspected prior to any roofing material being installed.
❑Yu Will me appllc ilding acupant sea equipment or devices which
If a roof is installed without first obtaining an inspection,I agree to remove
It harardnu.oI,coYel.,iwahmquimmnu..draepwr6,95offtCalifw-
ma
ad by me Bay Area All Quality Management all new materials for inspection.
imict7
❑ItsI how read theHmlthkSafdyCDdc.Sccth=25505.25533 and 2553/.l understand!ft lfthe building I `�
dors Out currently haw a unant.the it is my responsibility to actify the ouepuµof me
mquimmcnls which must be met plot to issuance of a Ctnirrcaa or Oce 1 atur of Applicant Date
.
�' "" 13 All roof coverings to be Class"B"or better
Owner or a cam Dme
CITY OF CUPERTINO
1 of 1 PERMIT RECEIPT OPERATOR: kiersaw
or COPY # 3
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35925042.00
DATE ISSUED. . . . . . . : 03/13/2006
RECEIPT #. . . . . . . . . : 33545
REFERENCE ID # . . . : 06030062
SITE ADDRESS . . . . . : 20896 JOLLYMAN LA
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : HARRAH ROBERT C ET AL
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4349
RECEIVED FROM . . . . : JAMES WHITAKER
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
SEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
______ _____________ __________ __________ __________ __________ __________
BPERMFEE VALUATION 18, 000.00 255.96 0.00 255.96 0.00
BSEISMICRE VALUATION 18, 000.00 1.80 0.00 1.80 0.00
__________ __________ __________ ----------
TOTAL PERMIT 257.76 0.00 257.76 0.00
METHOD OF PAYMENT AMOUNT NUMBER
_________________ ------------ __________________
OTHER 257.76 VISA
TOTAL RECEIPT 257.76
•
Community Development
10300 Torre Avenue
1Cupertino CA 95014
Telephone(408)777-3228
Cl OF Fax(408)777-3333
W.UPEkTINO
Building De artment
JospK j��` PERMIT # O(OC)3 DoLoa�
OWNER'S N`"'IIAME: b06 PHONE # -3 - Z 3(eG
GENERAL CONTRACTOR: 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
oc
Telephone: (408)'777-3228
C�����'�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$176.18. The re-inspection fee must
be paid before another inspection can be scheduled.
IMPORTANT:
1. Flat roofs must have a minimum of 1/4 " per foot slope and demonstrate
that there is no ponding.
2. An I.C.B.O. report is required to be on the job site at the time on inspection.
I understand and will comply with the above stated policy on re-roofing.
Homeowner's Name: RO'o 44 Gcr/a-A
Job Site Address: 203 9(a TO (4 rye/ 1-��1 L- nt�
y
Roofing Company Name: � Incl kc)0 '�, Ca
Applicant's Signature: 0 -VI -(o: Date3�O(�
0�
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINOZ�
REROOF
CUPERT,INO PERMIT APPLICATION FORM
No
APN_' Date:
Building Address: 42v8 (o -To1I vYto-e-) Lc,,-,e
Owner's Name: I Phone#
6aFj �G�rvGLrl U
Contractor: Phone#: License#:
Contact: 0 Photoa � Z I#: Cupertino}I i$s License#:
fr%
Type of Roof Covering:
Existing: Proposed:
• ❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles sr 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 ComRIZ With Cu ertino's Tear Off Policy:
Job Description: Pe-rnuutny eXiS ny 6`a;rk- ,ns �a-
caw._ k.E45a47&%L Di Ce rn . ShL S CLAS a
Residential a Commercial ❑
_ Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are an restrictions: LJ
Cost of Project: Type of Construction: Occupancy group:
•e — r'OD� cSin C�
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