03090136 IF—CITY OF CUPERTINO " f d s.
BUILDING DIVISION PERMIT 'Ab, NTRAGTORINFORMATIO P
BUILDING ADDRESS: LINDY ROOFING CO INC PERMIT NO 03090136
307 KEN-']WOOD AAT
OWNER'S NAME: 5554 HARVARD DR PER.MITMUEDATE
)NE: (408) 269-2025 SANITARY NO. CONTROL NO.
ARCHiTEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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±oo LICENSED CONTRACTOR'S DECLARATION
8 u C 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing Job Description
aZ with Section 7000)ofDivision3 oldie Business anal Professions Coda.and my license is c
mruur —
o
senses , � g — / REROOF r��ALE®
e�z License s
�F,p Datc CunirattgC
F� ARCHITECC1ZDECGI.ARATION -
f u U 1 undersand my plans shall w used as puNic records OCT T
eon License Noffcs,ional 1 - 2003
5 OWNER BUILDER DECLARATION
a S I hereby affirm that I am exempt from the Contractor's License Law for the
5 mp o following reason.
sn.(Section?In 1.5,Business and Pmfccsintm Cme:Any city or county �'�W I
NG
which requires
a perms to construct,alter,improve,demolish.or repair any structure
-z> priono its issuance.also rryuires the applicant for such perms to file a signed statement
< that be is licensed immnuolhe mvisionsorineConncbr'sU..�Low(Charter S Ft. Floor Area
asp p p ( p q. Valuation
(cat he is
(commencing therefrom
and ti Divisionr the
Busaged ess andexempt Profeson.Any
Cmlc)ur
_ that he is exempt thcgefrom and Ion baso for Ne allcgc0 exemption.Any violation of 35931003 . 00
Section 1031.5 by any applicant for a permit subjects the applicant o a civu penalty of APN Number
nmmogethan five hundred datmrs(s5W). - -- - ---- - ---- - - _ Occupancy Type. _
0 1,aa owner of the propcny,o my cmploYcea with wages as that,sole ci m xenaetion. -—
will do the work.and But shortage is not intended or offered for sale(Scc.7094,Business
and Professions Code:The Contrartor's License Law docs not apply b an owner of - E Regained Inspections
property who buildsm improves thereon,and who does such work himselfor through his 307 - INSULATION
own employeas,provided that such improvements ma not intended oraffined for ssfle If. 601 - ROOF TEAR OFF
however,the building or improvement is sold within one year of completion,the owncr-
budderwinhavethcburdenorprovingnullhedidnotwildorimproveforputomor 602 - ROOF PLYWOOD NAIL
sale 1.as owner of the o n. exclusively contracting 603 - ROOF BATTENS _
O Scp= ram= y gwnbEansmcnnwmonb 604 - ROOF IN-PROGRESS
conswa Nees not apply
to an Businessand Professionds or i proContractor's1J-
who Law docsnotapplytian owner ofproperty who wildsorimproves Comment
and
who concocts for wcM1 projccu with a conuacbr(s)licensed pursuant b the Conmaor'a
Lia=nsc Law.
❑ 1 am exempt under Sec. ,B&P C for this reason
Owner Date `
WORKER'S COMPENSATION DECLARATION '-
I hereby affirm under penalty of perjury one of the following declarations: .
I have and will maintains Cenifcate of ConscnL to self-insure forWorkar'sCumpan-
sation,as provided for by Section 37W of Ne Lid or Code,for the peRorman o of the
work for which Nis permit is issued. _
❑1 have and will maintain Workers Compensation Insurance,as required by Section
31 f the Labor Code,for the performance of N= p k for which this Pecom"is issued.
My orkehC mpensaho Insunrtcc came olicy number aa:
me r.�,�,�,.a.i�w(L alicy No.:9 lall '/ _
CERTIFICATE OF EXEMPTION FROM WORFI KERS'
COMPENSATION INSURANCE
(CSS)(this auction=ad not he completed if the permit is for one hundred dollars(S 100)
1!
I certify that in the Peilh mance of the work for which this permit is issued.I flail out
employ any person in any manner an az m become subject to the Workers Compausation
Laws or California.Date
Applicant
NOTICE TO APPLICANT:Ir,arta making this Certificate of Exemption,you should -
become subject to the Wofecr s Compcnuation provisions of the Labor Calc,you must
�Z forthwi th comply with such pmvickma or this permit shall be dermad revoked.
L O CONSTRUCTION LENDING AGENCY
1 hereby affirm Nat there is a construction lending agency for Ion performance of
1a Ne work for which this permit is issued(Sae.30P11,Civ.C.)
ALamla,'s Name
3.3.z Lander:Address
J Q I certify that 1 have read this application and state that the above information is
1 F- cancer 1 agree to comply with all city and county ordinances and sate laws relating to
Z)U building constriction.and hereby authmive representatives or this city to enter upon thc
ui mad
N Ck1 shove-menudgmenmp rtyoat fee dtuire umnses purposes.
Ow (We)agree m save,indemnify and keep harmless the City of Cupertino against ,
Z
liabilities,judgments,granond of this csmit, may in any wayaccrvc againstsaid City
J z A consequence of the Ranting Dr this D W1 /
r. 30IDRCE��/E GULATyIPPLICAW RSNSANDS AND WIIvL CO PLY WITH ALL NON-POINT Issued by: Date
�i tenrV dZ Re-roofs
Srgnatutf of Appit ntnocmr Doc
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will ft applicant or future building occupant sbrc or handle hazardous matenal
az defined by the Cupenion Municipal Cole.Chapter 9.12.and the Health and Safety
CWe.Section 25532(.)?
0y. #N. All roofs shall be inspected prior to any roofing material being installed.
Will the applicant of future building=upant use equipment or dcviaa which If a roof is installed without first obtaining an inspection,I agree to remove
it hmardnus air contaminants as define]by the Bay Arca Air Quality Management all new materials for inspection.
micrt �/
[I Yes IBNi, .
I have real the haMoblus materials requirements under Chapter 6.95 of Me Califor-
is nor ealth
ulli,ay Cak,Sa.omhatitIS.
.Myrespo25514.I undcrsund that if the willing �y ' j� r
me nm c&Bel y box:i.tenant thnt it is 55 3and25i334.1 b notify Ion occupant or the �/ / zz-- _V.�1}-
myuire� WhicM1m shot mono iss cc Ccrdfcam�ofy.��yf5��pancy S' nature of Appf t VDate
k Donne urauth sir ttagcm ---------✓ Date All roof coverings to be Class "B or better
Community Development Department
r Building Division
�� City of Cupertino
10300 Torre Avenue
4CITY OF Telephone: (408) 777-3228
UPE R.T 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.
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: C J�
Job Site Address: /1a Al lj:� _
Roofing Company Name: L /,�� �� YC71-"o my
A plicanYls/S�ig�nature: Date:
\N�tnlD�xl
• Greg t
eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF G
CUPEkTINO PERMIT APPLICATION FORM
APN # - Date:
Building Address:
Z/07 .
Owner's Name: Phone#:
2.4% olnt
Contractor: t hone #: yor License#:
L0-)
Contact: hone#: Y� Cupertino Business License#:
L i.� o
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#
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
. I Have Read, Understand and Will Comply With u ertino's Tear Off Policy: ❑ r
Job Description: Rg�,,�v ®�. r�pS/ �t L S C
Residential ^ Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning if
there are an restricti
Cost of P t: Irl Type of Construc[io Occupancy group: _
oZ
Qty. .
A tc le Fee ID Fee Description Fee Group
1 BPERMFEE BldgPermit Fees BUILDING
BENERGY Ener BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
IV7 � �