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03070232 CITY OF CUPERTINO /y'/. 'I a BUILDING DIVISION PERMIT A CQN�i RACTORrINFORMATION SLIMING ADDRESS: - LINDY ROOFING CO INC PERMITN003070232 OWNER'S NAME: 5554 HARVARD DR PERMIT ISSUE DATE SHELLWOOD RESLTY 07/11/2003 NE: (408) 269-2025 SANITARY NO, CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MEC13 loo LICENSED CONTRACTOR'S DECLARATION U I hcrcby affirm that 1 am licensed under provisions or Chapter 9(commencing Job Description °owith Section 7¢110 of Division 3.f the Bvsinuss and Pmfcssiuns Code,and my license is ma in run tome and erred. REROOF ' �Bu� Licenac ss Lie.N u�A OW ..t}aan I Contra T--•�I ARCHITECTS DECLARATION f a< .I understand my plans¢hal l M used es puhlic records I I(, LL 9q n �j� Licensed Professional AUG 1 e3 yg OWNER-BUILDER DECLARATION LOU <i 1 hereby affirm that I am exempt form the Contractor's License Law for the �� p a following reason.(Section 707 1.5,Business and Professions Code:Any city or county 1Lp'ya( which requires a permit to construct,alter,improve,demolish,or mpair any structure Qd'/ ya, _iy prior m its issuance,also requites the applicant for such permitto file a signed statement 9x0 that he is limawd punciant to the provisions(if the Contractor'&License Law(Chapter 9 Sq. Ft. Floor Area Valuation eN (commencing wi th Section 7000)of Division 3 of the Business and Professions Core)or 36652076 . 00 A that he is esempt feemfrom and the basis for Ne alleged exemption.Any vialauon of Section 7031.5 by any applicant for a permit subjects theapplieamto a civil penalty of APN Number _ Occupancy Type rc not mathan Eva hundred dollars($500). -. P Y YP ❑1,as owner or the property,or my employees with wages as their sole compensation, will do dm work,and the structure is not intended or offered form].(Sec.7060,Business - Re�� and Professions Code:The Cormoctors License Law dos not apply m an owner of 307 - INSULATI'Oyd Inspections . property who builds,mimprowa thereon,and who doesauch work himself or Omagh his awn employees,provided that such improvements Me oat intended at offered for sala.If, 601 - ROOF TEAR OFF however,Ne building or improvement is sold within one year or completion,Ne owner. Wilder will hive the burden of proving that he did not Wild or improve for purpoac of 602 - ROOF PLYWOOD NAIL .[A 1. 603 - ROOF BATTENS 01,as owner of the pmperty,am exclusively conuuting with licensed contractors to 604 — ROOF IN-PROGRESS construct the Project(Sec.70,f4,Business and Professions Cale:)The Contractor'.Li- cense Law docs not apply to an owner of property who Wilds or improves Braman,and who contracts for such projects with a contrecmr(s)licensed pursuant to the Contractor's License L. ❑1 am exempt under See .B&PC for this mason Owner Data WORKER'S COMPENSATION DECLARATION 1 hereby of nn under penalty of perjury am of the following declarations: 1 haw and will maintain a Ccri ficate of Consent to self-insum for WorkcYs Compcn. 73011M" an,as Provided for by Section 3700 of Ne tabor Code.for Ne performance of the rk for which Nis permit is issued. 1 have and will maintain Worker's Compensation Ineuranm,as required by Section ofthe tabor Cade,for the performance of the work for which this permit is issued. Workers,Compensation lawnned carrier and Policy numberart: .vrtier. 4/va-�6!//J..N Policy No.:��✓j/a/%� Od , CE TIFIC� ATE OFFXEMPr1ON FROM WORKERS' COMPENSATION INSURANCE (obis section reed not he completed If the permit is,[crone hundred dollen($1 00) mlcss) I edify that in the performance of the work for which this Permit is issued,I shall not ' employ any person in any manner so as in become subjmt to the Work rs Compensation Laws of Cali[omia.Data Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should Wcome suhject to the Worker's CamPeanlion pmviaiom of the Labor Code,you must 7zM fowith comply wife such provisions or this permit Nall be deemed minked. CONSTRUCTION LENDING AGENCY 1 hereby affirm the them its construction Lending agency for the performanw of Z 7 the work for which this permit is issued(Sec.3097,Civ.C.) 7.1 Q lender's Name lender Address ;) 1 certify Nat I have read this application and state that the abow information is y f' cortect.l agree 10 compLY wife all city and county oncinarrom and Mute laws relating to V building construction,and hereby authorise nprexntxtiveM of this city to enter upon the 4 above-mentioned pmpmty for inspection purposes. .. (We)agree Ice save,indemnify anal keep humtest fee City of Cupertino against rA Liabilities,judgments.casts and expenses which may in any way¢tame against midCity in of the granting of ..lZ s permit. APPLICANT eUNDERSTANDS ArND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. Re-roofs HAZARDOUS Signume of ApplicaDate HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or forum Wilding Occupant store or handle hasudous materiel as leaned by the Cupenina Municipal Cade.Chapter 9.12.and tM Health and Safety ale.Sccuon 25532(¢)9 All roofs shall be inspected prior to any roofing material being installed. C3 Y. Ad No Will Ne applicant or future Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove i1 haaudnus air conmminanu as defined by the Bay Arca Air Quality Managcmcnl all new materials for inspection. strict? t� D Yes A. I hats read dm hau rdrws materials mquircmcnss under Chapmr 6.95 office Califor- niaHmlth&Safoy Cabo,Sreuotu25505.25533and25534.lunder thuiDhc Wilding does nm anenI h a A,cent Nat it.my msponsihiliry n notify 1M Occupant of Ne ,(� -- /'�� mwiremc , ;wbie mauW etPnorwjaNran CmlfcateofOccupancy. Signature of an Dale r _T `� `� All roof coverings to be Class"B" or better Owner or am gent Data Community Development Department Building Division' City of Cupertino 10300 Torre Avenue Telephone: (408)777-3228 CITY OF Fax: (408)777-3333 UPEkTINO 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: %4= Roofing Company Name: / A plicant's Signature: ` _ Date: 1-Q z \�l/�SINDLXI • Greg teel Building Official Revised 1/30/03 Printed on Recycled Paper CITY OF CUPERTINO -3 ,-.:) 7�a 3 REROOF • CUPERTINO PERMIT APPLICATION FORM APN# r 5� r �, Date: 7- Building Address: Owner's Name: Phone#: O Contractor: Phone#: License#: L ' l Contact: t Phone#: Cupertino Business License#: Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles X Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other(Specify) ❑ Other(Specify) Number of existing coverings ❑ Provide I.C.B.O.Report# XTo be Removed ❑ Provide Mfgr.Installation Specs. • I Have Read, Understand and Will Comply With Cu ertino's Tear Off Polic : 11 Job Description: Re,b.,p✓-! e — its• t OS7j d� s /�r� G Residential ommercial ❑ Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if there are anrestrictions: IJ Cost of Prect: N Type of Construction: Occupancy group: Qty. if A able 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 � aa