04080163 CITY OF CUPERTINO
BUILDING DIVISION PERMITCONTRAC`'Tt7RTNFiU'ktMA'Y'TON�
BUILDING ADDRESS: LINDY ROOFING CO INC PERMIT NO.04080163
OWNER'S NAME: PERMIT ISSUE DATE
L
NE:
SANITARY N ONTROL NO.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
3Oo LICENSED CONTRACTOR'S DECLARATION
Ihcmby.in.that l am lianud under Provisions ofChapler 9(commencing Job Description
EM wit SOMMa7MBof D.vLu n30fthe Bull.. Rachme Code.end my liconx is
m full uqp
'S�Z Licenmf OY,-d erre Lic.N REROOF
Z—^p D, T Co Onclor
7W RCHITECTS DEC'rAR' 1
'� I Music stand my plans mall he used as u!O cCRU
Do Lt.emmdPmfesstan.l P SPARK ARRESTER REQUIRED
OanNE."Rept
from
DECLARATIDN
+� I I hereby.(Erre on I em ucmpt from Ne Contractors License Law for the
i p O following moon.(Sutton](131.;Buiner.oend improve.
de u i Code:Any city m county
,s3$ which mqulms a .also
recons de, alar,improve,demolish,or npoir any structure
h,�xy hath. itsissuance.ensedafwntto the tM applicant fauuchpernitm cense Laedalaumcnl
hat ha is licensed pursuant to the provisions OflW ContracmrS License law(Chapler9 Sq. Ft. Floor Area Valuation
aF$ (commencing with Section 7000)of Division 3 of the Business and Profession Cecil)or
.- Jut he is ascmpt therefrom end to basis for the alleged exemption.Any violation or
Section 7031.5 by any ipplleent for a permit subjects Me applicant to a civil penalty ofQCCU p y 'l pe
not mart than foe hundred dollars(M). 3�.PN M8Ber O O araC
❑!,u owner o(the property,a my emplayeu with wage u Mas sole mmpensstlon,
will do the work,and the sMumpm Is not intended or offered for sale(Sec.7044,Business
and PmfessicN Code:The Con macules License Law docs not apply m an owner Of Req ire n Cu
pmpeny who builds or ire prow thereon,and who does such work himself or through his
own employees,provided than Such improvements an not inunded proffered forssle.If. AUG 90 2UU4
however,Ne building ar improvement I.sold amid.one year of oralikum.the Owner.
bull&'will have the burden of proving that be did not Wild or improve fur purpose of
sale.).
❑L as owner or el pec.704 ,B uclus and eonaacting with:)The
luactoon i, BUILDING, 1 I 1 ®I w
venarum the pmjem(Su.8104,Business and Polfailliall Codeli The Conurtmt4 Li- ■`YOU L /V_
cove Law does not apply m an owner of property who builds or improves thereon,and
who contracts for such Projects with a cpnMaMMW licensed pursunt to to Con metol.
License law.
❑1 am exempt under Sec. B&P C for this mason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby art=under penalty of Perjury oro Of the following cludomona:
1 ham and will maintain a Certificate of Consent to self-imam for Wmker's Compen.
tion,as provided for by Section 3700 of the IaWr Code,for the performance of the
walk far which tis pemtit is issued.
❑I have and will maintain Worker's Compensation Insurance,u required by Section
3700 of the LaWr Code,for the performance of the work for which this pmmit is issued.
y W rker'a Cempena0on prance artier and PoTBlaq/yflp�.ambar Me:
Ca er. Policy y6;
�l/ 1 A OF E%FMPTION FRO WORRERM S' "
sy g!'�H e / COMPENSATION INSURANCE
our leu)This auction need not he completed If the knoll is for one hundred dollen(S 100)
1 coolly than in the performan a of the work for which this Permit is issued,I shall not
employ any parson in any manna,so ss m how..aubject m the Worken'Campeasation
Law.of CalifOmia.Data
Applicant
NOTICE TO APPLICANI.`If,after making this Certificate of Exemption,you should
became subject to the Worker's Compensation provisions of the Lmon Cad..you mus
.,O forthwith comply with such prnvisions Or this permit shall be deemed Looked, /
Z y CONSTRUCTION LENDING AGENCY
[—i I handily affirm that ten isocomroctinn lendingagency for Me perfermmceof
Qi► to work fur which this Permit ts issued(Sec.3(l97,Civ.C.)
WM Q Lenders Name
z Lenders Address
V O I certify tat I Tuve nod this application and sou to tW aWw information is
I6 f" correct.I agree to comply with all city and county Minimal and slat,laws Relining M
O V building convection,and hereby sutodse mpresenlatives of this city to enter upon the
W aWm-mentioned property forimpecuan whichpurpoes,
may
0. (We)agree m sae,indemnify and keep harmless the City of Cupertino silliest
/
h IlablIIau,judgmenu,cera udexpenas which may In any way accrue against raid City If//
V z in consequence of the granting of this Permit.
^ APPLICANT UNDERSTANDS AND LL COMPLY WITH ALL NON-POINT Issued by; Date
SOURCE EGUL NS
�11' 5L
Re-roofs
ign un of Jou prat au
HAZAR US MATERIALS DISCLOSURE Type of Roof
Will to appliesnt or future Wilding oaupent amre Or amoo homers material
as defined by to CuPmuml Municipal Cod•,Chapter 9.12.and the Health and Safety
oJc,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yu �fo
Wilt the applicant or future building occupant use cquipm en or devices which If a roof is installed without first obtaining an inspection,I agree to remove
I humorous
air conuramans ss deMcd by to Bay Am Air Quality Management all new materials for inspection.
Diohe'? ��//''''
❑Yes E aao
1 ham read the heratdnusmocrials requirements under ChaMM6.95afte Califor-
niaflculO&SafmyCede.Safionn25505,25533 and 25534.]undcnwd tuift•Wilding
Jona not currently ham a mnm4 that it is my napomibility to nadfy the=upam of tc
requiremen hichm mel ratio a erlsfcsu a]Occu anry. ra
r ` S' nature of li ant ate
9ahaar aatadvcd amt Date All roof coverings to be Class "B"or better
Q4 , .� Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
�UPEI�TINO
Building Department
JOB ADDRESS: r PERMIT#
OWNER'S NAME: Lre PHONE #
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
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
Ov�Ner/C tractor Signature Date
A
Community Development Department
Building Division
P, City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
OUPEkTINO
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 Y4" 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: ,, X &I/
Job Site Address: ®O y� /H kiao�
Roofing Company Name: %nc9�fir� LrJ
A plicant's Date:
�./VOL/�Ky.Jv c
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN# Date:
S
Building Address:
d
Owner's Name: Phone#:
Contractor: Phone#: License#:
Contact: Phone#: Cupertino Business License#:
Ge-.z
Type of Roof Covering:
Existing: Proposed:
Built-Up Roof E3 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 Com 1 With Cu erti o's Tear Off Policy: ❑
Job Description: Q
Restdenti ❑ Cj&mercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Plannin ept.
ere are anrestric ' LJ
Cost of Pro,
Wct: Type of Construction: V Occupancy group:
Qty.
A c 1 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
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