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03110116 ..CITY OP CUPERTINO Ruaowc mvlsloNPERMIT 'cCON�TRACTn12INFORMAIQN (BUILDING ADDRESS: LINDY ROOFING CO INC PERMITNF3110116 OWNER'S NAME: PERMIT ISSUE DATE AW1WRTTRR BEULAH A 5554 HARVARD DRi 1 121122_03 NL. SANITARY NO. CONTROL NO. (408) 269-2025 ARCHITECT/ENGIN[ER: BUILDING PERMIT INFO BLDG [CECT PLUMB MECH 100 LICENSED CONITUCfOR'S DECLARATION £u I hereby amrm that 1 am licensed under provisions lir Chapter 9 gnmmcncidg Job Description with Section TBIg))of D;viaion 3Orthc Business end Professions Cndc,end my license is ons ;n ILll force and elle iq? Lieensccasa L;e,g 215951IPREROOF-REMOVE SHAKE/.INSTALL +t° °" —� ARCHITECT'SD 1/2 " PLY COMP/MODIFIED '3 ,.,ad.Chit, cards C f�U I understand my plans shell W mad m public rtcnNs a ot o to Licensed Professional 5 g OWNER-BUILDER DECLARATION f 1 hereby a1Rrm that I am exempt from me Contranor's License Law for the p 0 following reason,(Section]W 1.5,Bmincss and Professions Code:Any city Or county 5$ which requires a permit to cnnstrun,after.improv,,demolish.lir repair any structusc poorm its issuance.also requires the applicant for such Permit file a signed statement that he is licensed pursuenu.the Provisions(if the Comnctur's License lsw(Chapter 9 Sq. Ft. Floor Area Val L$dd11b000 . ue� (commencing with Section 7")of Dremon 3.(,he Busi and Pmfetsent Code)tar y'3 Net he Is exempt thertfmm and the basis for the allegedn mpdon.Any violation of Section 7831.5 by any applicant for a permit auhjeeu 'plica u m e civil pemlty of P��a�.pI�i��b not more Nanfin thundmddollam(5588). 35 �,�I AL 0 Occupancy Type D I,uowner of the pnspeny,or my employe Ith wages as their sole compensation, ��g will do Ne work,and the an is notinte dol d(fao,1fida.Ic(Sec.70U,Btdmads and Professions Code:The chn�,.,', ame Law does not apply to an owner ofMAY p s r ,gttlred Inspections progeny who builds or improewhodmss=hwDrkhimmlforfmughhia euu4ownemplowOa.providedthmmenuamnotimmndedor.Eemdformle.ILhowever,the huilding.,impd within one year ofcompletion.theowner- builder win have the burdenhe did not Wild or Improve fur pur,ove of BUILDING sale.). 0 1,as owner of the pro Y.em exclusively contracting with licensed c.ovacmra to common the Project(Se:701 Business and Proforda as CWI:)The Cmaractor's LF ecru,law does not apply to an owner of property who Wilds or improves thereon,and who contracts(or such projects with a cantncmr(s)licensed puts....dm Convector's LKenY Law. 0 1 am exempt under Sea ,B&P C for this reason Owner Data WORKER'S COMPENSATION DECLARATION 1 hereby alfmm under penalty of perjury One of Ne following declarations: I have and will maintain a Cerdlica,Of Consent to self-insure for Worker'sCompcn- ration,as provided for by Section 37811 of the Labor Coca,for the pc rf nm moss of the work for which this permit is issued. 0 1 have and will maintain Wmots Compensation Insurance,as required by Section 37W of the labor Code,forthe perfm p ance of the work for which this peem;t is issu d. MyWorwex Compensation Ensure=nuicr and Policy number are: Carrier; M(}INS�a4J.g Policy No.: MBS Qf[bG/_� 1 CERTIFICATE OF'F FMP ION FROM WORKERS' COMPENSATION INSURANCE or Icss.)(This sectiw need nor be completed if the permit is far hundred dollars(SIP]) I cenify Nat in the performance Of the work for which Nis permit is issued,I shall not employ any person in any manpe`�y` `oata sublenmlW Worken'Compeasnion Laws of Caa[.rn'a Da 11 1 O! NOTICE 1U MPLICANT:If,after making this Cenifcam of Exemption,you should become subject to the Worker's Compensation provisions of the labor Cndc,you must 'z forthwith comply with such pr.viainm lir this permit shall W deemed revoked. zCONSTRUCTION LENDING AtENCY j—t Ihemhy allure Net there iso consWninn len ' agency lnnhe perfmmana of 1a the work(Or which this permit is issued(Sec.30 iv.CJ QLender's Name z Umber's Address V Q 1 mni(y Net I have read this plication end sum that the above information is ir„F correct.1 agree m comply with sty and county ordinances end stem laws relating m pU building construction,and he y suthorin reprcsentedwauf Nis city mcnter upon the LTl eWve.memi.nedpmpeny rimpeoion purpose. G (We)agree m saw,mdemmfy and keep harmless the City Of Cupertino against h incondea,jutlgm,nta.coeuendof this Non it. APPLICANT in any way eccmc against said City fJ z in consequence of Negmming of this permit. ^' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by- Date s0 GULA HONS. C , kiL[r� 11���D3 Re-roofs I Signal pplmanJC.ntmcmr '�a� (/ `/ 03 /� HAZARDOUS MATERIALS DISCLOSURE Type of Roof 2D l/ Will the applicant or futum building Occupant amrc or handle hevuduus material u derided by the Cupertino Municipal Code,Chapter 9.13,and the Bastin and Safety Code.Section 335)7(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes ON. Will the applicant s future building occupant um equipment or devims which If a roof is installed without first obtaining an inspection,I agree to remove naeardnm air contaminants m defined by the Bay Arca Air Quality Management all new materials for inspection. inricR it ❑Yes ON. thrvcmet thhat Scunusmamri5, requirements under u Chrstan" 95ifthe C.tri nice Health&Safety Cndc,Seasons 25585.2553)add 25534.1 unWrsmnd thaildm Wilding dues not currcmly haw a mnan4 Nat it is my.mtehil ity m dud ly the Occupent.f the l requirements which must W met prior to issuance of a Ccniricate of upanc �� _ I1°f � S of Applicant Date Owner orauthonxcd a gent TDac All roof coverings to be Class "B" or better Community Development Department Building Division City of Cupertino 10300 Torre Avenue CITY()f 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. 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: rr �lU (A N J-V a�nL�� Job Site Address: III `l S Lg 0Ata✓111� nI�/c Roofing Company Name: N c Aplicant's Signature:�� r_, —, Date: ( Z`)I©3 C�t/�10C.X1 Greg teel Building Official Revised 1/30/03 Printed on Recycled Paper r CITY OF CUPERTINO REROOF D5110110 CUPERTINO PERMIT APPLICATION FORM APN# // 03 c�2 Date: f j OF e s Building Add : (� �Q 1 S La Loni t DK Owner's N e: Phone BI< # u LA S��rt_ 252 4015 Contractor: Phone#: License#: Limol 2 -`�°i`lD z1s�34 Contact: Phone#: Cupertino Business License#: � ��►� 2g `1`Cb j Type of Roof Covering: Existing:g' Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt ShinglesX 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 Comp]With Cupertino's Tear Off Poles:__ _ ❑ Job Description: I w 1t'�tovt' SH-4f iro�t��:. /v C� �"1trocFCc� Residential pf Commercial ❑ Fire Zone: Yes ❑ No ❑ Confirmed with PI e t. if there are an ictions: Cost of Project:I C)ODI 60 Type of Construction: Occupancy"grovV Qty. A ca 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 a � -2,,-3 7 0