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CITY OF CUPERTINO""r«4�x
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BUILDING DIVISION PFRMITCONTR°AC
TOR'TNFORMATION ,
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nmLDINGADDRESS:
LINDY ROOFING CO INC
PERMITNc03110028
OWNER'S NAME:
5554 HARVARD DR
PERMIT ISSUE DATE
ROBERT CASEY
11/05/2003
NE:
(408) 269-2O2S
SANITARY NO. CONTROL NO.
ARCHITECFIENGINEER:
BUILDING PERMIT INFO
BLDGELF.LT PLUMB MECH
�� t� eh
LICENSED CONTRACTOR'S DECLARATION
lob Description
1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing
p
with Section 701gq of Division 3 or the Bda a&&and Profeaeinns Codc,and my license is
in full force one cffec�_
3
ROOF
License I Ila.«
Date Can,ncmr
ARCHTf:C SOEC RATION
I understand my plans shall he used as public rtcards
/
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from Be Contractor's License Law for the
following maven. (Section 7031.5, Business and Profession Code: Any city Of county
which requires a permit to construct, alter, improve, demolish, or repair any structure
$7500
Sq. Ft.; Floor Area
Valuation
prior In its issuance, also requires the applicant for such permit to file a signed statement
that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9
(commencing with Section 7") of Division 3 of the Business and Professions Code) ser
32619107.00
that he Is exempt therefrom and the basis for the alleged cmmplion. Any violation of
APN Number
Occupancy Type
Section 7031.5 by any epiloam fan permit subjects the applicant in a civil penally of
not more Nan five hundred dollars ($500).
❑ 1, ss owner or the property, or my employees with wages as; their sole compensation,
will do the work. and Ne swcWas is not intended or offered tarsal. (Sec. 7044, Business
Required Inspections
and Professions code: The Cnnuacmr'a License Law docs not apply to an owner of
prapeny who builds or improves Iheraan, and who docs such work himself or through his
own employees, pmvidcd that such improvements art not intended or offered for role. IL
however, the building or improvement is sold within one year of completion, Ne owner.
builder will have the burden or proving Nat he did net build or improv for purpose of
sale.).
[] 1, as owner of the property, am exclusively contracting with licensed contractors to
convect the project (Sec. 7044, Business and Professions Code:) The Contscmr's Li.
erase law does not apply to an owner of progeny who builds or improves thamon. and
who contracts for such projects wit a contraclorfa) licensed pursuant to the Contractor's
License law. -
0 1 am exempt under Sec. . B h P C for this reason
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby salon, mother penally of perjury one of the following declarations:
1 have and will maintain a Certificate or Consent m self -insure for Worker's Camped-
'
cation, as provided rad, by Section 3700 or Be laborrfor
Code, for Ne pemance or the
work for which Nis permit is issued.
12 1 have and will maintain Worker's Compensation Insurance, as required by Section
3700 of the Lobar Code, for the performance of the work for which this permit is Issued.
My Worked Cnmpenmtiq�¢�1 nr�c eartiennd Policy nu{�g�e'r
1a.,m�g:_(/..l/',
Cartier A I N J f Q Policy Na.:—CV
CERTIFICATE OF EXEMPTION FROM 0 KERS'
R '
COMPENSATION INSURANCE
(This section need not hcemancted irthe permit la forst hundred dollars ($100)
or less.)
1 certify thio in the pe,r,,..n,. of the work for which this permit is issued, l shell not
employ any adian in any manner an as W become subject to the Workeri Compemallon
Laws of California. Dale
Applicant
NOTICE TO APPLICANT: If. after making this com ncale of E.em prion, you should,
become subject to the Worker's Compensation provisions of the labor Code, you must
forthwith comply with such provisions or this permit &hall he deemed stoked.
CONSTRUCTION LENDING AGENCY
1 hereby aMo. that Hera is. canewnWn lending all for the aformad. or
the work for which this permit is issued (See. 3(797. Civ. C.)
Lender's Name
Lender's Address
1 minify that 1 have sad this application and sure that the above inrmmatiun is
ConecL 1 agree to comply with all city and county ordinances and stale laws relating to
building construction, and herby authome mpremnUlires or this city to enter upon the
,
above-mentioned property for inspection purposes
(We) ag. I. save, indemnify and keep harmless the City of Cupenum against
liabilities. judgments, costs and expenses which may in any way senor against said City
in consequence of the granting of this permit,
APPLICANT UNDERSTANDS AND WILL OMPLY WITH ALL NON -POINT
Issued by: Date
SOU E?fl1L
Re -roofs
Type of Roof ^--�
Signamreor p Bea 0 Dam
NAZARDO MATERIALS DISCLOSURE
Will the applicant or fund ebullding Occupant score or handle harard0ua material
( ""ei
as defined by the Cupertino Municipal Code. Chapter 9.13, and the Health and Safety
de, Section 25532(a)7
All roofs shall be inspected to any roofing material being installed.
❑Yes oNu
prior
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building Occupant use equipment or devices, which
It havardou. air contaminants as defined by the Bay Area Air Quality Management
all new materials for inspection.
strict'
CYes - ONO
Id..
IhawmctyCed a.Nuus ar
quiudc 5u.l
Caldron
505.25l.
unhaptadh wifthe
Health&SafnyCak.Sadom 25NI5.255JJ and 2553d.l undcmund Nairthc building
not currently haw a mmol that it a my desponsibillty to notify the occupant of the
aismdiswhich moat Be mel prioton issuance orae ruficataor Occopmey.
Signature of Applicaff L Date
All roof coverings to be Class "B" or better
Owner
agent Dow
�CITY OF
UPE TINO
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408) 777-3228
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. I
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: C A S I
Job Site Address: 2 / t?
Roofing Company Name:
A plicanI Signature:
Greg teal
Building Official
Revised 1/30/03
Printed an Recycled Paper
Date:–ZZ— J 3
aCITY0
CUPEkTINO
CITY OF CUPERTINO
REROOF
PERMIT APPLICATION FORM
APN #
Bldg Pemtit Fees
Date:
Building Address:
Energy
BUILDING
BSEISMICRE
Owner's Name:
BUILDING
Phone #:
Seismic Commercial
CAS,0:_(t1
TZ SOT
Contractor: /
Phone #: Dd
License #:
Business License
2G Yo
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Contact:
#:
Cupertino Business License #:
1,1121,112Phone
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Type of Roof Covering:
Existing:
Proposed:
❑ Built -Up Roof
❑ 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 Comply With Cu�pertino's Tear Off Policy:
Job Descriptiotir'
CaIV) �
r
Residential
Commercial ❑
Fire Zone: Yes ❑ No [J]/ Confirmed with Planning Dept. if
there are an restrictions: LJ
Cost of Project:
D
Type of Construction: Occupancy group:
Qty. if
Applicable i Fee ID
Fee Deacrintinn
Fee. (:rnnn
BPERMFEE
Bldg Pemtit 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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