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CITY OF CUPERTINOr7,
BUILDING DIVISION PERMIT
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BUILDING ADDRESS:
LINDY ROOFING CO INC
PERMITNO.06080048.
10726 LARRY WY
OWNER'S NAME:
PERMIT tSEUEDATB
WEIGEL WESLEY W AND CATHY
5554 HARVARD
E:
SANITARY NO. CONTROL NO.
(408)286-9990
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDOO ELECT PLUMB MECH
O O O
LICENSED CONTRACTOR'S DECLARATION
Job Description
bereby affirm that I sm licensed under provisions of Chapter 9 (mmmetwing
with Section 7000 ofDivialon 3afthc Buainev and P futurnmiLmia, dory licenan is
Infallrartcana 2t
REMOVING THE EXISTING 2 LAYER COMP OVER WOOD.
o �c aawr
TALLING 1/2" OSB, 30# FELT AND 29 SQUARES OF
RCHTTECo DECLAR
NEW 50 YEAR DIMENSIONAL COMP.
1 tine rw my p ant Wall he tared as public recnrW
Licensed Professional
OWNER -BUILDER DECLARATION
I heteby eras, that I em exempt from the Contractor's License Law for the
fallowing mason (seNan 7031.3. Business and Prolamines Cale: Any city or county
which squires a permit to conwut alis, improve. demolish, or repair any strvnun
prior in its issuance. also, requima the applicant farsech permit w Rk a signed atstement
Conuacwre Uoenn law (Chapter 9
Sq. Ft. Floor Area
Valuation
that he is licensed punusm to tine provisions afthe
(commencing with Section 7000) of Division 3 of the Business and Professions Cade) or
$15000
Nu he I. exempt therefrom and the basis fur the alleged ramnptiaa Any violation of
APN Number Occupancy Type
Section 7031.5 by any applicant for a permit subjects On, applicant m • Civil Penalty of
nut mon Nen five hundred dollars ($5071.
0 I. a owner of Ole property, m my employeu with wages u Weir mkcampensadon,
will do We York, and WC summa els Out Intended a, Offend raraale(Sm. 704, fluxional
Required Inspections
P
rr LiLaw dors rot apply m an owner Of
and Pmftund. Cade: The Caotrmsea se
q
property who builds or impmwsdince n. and whadeerm ichweahwuelf ar though his
(orale. If.
own cmplayea, provided Watmeh Impmvereanu an, not intended araffered
however, We building or Improvement is sold within and year of completion. the awms-
Wildm MB have the handan or proving Wert he did not boiW or improve for purpose of
sale.).
❑ 1. as owner of We property, am exclusively contracting with licensed common to
construct the project (Sea 7607, Business and Professions Cade:) The Cmtraawrs U -
came law does out apply to an owner of property who builds or Improsn thereon. Md.
who comiacu for such projem with a eonuxmr(s) licensed proment to the Contractors
License Law.
❑ T am exempt under See. ,B B P C fa this mason
Owens Das
WORKER'S COMPENSATION DECLARATION
hereby firm under penalty of perjury ante of the following declam l=
low and will ..Irwin a Certificate a Consent w ulf-thus fee Wmkers Compen-
"on, ss provided for by Section 3700 of do Inbar Code, for We performance of We
work for which this permit u issued.
❑ I have and will maintain Workers Compensation Insunna. as required by Section
3]07 of the Labor CUM. far the performance ofthe work far which this permit is Issued.
'
My Warkeh Compe�swwauon Nsu as rind Policynu7 /(.��?/j
412M
Carver. n a Policy No.:
.
CERTIFICATE OF E7 ON FROM WORKERS'
COMPENSATION INSURANCE
(Thes=ran need ant be completed if sate Permit Is tartan hundred dollar (SIW)
or less.)
1 cemly, dist in %e performance of the work for which this permit is mowed. I shall not
employ any person in any manmr m u w became subject mdse 'Com sera
Laws tfC ran
Applicant
NOTICE TO AP NT: Jr, after making this CeniRaw of Exemption. you should
become subject m the Workeh Compensation provisions of the tabor Cork, you muse
' forthwith comply with such provisions a this permit shall be deemed invoked.
CONSTRUCTION LENDING AGENCY
1 M1enby spasm situ Wen is a Construction lending agency for dw peormnarce of
the work ror which ft permit k issued (Ser. 3097. Civ. C.)
iLendcra Name
Lenders Address
I coolly that I have road this application said Stan situ the above infomsuun u
' correct. ) agree to comply with all city and county militantness and sun lows miming m
building construction, and hereby sutbtme mpreaenta0ves of Nis City to enter upon me
above-mentioned property for inspection purposes.
(We) agree to ave, indemnify and kap harmless Cite City of Cupamrw against
I liabiliuu,judgmcnu. anti and expenses which may in any way aecxue against said City
F in consequence of the granting of this permit.
'rA UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
TIONSRe-roofs
Type of Roof
pplianDamHAZARDOUS MATERIALS DISCLOSURE
e applicant err future bis ing oecupanlaort err haMle haallom maseriai
de Cupertino Muni1Calc. Chalrtsr9.13. and Ne Halm antl Safety
2553244!
All roofs shall be inspected prior to any roofing material being installed.
o10
a roof is installed without first obtaining an inspection, I agree to remove
Iding aceupam uso uluipmmtt m ticviaa whichIf
air cofreed by Os Bay Amer Air Quality Management
e applic26413
all, new materials for inspection.
District'?
DYar
I haw read the requirements under Chapanr 6.95ortheCaiifor-
V, (olo
riaHalthB Sercty Cale,SeW=25505,25533 and 25534.1 undersand dm lithe building
\ XvL v� T
dace not currently haw a annual, that It is my responsibility to soul'y do cu of the
ratio metnt�vhicn mo x met poor w uanacc of a canincaw of
Sig Applicant Date
!Cj' c.�..�/�
All roof coverings to be Class "B" or better
Owner arixedagent DIM
om 1 of 3
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 31602038.00
DATE ISSUED.......: 08/08/2006
RECEIPT #.........: 35550
REFERENCE ID # ...: 06080048
SITE ADDRESS .....: 10726 LARRY WY
SUBDIVISION ......
CITY .............: CUPERTINO
IMPACT AREA ......
OPERATOR: amyw
COPY # : 2
OWNER ............: WEIGEL WESLEY W AND CATHY
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 15,000.00 223.56 0.00 223.56 0.00
BSEISMICRE VALUATION 15,000.00 1.,50 0.00 1.50 0.00
TOTAL PERMIT : 225.06 0.00 225.06 0.00
L.
0
6.1
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
Fax (408) 777-3333
Building Department
.:...•
• .
SUBCONTRACTOR
BUSINESS NAME
•• • NI, !yriT06 A=
am not using any subcontractors: 8 I g "`g
Signature Date
Please check applicable subcontractors and complete the following information
Owner/ Contractor Signature
Date
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
i�
CITY OF
CUPEkTINO
Community Development Department
Building Division .
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
Far: (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
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: Oe.s C ggjh,qn: I e—c
job Site Address: �D %�G �Gtir4, "u"
Roofing Company Name: I n
Applicant's Signature:
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
CO
Date: 9-2-0,6
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 $176.18. The re -inspection fee must
be paid before another inspection can be scheduled.
IMPORTANT:
1. Flat roofs must have a minimum of 1/4 " per foot slope and demonstrate
that there is no ponding.
2. An I.C.B.O. report is required to be on the job site at the time on inspection.
I understand and will comply with the above stated policy on re -roofing.
Homeowner's Name: Oe.s C ggjh,qn: I e—c
job Site Address: �D %�G �Gtir4, "u"
Roofing Company Name: I n
Applicant's Signature:
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
CO
Date: 9-2-0,6
0
a10F
CUPEkTINO
CITY OF CUPERTINO
REROOF
PERMIT APPLICATION FORM
APN # 3 t to_ n �nn
V ��p
Bldg Permit Fees
Date: 6 -?-46Building
Address:
/O -7c;
1�
Energy
Owner's Name:
BSEISMICRE
Phone #:
aS� -Dat
Contractor:�t -d�/t Phone#:
License 9:
(o
o-a8G-4?4b
BUILDING
�;,!S
Contact: Phone #:
BUILDING
Cupertino Business License #:
(,o l
b
Type of Roof Covering:
Existing:
Proposed:
❑ Built -Up Roof
❑ Built -Up roof
�$ Asphalt Shingles
SR�' Asphalt Shingles
\0 Wood Shakes
❑ Wood Shakes
❑ Wood Shingles
❑ Wood Shingles
❑ Other (Specify)
❑ Other (Specify)
Number of existing coverings_
❑ Provide I.C.B.O. Report #
XTo be Removed
❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: 1'CmOU,n-3
liytr O✓>lIOOUer 1n
112-" ii -et' a.^& .21 Uc✓e5. a4' /IRS SO Ps✓ Dfinensto-i CO
esidential X Commercial ❑
Fire Zone: Yes ❑ No ❑
'Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project: Type of Con etion: Occupancy group:
9
151660 e r -O0
SI n
Qty. if
Annlicahle
Fee ID
Fee Description
Fee Grout)
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