03010030 a
CPPV of CUPF.RTINo
BUILDING DIVISION PERMIT CONTRACTOWINFORMATION '
BUILDING ADDRESS: LINDY ROOFING CO INC PERMIT NO.
7456 ROLLINGDELL DR 03010030
OWNER'S NAME: 5554 HARVARD DR APPLICATION SUB DATE
ESFANDIYAR ALAEE 01/07/2003
]ONE (408) 269-2025 SANITARY NO. CONTROL NO.
ARCIIITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
�pp LIC ENSEDCONTRd under
DECLARATION
hap
I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing Job Description
with section)IMMB of DivisionJof NC Business and Pn+fcxsinns Cndc,and my license is
�?N in full force and effect REROOF
ZOnoi Liccnu las Lic.x
Fz�w ome�Cmmen,r REMOVE 2 COMP. , INSTALL 50 YR. COMP. SHINGLES
mqq ARCHITECr:S DECLARATION
a2 C a J 1 understand my plans shall be used as public records
%O�U
�aG Licensed Pn,lcxsional
S
OWNER-BUILDER.exempDGCe Coma ON
or n o 1 hereby affirm that 11. exempt tram the Cssions Co License law for the
u 600 following requires
a (Section)O3L5.Business and improve.
de rob Code:Any tiny or county
Q which)us isss a permit re quires the alms improve,demolish, file
repair any statement prior m its issuance,also requires the applicant for such rermiun lilts signed s haps em
�gqSxSathat he(commesuaawdpSectamtamnofDiaooaoftheBumetnrandProll„w(Corindv Sq. Fl. Floor Area Valuation
(cat he is seemwith Section 911ad di Division r the al aged Business,exemption.
vis CMe7 of $6000 6 0 0 0
— that he u exempt therefrom end the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects to applicant to a civil penalty of APN Number Occupancy Type
non mom ten five hundred d.11...DY10)' 35931063 . 00 p Y YP
❑1.as owner of the pmpeny,or my employees wit wages as their sale compensation,
will do the work,and the structure is not intended or offered for sale(See.701 Business
and Professions Code:The Comractr's License Law does not apply to an owrcr of 305 - FRAME Required Inspections
Property who builds or improves tenon,and who does such work himsel for through his
own employees,provided that such improvements are non intended or offered for We.If. 307 — INSULATION
however,the building or improvement is sold within an year of completion.to owner
builder will have to burden of proving that he did not build or improve for purpose of 601 - ROOF TEAR OFF
azle)' 1602 - ROOF PLYWOOD NAIL
01,as owner of to pmpcny,am exclusively commning with licensed contractors to 603 - ROOF BATTENS
conswct to project(Sec.7800,Business and Pretensions Code:)The Consrutor's Ll�
cense Law docs not apply to an owner of property who builds or improves thereon,and 604 - ROOF IN-PROGRESS
who contracts for such projects with a contractor(s)licensed pursuant o the Contractor's
License Law. ®tv
❑ lam exempt under See. ,B&PC for this reazon
Owner Dam to
WORKER'S COMPENSATION DECLARATION JAN 1 .110
Ihercry
afrrm under penalty of perjury one of to following declarations: 0 9003
Ihavc andwill maintain a CcniriicamnfConsento,self-insumfnr Wnrkeh Comp n- L
aation,as provided for by Section 37Ikl of me Labor Code,for the performance of she
work for which his Permit is issued.
❑ I have and will maintain Worker's Compensation Insurance,as required by Section •'�
3700 of to Labor Code,for me performance of the work for which this permit is issued.
My Workm'a Certificate Insannal artier and Policy admMtion
Cartier:<�_ Policy Nei�//��
CIRU TE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
G'his doer an need not be completed if me permit is forane hundred dollars(S fix))
less.)
I candy that in the performance of the work for which this Permit is issued.1 shall not
employ any persed in any manner an a to become subject o the Workers'Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should
hemme subject to me Worker's Compensation previsions of the Labor Code,you must
OO forthwith comply with such provisions or this perm it shall the deemed revoked.
� .~N. CONSTRUCTION LENDING AGENCY
[—t I hereby affirm that mere is a construction lending agency l or the Performance of
6i to wo k for which mix permit is issued(Sce.30)7.Civ.C.)
UJ Q Underi Namc
z Lender's Addmss
U O 1 cenify that 1 have read tis application and sant that the above inramarioo m
lt. f-' correct.l agree to comply with all city and county uninances and sum laws relating to
DUbuilding conSnmnion,and hereby Ordnance representatives of this city m enter upon the
do ebovcmcnsioned Propeny for inspection purposes.
Pr (WC)agree to save.indemnify and keep harmless to City of Cupertino against
to liabilitiee,judgments,coses and expenses which may in any way accrue against said City
U z in consequence of me granting of this Permit.
'^ APPLICANT UNDERSTANDS AND WIL COMPLY WITH ALL NON-POINT Issued by: Date7/ ,_ J
soutic64EGUl. AS.
/,,�_ 7 iV,_ •41 C i 0 Re-roofs
Signature of Ap mracmr 4, aD�
HAZARDOU MA LS DISCLOSURE Type of Roof
Will to applicant or fuwrch' mgoceupamsom or handle ha/mdaus material
as derided by the Cupenina Mu '"0'Codc,Chapter 9.12.and me"arh end Safety
tole,Sextan 35532ar1 All roofs shall be inspected prior to an roofing material being Installed.
❑Yes ❑Nu P P Y g g •
Will the applicant or future buil rccupant use eyuipmenu+rdevices which If a roof is installed without first obtaining an inspection,I agree to remove
mitharammetrircodmmibants recdlytheBayAreaAirQualityManagemem all new materials for inspection.
District/
❑Yes No
I have read the traNnus materials mquiremencs under Chapmffi95 of the Califor-
nix Heath Asafety rood,Craft,Secsnushat it i,25533 myrespd35530.1 a,rout abeoccup Wilding
hiss net currently bora a wnank that 0 is my responsibility un nasty the od does ccupant are, of
mquircmcros ichmusnhemenp'nrh,issuan' 6fa ani0cacofQcupancy. Signature O ppllCant/ Dale
l
Ownerauthorbc Dane All roof coverings to be Class"B" or better
Building Division '
10300 Torm Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
CIO Fax: (408)777-3333
CUPEkTINO
Building Department
Subject: Reroofing policy for the City of Cupertino.
1. Prior to permit issuance,you must agree to comply with 1997 UBC Standards
and manufactures specifications on reroofing.
2. ,New roof coverings shall not be applied without firstobtaining all inspection
snd written approval from the building inspector.A final inspection and
approval shall be obtained from the building inspector when the reroofing 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) Preinspection 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 that the
proper City inspection can be performed.
111 PORTANT:
1. Flat roofs must have a minimum of V"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 of inspection.
We understand the above policy on reroofing and will comply with this policy.
Homeowners Name:
Address• /aO /
Reroofing Company Name: L
Applicants Signature:
Joe Antonucci
(Chief Building Official)
6/25/01