03100175 -CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION a
BDILDINGADDREss: LINDY ROOFING CO INC PERMIT NOO 3 10 0 17 5
i 706 NOONAN CT
OWNER'S NAME: 5554 HARVARD DR PERMa ISSUEDATE
MANOJ GOYAL 10/23/2003
'NEO (408) 269-2025 SANITARY NO. CONTROL NO.
ARCHITECrIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
X00 CONTRACTDR'S DECLARATION
I u 1 hereby affom that 1 am licensed under provisions of Chapter 9(commencing lob Description
with gCCltan 701k)l,f DivisionJo(dm Busincu and Pr'fcuinm Cmle.and license is
in full I...and r f�ctrt R OOF
s l
i = License CI Lk.N
s p F p Dau C.
ARCHITECT'S DISCLARATION 21 !;9 /6
W WV 1 understand my at
ahall ba used As public records
Licensed Professional
3 OWNER-BUILDER DECLARATION
<E 1 hcrchy from that 1 am exempt from this Cantnnah License Law or the
5
00
following..Co.,(Section 7031.5,Business and Professions Code:Any city or couny
which requires a Permit to construct,elle,improve,demolish,or repair any structure ...fin•\ 1 O 9 O O
prunes its issuanw..1m acquires the applicant rmsech permit.fleasigmd statement
as that he is licensed pursuant to the provisions nfthe Contractors LicenmLaw(Chapter 9 'Sq. Ft. FIOorKrea1 Valuation
�F$ (commencing with Section 7")of Division J aide Busioessand Profusions Code)or
on of 357190'71 . 00 �
�.. that he Is exempt therefrom and the basis for the alleged exemption.Any violati
Section 703 1.5 by any applicant fur a permit subjects to applicant to a civil penalty of ApN NImbBrJ Occupancy Type
not more than Rve hundred della,,($300). y , p y yp
I,uowncr of the propeny,mmy, employes with wages as their sale compenutlon,l' i��
will do the work,and Neawcture is not intended proffered for sale fSeaIDl4,Buiimss - 1
and Professions Code:The Comastor's License Law data not ply io in owner of )\ \` Required Inspections
property who builds or improves the.on,and who doessuch work l�mselfar through his \\U U
own employ ea,provided ton such improvements are not intended orglrared far Asia,If.
however,the building or Improvement is mid within arc yew ofcomplNon.the awtrco-I \\'a
builder will have the bund,.of proving Nu he did not build m imprd`;ar i urpme of Ve>
Calc.), �k t'J) VVV
O h a owner of the property am exclusively contracting with licensed roriysamTs to
convect the project(Sec.7014,Business and Professions Code:)The Cm cars Li-
can=law does not apply to an owner of property who Wilds or improves Watch,and
who contracts for such projects with o contrmul licensed pursuant o the Cantnnah
Licence Law.
❑I em exempt under gee. .B At P C for this...
Owner Dau
WORKER'S COMPENSATION DECLARATION'
_ 1 hereby aBirm under penalty of perjury am of the following declarations:
I have and will mainuln a Cenibeate of Consenuo sel6laum far Worke(sCompeb-
Cation,u provided for by Section 37m of the labor Coda,for Ne form
perance of are
W
ork far which this permit is issued.
I hove and will maintain Wutrri Compensation Insurance,As myuirtd by Section
]00 of dre labor Code,fur the porfonnmm of the work for which this permit is issued.
My WorkkCr�ss Cam nrk�eti�on/)�nsunnce co mer and Policy number are:
Carrier.//N.rJ' V✓/sWYs Policy No.; « _
CERTIFICATE OF EXEM MON FROM WORKERS'
COMPENSATION INSURANCE
(IT0 sectio need not M completed if the l vomit Is furore hundred dollars(SI00)
or Ices.)
I certify that in the performance of the work for which this permit is issued.I shall not
employ any person in any manner an As At become subject to the Workeri Compensation
Lawsof Califomia.Data
Applicant
NOTICE TO APPLICANT:If,after making this Ccr11Et'ale of Exemption,you should
become subject.the Worker's Compensation provisions of the labor Code,you must
O forthwith comply with such provisions or this permit shall W doomed revotrd.
Z h CONSTRUCTION LENDING AGENCY
I hcmby from drat them is a...arm lending agency far the performance of
1vthe work far which this permit A;issued IS..3M,Civ.CJ
YQ Lender's Name
5 Z Lender's Address
Q 1 Certify that I have need Nu application and sum that the above information is
y F contact.Isgme to amply with all city and county ordinances and lues laws relating to
�U building convection,and hereby aumbrrm representatives of his city.enter upon the
G ahov-ame ioned property for inspection purposes.
r (We)agree to save.indemnify And kap onmlesa the City of Cuperlim against
vy liabilities,judgments,costa and expenses which may in any way accrue against mid City
;J7 in consequence of the grunting of this permit.
w•^7. APPLICANT UNDERSTAND AND WILL CO LY WITLL NONP Issued by: Date 1.
SOURCE REGULATIONS.
Re-roofs
gignsture of Applicant/ onmcror Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Wil the applium or fate.Wilding occupant port ar har ale haCallous matelot
u de0ned by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
e. CY.zss5z(.1]�n� All roofs shall be inspected prior to an roofing material bei,,
❑res y Na p p y g g installed.
Will the applicant or futum building Occupant
use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
ho
it nrdous air cd ..ants u dcfmcd by too Bay Area Air Quality Management all new materials for inspection.
tablet?
C Ycs �I No -
Ihave SacyChunrd...255 materials 55under Chapter fihro(the Califon �\ ��
nit nelthdrSro?,ho de,Sao.Manor, hat i13.255JJ and 255314.h.a unde,,1and thmlfthe ht ofag (x•-- ( //_
data not curtendy how a¢Bent.Not B is r rcspons,hiity w nndly the occupant of Ne � V
rcuiremcnks whic st be mel 'or �mcc nfe tOca rampancy. Signature of Applcant Date
R � All roof coverings to be Class "B"or better
Owncrmau odzad agcm me g
SME
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
CUPEkTINO
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:
Job Site Address: 20 G ► I.tTU 1 I a.>^-
Roofing Company Name:
A pficanYsSignature: _ / Date: L� 3,/6Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
1
CITY OF CUPERTINO i
REROOF �/ L L
f�
CUPETiNO PERMIT APPLICATION FORM
APN# �J •S r — 15 — Q —I I Date: /6]
Building Address:
Gt�l�
Owner's Nam),),
� Phone#t n —10/v
Contractor: rPhone#: License#:�f
Contact: / Phone#: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles Asphalt Shingles
6)( Wood Shakes Wood Shakes
�j Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
N,/umber of existing coverings I L3 Provide I.C.B.O. Report#
�
7 To be Removed ❑ Provide Mfgr.Installation Specs.
• I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job D scrip 'o
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Det. if
there are any restrictions: LJ
Cost of Project: 00 Type of Construction: Occupancy group: 7
/O
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