03120018 F0CITY OF CUPERTINO . `t "BUILDING DIVISION PERMITDINGADDRESS: LINDY ROOFING CO INC PERMITNOfl3120018
R'S NAME: PERMIT ISSUE DATE
to-,
CARROL 5554 HARV 2003
.!J11 NOVEMPER DR
E: SANITARY NO. CONTROL NO..
(408) 269-2025
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
.00 LICENSED CONTRACTOR'S DECLARATION
L to C I hereby affirm 3
Thai i am licensed under provisions of Chapter 9(commencing Job Description
e<b with Secium7M)fnf0ivisionofihe Businexamid Profardhea Code,andmy limnsais
in fu mreconda cr EMOVE SHAKES -
)44 License lade Lica l
Dan
4.Z-`V_� convenor INSTALL 1/2 " PLYWOOD & C
'QQ ARCilllie as
RATION 30-YR. COMPOSITION SHINGLES IN�LLk.EO
E 2 U 1 understand my plans shall M used as public Accords 1 q
sQy Licensed Professional JAN O ( 2004
OWNER-BUILDER DECLARATION Cono ON
COO Wrathy maso .('Seco 1 sus exempt from the famine Code:Any c Law
for the
COO followwhich ire mason.(Section]1131.5,Business and improve,
inm demolish,orAny city s county
$ wnich rcyutres a permit re quires t e,aper improve,hpermittfi repair any structure
^iy
prior to incensed pursuant
ntto the pro inion of for sucContractor's
Bessle ae ave statement
2�th< thmhcieei.9 wit pSectio 7 the provisions of the License Law Code)or Sq.FL Floor Area "WHOMon
thame,is exemptheareion7(1ndth)of basis for
of the Business andon.Any
Cnde)ser
Net he is exempt themfmm and dre basis for Ne alleged exemption.Any violation of $7260
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not more than live hundred dollar,D500). P y YP
1,u owner of the property,or my employees with wages as their sole eampemout an,
will d9 the work,and the structure is not intended or offered for sale(Sec.704,Business
and Professions Code:The Contractor's License Law does not apply to an owner or Required.Inspections
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements arc not intended oroQerad for sale.If.
however,the building or improvement is sold within one year of completion,the rwne>
builder will have the burden of proving that he did not Wild or improve for purpose of
sale.). .
❑1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Centimeter's LL
cense Law docs not apply to an owner of property who builds m improves thereon,and.
who contracts for such projects with a contractor($)licensed puravanno the Contractor's
License Law.
❑I am exempt under Sec. ,B&P C for this noon
Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a Cenificpte of Consent to m1(-insure for Worker's Compen-
salver,m provided for by Section 3]00 of the Labor Code,(Or the performance of the
work for which this permit is issued
I have and will maintain Worker's Compensation Insurance,as required by Section
3700 of Ne Labor Code,for the performance of the work for which this peon it is issued.
My Worker's Compensation Insum�carrter and Policy number am:
Camer:"IERTl,/ YI2. PolicyNo.:��//� :
CERTIFICATE OF XEM MON FROM ORKW ERS'
COMPENSATION INSURANCE
Mia section need not hecnmPIctcd if the remit is for one hundred dollam(g100)
or less.)
1 certify that in the p i-Comname,of the work for which this permit is issued,1 shall not
employ any person in any manner an as to Weirom subject to the Workers'Compensation
Laws of California.Data
Applicant -
NOTICE TO APPLICANT.If,after making this Ceni ricate of Exemption,you should
become subject to the Worker's Compensation provisions of the Later Code,you must
z fonhwilh comply with such provisions or this permit shall he deemed revoked.
O� CONSTRUCTION LENDING AGENCY
�-a .. I hereby affirm Nat there is a construction lending agency(or the performance of
Y, the work for which this permit is issued(Sec.3('97,Cih,C.)
A Lender's Name
Z
Lender's Address
U C I certify that 1 have rad this application and state that the above information is
(~ correct.I agree to comply with all city and county ordinances and state laws relating to
U building construction,and hereby authorize mpmnte
rcseatives of this city to er upon the
4 ahovmms,judgmenva,property
costs
fande inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
UZinconsequencorthecrauing espenmswhich may inanyway accmc against said City
U ,^�{ A consequence of DERST N of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE.R%Fu�G-ULy}/{1/N$
Signawrc of Applicate
n- UC r ter Ea�[s/F -/�' p Re-roofs
AHMA EftT IALS DISCLOSURE Type of Roof .
Will the applicant or future building occupant store or handle harsoduas material
dc0nc❑Yes d by the CupertinON.o Municipal Code,Chapter 9.12,and the Health and Safety
.Scction25532(a)? All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or(inure building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
It Waardnus air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
isvict?
❑Yes ON.
Ih&Safave et thode,Sehms255ments 5, 553ls and 25534.1 uChap¢rti.95ofthe Califor- / . i� �
. ria Health&Safety Code,Sections 25X15.35577 and 2557d.lundcrsmnd thatif the huilding V/ S//�P1/ 1// � d
does not emmady have a tenant that it is my re mormsihil it m nodl'y the rccupent of the ��
requbementswnirnmus metp' miximrme mamofOccupancy. Signature o Applican[ �'- Date
0wmer or authoHzed Dp,u All roof coverings to be Class"B"or better
CITY OF CUPERTINO � ppp�
CUPEI�TINO REROOF d'
PERMIT APPLICATION FORM
APN# Date:
2 AP-- -
Building Address:
Owner's Name: Phone
G+ kq
Contractor: Phone#: A/O License#
Contact: / Phone#: yp Cupertino Business License#:
Type of RoofCovering:
Existing: Proposed:
❑ Built-Up Roof Built-Up roof
El Asphalt Shingles Asphalt Shingles
Wood Shakes /L❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report#
9 To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑
Job Description: _24 Z04r
Residential Commercial ❑
Fire Zone: Yes ❑ NO/4—
o Confirmed with Planning Dept. if
there are anrestrictions: LJ
Cost of Project: Type of 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
Community Development Department
T r Building Division
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
U P E(�T I N O 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 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: �� �Oy etiaP2 ��
r
Roofing Company Name:
Aplicant's Signature: Date: y
�.NOV WXN
Greg teal
Building Official
Revised 1/30/03
Printed an Recycled Paper