06060099CITY OF CUPERTINOr
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BUILDING DIVISION PERMIT..CUNTRACTQR°INFORMr�TIO�
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BUILDING ADDRESS:
LINDY ROOFING .CO INC
"'a"" "u-06060099
7791 LILAC WY
IVR'S NAME:
PERMIT ISSUE DATE
RICK SHIN
5554 HARVARD DR
0
PHONE:
..
SANITARY NO. CONTROL NO.
(408)286-9990
ARCHIIECl/ENGiNEER:
BUILDING PERMIT INFO
BLDG� EMECH
MO
O O
LICENSED CONTRACTORS DECLARATION
Job Description
I hereby afarm Nat 1 Me Incurred under provisions of Chapter Y (commencing
with Section 7000) ofD,,i ion 3 of ha Bud. and Fmicuum ns Codd, Md my Ikeue 4
Wfall rata and elf ,_ 2
REMOVE EXISTING WOOD SHAKE ROOF. INSTALL 1211 O
Licen, Clua Lk.N
LDo.I. Conuumr
30LB FELT AND 30 SQUARES OF DIMENSIONAL COMP
CHI7ECI•S DFLLARA ON
I untie nJ my plans Nall be used u puhlic na:orhM
'NJ
� � ����
Licensed Pmloneiaoel
OWNER-BUILDER DECLARATION
1 hereby affirm that I am exempt from the Cont,torli License Law for the
fallowing hansom (section 703IS. Business and FmleVmer Calc: My City as Manly
JUN /- 2DO6
which mquhes a permit m caR{INCL alter. improw. demolish. or repair my Moment
prior to its outcome. also requires the eppliease fonuch permit to file a alined statemem
in At ,hikin LM rerselad(Chapters
that haiscingwdpuraMt in At Law (Codd
noainmaM
Sq. Ft. Floor Area
Valu ii610000
ofDorins 3thaieenuecucia
(commencing with Seaton of n 3 of the Pmn or
M HI
that he u exempt therefrom and the bash for to alleged exemption. Any violation of
Secdon 70313 by any applicant fora permit mbj= Ne applicant m a civil penalty oI
AD �T N�svt her
- upancy'[�r�
not more them Rw hundred dollars (2300).
3' 7 V
5 9 o G]: 10 0 O
(] 1, se owoer of the property, army employees with wages u theirtalc compensation,
Required Inspections
e
will do the work aid the structure Meet intended or o@led for We(St. 70th. Business
not apply to an owner of
and Profedons Cede The ConmcmLicenses License Law doe w
9 P
property who builds or im proven daemon. and who does such wort himself cur enough his
own employes, provided thalwch imprawmMh art an[ ul,MW orartetM forsale. a,
hawcm. the building or improvmnMt is aid within one year of Compledan, the owner.
builder will haw the burden of proving that M did not build or minnow for purpose of
seleJ.
-
❑ 1, as owner of the property, am mteluawly canuacting with licensed anuscmn in
conswm the project (Sec 7044, Business and Professions, Code) The Conmemrh U.
can, Law docs oat apply W , mutter of property wha buiWt cur improves thereon. and.
who contacts for such pmjeeu with a Mntractot(s) licensed punuam to the Contractors
Liccase Law.
❑lam uampturder See .BAPc Nothiamuon
.
Due
WORKER'S COMPENSATION DECLARATION
1 hereby 911m, under penalty of perjury nM of the following declarations:
ham and will chalnWn a CeNOate of Consent to self-Wure for WorteraCwnpcn-
sa0on, u provided ran by SMtion 3700 of die labor Code. for the peMonnasha of An
work for which this permit is issued.
❑ 1 haw and will mountain Worket, Compensation insurance, as required by Section
3700 calm Labor Code, for the performanaof the work for which MOM permit h iuucd
'
My Worker, Caepenatian lnciamnce�camer and Policy numbLL�r raaamm.�, (f• r�
,r
(y�r
ZOOW
Carrier. S-TNT E iii Policy No.: —t 12-f
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This mile aced not he Completed if the permit IAforom hundred dollars (2100)
or lewd
I artily that in the performance of to work for which this permit is Wood. l shall rte
'
employ any person In any mucerm as m become subject to the Wortrn'Compcnsaton
Laws of Calirpmil. etc
Appl oto `
NOI7CE TO APeP C! REIT. IL aMr making Nb CeNReee of Esemptian. you NouIJ
become subject an the Workers Compensatan provisions of the Labor Code, you muse
forthwith comply with Rich pmakdons or AU permit Nall be dcemW tewtrd.
CONSTRUCTION LENDING AGENCY
Ihatebyich ntut Vert hs construction funding agency for the peMunnana of
C.)
At doh far which Ihia permit M luted (Sec. 7077, Civ. C.)
ed (S
'
Lenders we .
Lcndera Addmsa
1 certify that 1 haw read this applieaOon and Aute that the above Infotmadm h
comet. I agree in comply with all city Nd county oN oarmt, and sate laws relining W
building theme tion, Md herehy ay'Kcnve myresemtim or this city to enter upon the
aWve-mentioned far i Mon
property pugwxs.
(We) agree , sew, h comfy sed kMp humless the City of [upcnin0 against
j IiabilWq,Judgmenu. c tapcnses which may lit My wayam,agaluuMO City
in conseque of the Swung of this permit
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT
Issued by: Date
SOURCE REGULATIONS.
Type of Roof
�^bll10l,'Re-rools
SI .e a11A Oanucommeor Date
HAZARDOUS MATERIALS DISCLOSURE
WI to applicant or forum Wilding occupant Mom or handle husNous material
by the Cupertino Municipal Cade. Chapter 5.11. and to Health and Safely
S coy" 25531(.)7
IFReed
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
Will Ute applicant or future building occupant um equipment ordefiers which
emlt huudnu ak cMtae Is deOned by the Bay Area Air Quality Management
all new materials for inspection.
Gimlet?❑Yen
Nu
Ihow mad theInitiation, materials requirementsr Chapter f l
Le
NanaSafetyCodc,SnU=255052553and25nd.Nn ieWiding
dawMtcurenuY hew•tmunLtouthis myregairdtaiity in mifY theoexupaalofft
reyulaemenu which muM Wmetpdorm Mauaoeeofm CcNkateaf pns
Signat r bfA plicant Date
aag<-��~1 f
All roof coverings to be Class "B" or better
owneraraama� ate
0
Item 1 of 1
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 35904010.00
DATE ISSUED.......: 06/13/2006
RECEIPT #.........: 34825
REFERENCE ID # ...: 06060099
SITE ADDRESS .....: 7791 LILAC WY
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OPERATOR: amyw
COPY # : 2
0
OWNER ............:
RICK SHIN
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 10,000.00
---- - ------ -
169..56
- - - - - - --
0.00
---- - - - - --
169.56
- - - - - - - - - -
0.00
BSEISMICRE
VALUATION 10,000.00
1.00
0.00
1.00
0.00
TOTAL PERMIT
170.56
0.00
170.56
0.00
METHOD OF
PAYMENT AMOUNT
NUMBER
-----------------
CHECK
------------
170.56
------------------
1821
TOTAL RECEIPT
170.56
0
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Building Department
JOB ADDRESS:� / / I �G � PEIt (5 o) 66ogq -9"
OWNER'S NAME: (C.rL -S//l" 1PHONE#j
GENERAL CONTRACTOR: VIA -4.2 -Le MFe till I FAX #
I
I am not using any subcontractors:C� `� "`�`'`--- 1-136 �p
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
•
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
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: sk r• r1 ✓1
Job Site Address:
0
Roofing Company Name: LI �d kpo-ge Go
01
Applicant's Signature: Q In - t. )_Q_ CQr Date: rP / 3 6f6
Greg Casteel
Building Official
Revised 11/2/04
Prinfed on Recycled Paper
r
CITY OF CUPERTINO a,�� cf
REROOF
PERMIT APPLICATION FORM
APIC# ,3� - O 4 -
OI O
Date'
"Up
Building Address: `% r7,9(
L L0. G G 9
Owner's Name:
IcK
Shinn
Phone #:
o8-S/5-15�/
Contractor:- Phone #:
/—/;koo? D a8(p-1`140
License #:
:2 1501
Contact:
l.�
Phone #:
o 8_d_&P_ o
Cupertino Business License #:
Plan Check Fee
Type of Roof Covering:
Existing:
Proposed:,
❑ Built -Up Roof
❑ Built -Up roof
o Asphalt Shingles
X Asphalt Shingles
X . Wood Shakes
❑ Wood Shakes
'❑ Wood Shingles
❑ Wood Shingles
❑ Other (Specify)
O Other (Specify)
Number of existing coverings
❑ Provide I.C.B.O. Report #
❑ To be Removed
❑ Provide Mfgr. Installation Specs.
Have Read Understand and Will Com 1 With Cu ertino's Tear Off Policy:
Jobe�s+cri��/ption: 1'' w. d G -e
/
'0-1e.
6 0
S Gres O?- 0rVNpn S/_ovtc-t; G!n'1 OS��iori
Residential
Commercial ❑ .
Fire Zone: Yes ❑ No Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project:
Type of Construction: Occupancy group:
/0eel
Sia (�
Qty. if
Annlicable
Fee ID'
Fee Descrintion
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
i