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CITY OF CUPERTINO7.
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BUILDING DIVISION PERMIT€Ct)1'aikAOTt'INFURIVfATT01�
BUILDING ADDRESS:
LINDY ROOFING CO INC
PERMIT No. 04080164
OWNER'S NAME:
PERMIT ISSUE DATE
ONE:
SANITARY 0 OL NO.
ARCHITECVENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
j LICENSED CONTRACTOR'S DECLARATION
Chapter 9
Job Description
1 beauty affirm that 1 am licensed under previsions of (commencing
with Scelion]OW7o(Diviaimn3of dm Buainnes esM Profcssimna Codc, end myliccnse i¢
in fu e.nd elle ...
LIee sect. a tie.
REROOF
D ConRomr '�
ARCHITECTS DEQMRmcn�Js
lunticm.imml phos.haliteusedaspuallmlpp
SPARK ARRESTER REQUIRED
LICCnbetl PNf¢SalOaal
J2 frDECLARATute
E 1 .('firm don I am exempt Law for the
1 am exempt from the Conies
on o e: An, c
ifollawingseason.(Sccdmn WI3s4Businessand Prolamines Calc:Anycity or county
masa
which regorm a pmmil ri sig any structustatement
alter impnapplicant
conchem
y^ prior .iuissuance. ac On for h Permit t e a
< amot ithoprovi ocansforauehpe Ion'lLiccn=lCOe(Cha.CrII
9
Sq. Ft. Floor Area Valuation
relpialso
)ofDisesion3
ftheBuooasniccnxlaw(C rude)
(commencing Section r the ess Professions Cole) of
basis
Out he in exempt Nertfmm and f aged coned
Net u ex5 and the the
aura for Ne alleged exemption. Any violation of
Section b fora permit objects the applicant to a civil penally of
io by any or
3 ATS V019 Wr 0 0
Occupancy e
P Y �'P
oar mare Nan R. hamree mnars (ssoo). - -
Mo. red d.11
❑ 1, as owner of the properly. m my employees with wages u than sole cmmpe ention,
will do the work, and the structure is not intended or offered for sale (Sm. 7044, Business
and Profanities Cade: The Comuacors Lianx Law dam not apply to an owner of
Required Inspections
b, imptovesihereon, and who mk immlf
, and w his
budsoriprovided ar self ar hr ugh his
own thmsuch imp an, notch nded ed for We
own employo o an, natinte
FINALE
however, to building or Improvement is old within am yem of completion, the owner
D
builder will have the burden of proving that he did not build or improve for purpose of
set,.).
❑ 1, as mune, of Ne properly, em mclusivsly emornusing with licensed...senors to
consuum the project (See. 7044, Business and Professions Code:) The Conlncor's Li.
I try `fs 2004
AUG yoo 1
AU_ G JY [ 4
came Law does not apply N an owner o(propeny who builds or improves therms, and
whoacm ru
for such projecte with a cmntoHsl licensed Pursuant die
License L
Law.
0 1 mr,NB
1 am exempt under Sec. . B & P C for mason
6 (, J I L D I N G
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby &Rhea under penally of perjury, am of the following declarations:
\
I hers and will maintain a Cardinale ale of Cement to self -insure for Worker's Camper -
sedan. as pmvided far by Section 3700 of an, labor Code, for the pa liamence of the
work for which Nis permit is issued.
❑ 1 have and will maintain Workers Compensation Insurance, m required by Section
3700 of the labor Code, for the performance of the work for which this permit is issued.
My Workers Compensation jnsurayca carrier and Policy number am:
y
artier. Polieeyy��o.:
RTIFICATE OF E)TEMPITelf FROM WORKERS'
W 41144 LQJ a I K COMPENSATION INSURANCE
Tl ssuction Bond not he completed if the permit is for one hundred dollars(S100)
or less.)
I certify Not in the performance of the work for which this pu,ran is issued, I shall not
employ any person in any moire as in become subject o the Workers' Compensation
Laws of Ci liferia. Dam
Applicant
NOTICE TO APPLICANT: if, .flet making this Cenifirm, of &..Pa.., you should
become subject to Ne Worker's Compensation previsions of the labor Crude, you must
a foMwida comply with such provisions or this permit shall he deemed revoked.
CONSTRUCTION
ON LENDING AOENCV
is a construction
aRthi Nes Nerc u rending agency I'm the performance of
1 hor
w
rac work far which this permit is issued (Sec. 309'!. Civ. C.)
sed(Se.0
Name
LealoLeaders
� Lenders Address '
I modify Nal I haw read this application and state Oat the aINYe Information is
cored 1 agree to comply with all city and county ordinances and sate laws relating to
building construetion, and hereby authorise repaxmadws of Nis city to enter open ene
ldged property for humectant uss which may
(We) agree o save. indemnify and keep hanmles, the City of Cupertino!garret
j liabilities. expenses which mayin any way cameagainst said City
of Nc Standing of this Permit.
inconexamudgmenb, Staring
A
APPLICANT
APPLICANT UND ANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date 1
SOURC GU S
Re -roofs
Type of Roof
Signemm of Applin nuumr am
HAZARDOU ATERIALS DISCLOSURE
Will da mplicans or farm. building occupant sore or handle haurdous mamdai
u defired by the Cupertino Municipal Cade. Chapter 9. 12, and the Health and Safety
Code. Secure 25532(.)?
❑�X m
Yea
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 the applicant orfuturebuilding occupant use equipment or devices which
It h Malm eS air contaminants defend by led Bay Area Air Quality Management
all new materials for inspection.
District?
Ely.No
I have mad Ne harardmms materials requirement under Chapter 6.95 ofthe Califon
nix Health&SafelyGade. Sections 25505.25533 and 25534.1 undcrwvid Oat if the building
5
does. sol currently hoc a tenor. Net it is my responsibility o notify the occupant of the
i w .�
reqummcn Shich term rmissmic, xcc cam orOcapuay.
SlgnatdreofAp ant ate
All roof coverings to be Class "B" or better
ser or authorize Ccm Data
E
JOB ADDRESS:
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
artment
PERMIT #
OWNER'S NAME: 1,;ee 4///, ;f>k I PHONE # f
GENERAL CONTRACTOR: -!/ I FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following informaHnnr
�/ 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 .
�/ Date
i
Community Development Department
Building Division
,� 1 7 City of Cupertino
10300 Torre Avenue
Telephone: (408) 777-3228
CITY OF Fax: (408) 777-3333
SUPEkTINO
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: .+7j� Vfh 12
i
Job Site Address: ler-s--y
Roofing Company Nan
t h . el /—__Zit, eo.
A plicant's Signature: ` `r Date: . /may
\�l/�DCX1
Greg teal
Building Official
Revised 1/30/03
Printed on Recycled Paper
t
CITY40
CUPERTINO
CITY OF CUPERTINO
REROOF
PERMIT APPLICATION FORM
APN #
Bldg Permit Fees
Date:
Kc T -- a ,Q
Energy
BUILDING
Building Address:
1
BUILDING
BSEISMICOM
Owner's Name:
BUILDING
Phone #:
Plan Check Fee
BUILDING
BUSLIC
Contractor:
Phone #:
License #:
Contact:
Phone #:
Cupertino Business License #:
t13
4 d
Type of Roof Covering:
Existing:
Proposed:
❑ Built -Up Roof
❑ Built -Up roof
"I'—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 #
- y To be Removed
❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑
Job Description: )? y0v.e
—/I vo 4L s C/
Residential F!mmercial
F-1'
Fire Zone: Yes ❑ No ❑
Confirmed wiing Dept. if
there are restrictio : lJ
Cost of Project:
Type of Construction: Occup gro
Annl, cakl J.
Fee m
Fee Descrintion
Fee GrouD
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
2G76�
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