04050144 CITY OF CUPERTINO a
BUILDING DIVISION PERMIT ,4CONTR?iCTkORINFORIVIA.TIIAN
B_LDINGADDRESS: LINDY ROOFING CO INC PERMIT NO 04050144
21912 LINDY LN
OWNER'S NAME: PERMITLSSUEDATE
i, BOB ROBERT 5554 HARVARD
NE: SANITARY NO. CONTROL NO.
(408) 269-2025
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG EL,E},C,T PLUMB MOECH
Y00 LICENSED CONTRACTOR'S DECLARATION 70b Description �'P1
1 heroes affirm Nat I am licensed under previsions of Chapter 9(commencing v'Islam//
with S'g9d 7M(p.fDivmio dm Businasfad fessi .Code ,immseis �r
A'1 immu aneerc �� (��� n REROOF W/OSB & PRES ..COMP.
,3e0? Date�nsc�ClCass�141- A CHITECTSDECLAR N
02711 ZL9_ddcraund my plans shall M used u puhl c rt,moss
u Licensed Professional !/Y/
q I1ggjF�- OWNER-BUILDER DECLARATION
y I hereby attiren that I am exempt to)m dm Conwclors License Law far the
COO following mason.(Section 703 L5,Business and Professions Code:Any city of county -0
1§0! which.,.Iran a permit In enmwc4 alma improve,deellsxwtu
mh,or input,any cre
y prior m its issuance.also requires the applicant for such permiuo file a signed statement
that he is licensed pursuant to the provisions of the Contractor.UnmeLaw(Chaplcr9 Sq. Ft. Floor Area Valuation
(commencing with Scetion 71100)of Division 3 of the Business and Profusions Code)or
`t$ that he is exempt therefrom and the bssu for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjecu the applicant m.civil penalty of er0 0 Occupancy Type
not mom Nn five
ahundred dollen p y yp
0 I.as owner of the property,or my cmploycu wish wages a their file compensation,
will do Newort(,andO swctum IsnotintendedoroRemd ferstae(Sac.706/,Bnsixss
and Professions Code:The Conuanors Llanae law does not apply in an owner of Required Inspections
pmpeny whobuildsorimprove i lhereon,andwho dao suchwee k himself or through his
own employers,provided that such irepronmen mines intended orofferad formic.If.
however,the building or improvement is sold within one year of completion,the owner•
builder will have dm burden of proving that be did not build or impron for purpose of
ask I.
0 I.an owner of the property,am exclumely cormening with licensed convmNm to
construct the ponies,(Sec.7(164,Business and Professions Code:)The Canlrctor's Li. .
cense law does not apply to an owner of property who builds or improves thereon,and
who contracts for such pmjecm with a conlactor(U licensed pursuant to the Conwetora
License Law.
0 l am exempt under Sec. ,B&P C for this aamn
1031.1W"
ner Data-
WORKER'S
ate
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I haw and will maintain a CeNOcate of Cmum,,to sc[No ore far Wahefs Compere
on,u provided for by Section 7700 of dm labor Code.for Ne performance of Nc
rk for which this permit is issued.
i have and will mainWn Workers Compensation Insurance,ss required by Section
of the Labor Code,far Ne performance of Ne work for which Nis Permit is issued.
Workers C9mPeon Insumna carriv�tnd Policy nyryp�ybegZ:p��,ekni � UN Polity No.: " ' W i
CERTIFlCATE OF EXEMPTION FROM WORK S'
COMPENSATION INSURANCE
(This section need not no completed![the Permit is recent,hundred dollars(SIM)
or less)
1 ar ify Na,in to performance of the work for which this permit is issued.I shall not
employ any Nixon in any manner an as in become subject to the Workeri Compensation
Laws of Califomia.Date
Applicant
NOTICE TO APPLICANT:If.afler making this Certificate of Exemption,you should
become subject in to Workers Compensation ponvlaions of the labor Code,you must
,`O forthwith comply with such provisions or Nis permitshall be,deemed reveled.
Z CONSTRUCTION LENDING AGENCY
(rte I hereby affirm that there iso mnswcom lendingagerey for the performamnuf
CC ti f work fur which this permit is issued(Sec.3m,Civ.C.)
aQ Lenders Name
=z Lender's Address
V Q 1 cenffy that 1 ban reed Nis application and mute that Ne above inl namun is
W ^ cari 1 agra in comply with all city and county ordimncos and trate laws beluting to
O CSJ' building construction.and hereby author=mprrxntsives of this city to calm upon to
W shove-mentioned property for inspcefion purposes.
06 (We)egme to cove,indemnify and keep hart in an w City of against against
to liabilities.Judgments,cons and cantons which mrylnany wayty of Cupertino
tmid City
V Z in consequumc,of the granting of this permit.
.. APPLICANT UNDERSTANDS AND WILL COMPLY WE ALL NpIj.P�INT Issued by: Date
SOU EGULATIONS. F/rJC/
`-'L ` 6 y Re-roofs
S plic dConuemor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant nom rehandle hagardous material
u defined by Ne Cupertino Municipal Code.Chapter 9.12,and dm Health and Safely
do.0 en 25532(.)? All roofs shall be inspected prior to any roofing material being installed.
Yca
Will the applicant or .tum building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
7m4Dim,ict?
0Yal have mW aathe hrdous materials requirements under Chapter 6.95 ofthe Califonfety and Health&SaCede,Section 25505,25533 25574,I understand Nthe at if buildinges not commity have a tenant Nat it is my responsibility m notify the me pent of the
uiam wit m'u�s"rbcmetpnorwissmnccoraCenifamof upme Sig attire licant Date
" � All roof coverings to be Class "B" orbetter
Owner. ut naed agent from g
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
qUPEkTINO
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.
J 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: Rv g 1CabV be<
Job Site Address: 21111 L/N 01 *
Roofing Company Name:
A plicanYs Signature: ^ ' �` Date: 51 2
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROO
F 6
CUPEkTINO PERMIT APPLICATION FORM
APN # J 5 !l( Z -� I S^ Date:5
Building Address:
Owner's Name- Phone#:2 S l `2— _07
ba oq�� T le
Contrac or: Phone License#
:.2 (68((o
Contact: Phone#-
O Cupertino Business License#:
2
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles 112( Asphalt Shingles
Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report#
Z"/' To be Removed ❑ Provide Mfgr.Installation Specs.
. I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑
Job Description:
OV E S41AIC6 �NS74V, os 19 A-0`10 Co
Residential4 Commercial ❑
Fire Zone: Yes ❑ NoConfirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Projec Type f Construction: Occupancy group:
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