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03090249 CITY OF CUPERTINO xs' v +.x'*'''-•m. -; + --.*3sve BUILDING DIVISION PERMIT CONTRACTOR INFORMATION -€ auI LDING ADDRESS: LINDY ROOFING CO INC PERMITNO03090249 OWNF,R'S NAME: 5554 HARVARD DR PERMIT ISSUE DAM LUCIANO SACCANT ng 0./2003 I ONE: (408) 269-2025 SANITARY NO. CONTROL NO. ARCHITECrIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH loo LICENSED CONTRACTOR'S DECLARATION I hereby affirm that 1 am licensed under provisions of Chopper a(commencing Job Description with Section 7000).f Division 3.fO.Basin rse rofessinm ode, ylicenu' / .o r'n mmB fame ande�Bac1� 5' E OOF d s�Z LlcenuC L a . ❑W Daub� Co clor l3 u ARCHITECTS DECLARATION I O/ i w understand my plans shall he used public records U ,6 G Liccn.0 Pmfcssional g OWNER-BUILDER DECLARATION Contractors ON )<Z 1 hereby maso .(Sero that 1 1. exempt from the Camrnclnrs License Law for the pO follwhnwing."t a Per(Semit 7onstr t,alter, and improve,demolish. Any city or county S$� which myuirts•permit ns construct,alter,improve,dcmolah,m repair Any structure Patlbb incensed pursuant thovisiocanf for such Permit micensc ave stammcm I $< (comma cingwidpSectio 7to")ofDivio"nftheCanwnessanicenulsw(,Code)9 Sq.FL Floor Area Valuation (commencing with Section 7")of Division)of the Business and Pmf"sinna Cmle)ur Not he Is mempl the.from and the hada far the alleged"emption.Any violation of 36210011 . 00 Section 7031.5 by 1,applicant fon pment.objects the applicant I...ML pc.,Iiy of APN Number Occupancy Type not mo.Nan Bve hundred dollars(5500). P Y YP ❑I,As owner of the property.or my employe"with WAS""their sole compensation, will do the work and the summer is not intended or offered for sale(Sec.7044,Business — RC aired Inspections and Professions Code:The Contractors License Law does not apply to an owner of 307 - INSULATION P property who builds or improves thereon,and who does suchwmk himself or through his Own employees.provided that such improvements are notinundedmo0ered formic.It. 601 — ROOF TEAR OFF however,Ne building or improvement is sold within one year of completion,the ownen, builder will ban ft chat of proving that he did not Wild or improve far purpose of 602 — ROOF PLYWOOD NAIL Ell,' 603 - ROOF BATTENS 1,as owner of the property,,Business exclusively contracting with licensed hormion t. copal La tM1oes jot apply to an weo fprprty who ns Wilds oCmprowsomon,AnLt.d. 604 — ROOF IN-PROGRESS tt"e Law does not apply to m owner of property who Wilds or improves Neeson,and who for such projects with a contnetor(s)licensed pursuant,.the Contractors 'censen.Law. such . exempt under Sec. ,B&P C for this mason Owner Data WORKER'S COMPENSATION DECLARATION I hereby 4MM under Penalty of perjury one of the following declatathms: I ban and will maintain a Certificate of Continuo self insum for WOrkers Compere sailor,"provided for by Section 37W of the Labor Code,for Ne Performance or the w k for which Nis permit is issued. - have and will maintain Worker's Compensation Insurance,"required by Section 700 of Ne Tabor Code,for the lenarmantt a!an,work far which this Permit is issued. My Wes A Compm Adan lnsum_nm ler and Policy,number am: Carrier a L�/�4alley No.: u JI Z! CERTIFICATE OFEK. PION FROM WORKERS' COMPENSATION INSURANCE Mussection need not hecomplced"the permit is far one hundred dollars(51110) less.) I certify Nat in the performance of the work for which this Permit is Issued,I shell not employ any Person in any manner so"m Wcume Subject o the Workers'Com mrsallon Laws of California.Data Applicant NOTICE TO APPLICANT:IL at her making this Cenifcate of Exemption,you should become subject to the WOACOS Compensation previsions of the LaWr Code,you must �Q fonhwi N comply with such provisions or this Permit shall he memed mvnked. z'y CONSTRUCTION LENDING AGENCY 1 hereby affirm that Noe is A construction lending agency for the lerfurmance of Y, the work for which this Permit Is issued(Sec.3097,Civ.C.) Landes Name 2 z Lender's Address 1 cenify Nat 1 have read this application and state Net Ne shove information is y F coacm.I agree to comply with All city and county ordinances and sure laws relating to �(J Wilding convection,and hereby authorm representatives of this city to cater upon the U above-mentioned pmpeny for inspection purposes. (We)agree to"eve,indemnify and keep harmless the City of Cupenine against v) h4bilidesjudgmenu,cosu And e.N.,which rosy.any way scene again.said City )Z in con uquenc thegramin oft' r I. APPLICA ND A WILL MPLYnVITH ALL NP N-POINT Issued by: Dale SOU sign...orA,lic.mJCcm.mr /per Re-roofs HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant lir future Wilding Occupant store or handle haruduus material As defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Code.Sermon 25533(¢)9 All roofs shall be inspected prior to an roofing material beim Installed. ❑Y" C9i+�� P P Y g g Will the Applicant or future building cedupanl use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove it hasudaus air contaminants As defined by the Bay Area Air Quality Management all new materials for inspectii/ogn. tstrin? Yes ❑No 'iv17_!"-'�J/// / !/�►W6/JW-Y•_a/ Ihave acad the N14 s.quirnCha5afhCaldn nixes"IN&SafcryCod.Swam 25505,235JJad25534.1 undersboultubuilding Jets y espmihiliy m dually the'..Pnt of the CL/ 0 p3 .yui.mcn ch mus r issuance n Cerdf au of Oc u ane. Signature of Applicant Date Owner lir aulhoriasd agent V ,/,c All roof coverings to be Class"B" or better Community Development Department Building Division J+ 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: ,C.,t � d cz-c.��.er� Job Site Address: 7 9 3 3/ 1&e�� Roofing Company Name: L•/- ' - A ph ants Signature: �- C to Date:_��03 Greg eel Building Official Revised 1/30/03 Printed on Recycled Paper CITY OF CUPERTINO g q - REROOF o3 0 / CUPERTINO PERMIT APPLICATION FORM APN# I . Date: cj 3 f D 3 J Building Address:-793 3 J Owner's Name: Phone#: Contractor: / Phone 0 License 21 Contact: Phone#: Cupertino Business License#: Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles 15(_ 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, Underst nd and Will Com With Cu ertino's Tear Off Polic : Job Description: Tp — - e7o y Residential J25, Commercial ❑ Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if there are any restrictions: LJ Cost of Project: oo Type of Construction: Occupancy group: Qty. if Applicable Fee ID Fee Description Fee Group f BPERMFEE Bldg-Permit Fees BUILDING BENERGY Energy BUILDING 1 BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING z�� 3 l Zz�. 70