01110005L.
CITY °
CONTRACTOR INFORMATION:
DIVISION
PERMIT
BUILDING ADDRESS:
PERMIT NO.
22392 SALEM AV
LINDY ROOFING CO INC
01110005
OWNER'S NAME:
JAY BACON
5554 HARVARD DR
APPLICATIONS B DATE
11/01/2001
PHONE:
(408)269-2025
SANITARY NO. CONTROL NO.
ARCHITECmENGINEER;UILDING
PERMIT INFO
.DG ELECT' PLUMB MF,CH
C O U -t
LICENSED CONTRACTOR'S DECLARATION
Job Descri IOn
1 hereby affirm Thal 1 am licensed under provisions of Chapter 9Iroencome ng
REROOF.
wish Section 7000) of Division 3 of be Buslnelliod Professions Code. and my license
ufla.=nd eBY; Lie.g
T/0 SHAKES , INSTALL OSIS & LITE W/TILE.
,ren Comreno
ARCHITECT'S DECLARATIO
1 and ... trnd my p1mv shall be used e.s polite records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor s License Law for the
Ibllowmg reason. (Section 7031.5. Business and Professions Coda Any cin, or county
._
which requires a permit m construct, alar, improve, demolish, or repair any swdurc
_ alsorequthe thVvisioso for such m:mtiuoicense
_.. _"_ ____ -
Chtemem-
aw(Chapter
that h9 ii li¢ns<E DursuSrit td the provisions of the Conlrazmts License Law (Chamcr9
that hq.licensed
Section)(IW)of Division 3 the Business Professions Code)
5 F[, FIOOI•A eajY, a:• - Valuation
y 9
1, (,J• V �'Ixi l �, !.All l3
(commencing with of and
or that he is exempt therefrom and the basis for the o11Egell dlmpdon. Any violation
S, s'. L -'l f i.Il't .
of Section 7031.5 by any applicant for a Wmm subjeee the applicant to a civil Penalty
,of not mart them five hundred dollars ($500)..., ..
APN Number -
L ;. Occupancy Type
01, as owner of the pmpeny, or my employees with wages as their sole compensation,
-
30S FRAME
307 - INSULATI hired Inspections
'wlll do the'work and -the swmure is not intended or offered for sale (see Tau.
Business eM Professions Cada, The Comma s License Law does not apply to an
owner of mopeny Who builds or impmyee thereon, and who does such work himself
601 - ROOF TEAR OFF
nr thmugh his own employees. provided that such improvements are not intended or _
--.Rend f . k If however,lti l ld g u imp a tis: Id Ih }ear of
, - __- _ , _ ..-...... - .. _._ _-_ --_. _ .
_-7'6
- 602 = ROOF "PLYWOOD NAIL 3. t' .... ,
completion,theawner-bnlderwillhavetheburdenofWavingthathedidnotWildo,
improve for purpose of sale.).
603 - ROOF BATTENS
-- - — ------ --
Q 1, as owner of the property, am exclusively contracting with licensed contractors to
--- -- - ---------'- __ - -
6 Q 4 - R - - I .
fr'r
consumer the project (Sec. 7044, Business and Profcssioms Code:) The Contraaar's
p.„ t ,n
License Law does non apply to an owner of pmpeny who builds or improves Thereon,
- - -
_.and who contracts.for suchprojects with a.conlmemans) liceneaTpuramnt.lo.the._-
CnrectnlsLicemseLaw., .,.
O lam c.c."under Sec. " ,B&PCfv thisrcF1
/1.(�®
'Sam Ci
�
Own '.Date,...
WORKER'S COMPENSATION DECLARATION
AY 2 8 2002
I hereby affirm under Penalty of perjury oncod the following declarations:
O I have and will mainl9in a Ccniftcam of Consent to sdLinsure for Worker's
Compensation, as,movided foo by Section 3700 of the labor Cade, for the
UILDInIC�
performance of the work for whic11 h this permit is issued..
❑ 1 haJ d will onamo in Worker's Compensation Insurance, as required by Section
37 f the Labor Code. for the performance of rhe woek'for which this permit is
' ed y W ke's Compensau Insurance canner and Policy number arc
- - -- ••
VV
mm t -q '/ S -i
`r s ', F :.toMPTI
f..5 �s t. q'+i.-
NFR9�y-/
4 , CCRTIFICATION OF EXEMPTION FRAM WORKERS S
SSI i Kl..
COMPENSATION INSURANCE .. vim."" •_�.-. -
- -
�•'
"" l(This section need not be completed if the permit is for one hundred dollars
\ - .. _ 't ' lirC' i%til, r
ISIO )9r
I iumif that in the perfomun¢ of the work for x hich this pemnl is issued; I
\ I it -I .. `: itif `
slight 61 employ any person in any manner, so'ax m bedome svbjed ro the Workers'
.,,
Cgmpcorate. LeCif eDro -
wrap,....
Appl an, ......
._. ... _ ..._. .-..__. ....... .. .. .. _ _ ._ ... .. _. - ... _..-.____.
NOTICE TO APPLICANT ICafter making lbu cerfftcale of Ex option. you should
"l
become subject m the or ter Com asthma provisions of the labor Code, you must
ked.
fanhwith rods 1 with such s or is emu she ante revoked.
D'Y-
-. '"..
CONSTRUCTION LENDING AGENCY
" r'''Ihe¢tiy aFrin that there' is a construction lending agency'for me performance
ufine won, for which this'permit is issued Sed3W7, Civ. CJ .....,..
.•_..
...-. _ .. ______.--_-__ _. _. _.____ _
Lender's Name.: -`-`• ._'-_••`.'',r.:...__ .....:....... __
_- ___ -.-._ _-.-._.—_.._-.__
Under's Address,;"
I certify that I have rtW this application and state. does Ne above information is
correct: 1 agree on, comply with all, city and county ordinances v,d state laws relating
- - - - - -- --- ---- - -- - -- ' '
to building cons oneLmn, and hereby authorise repfesenmtives of this city to enter upon
for mspecuon WhWises. s
the ebo(Weleagree "unt
-
.._..,property
- of Cupenmo ego nst-
to savC, Indemmily and keep harmless Ne City
_ -
imb'1 t es pdgrommi. curls and eapenus h ch may n any ay accrue against sand
cry -in consequence of the'grin ding of this pe 1
A CANT TNDEk )NDSANDWIL OS YN'1'fHAU-NONPOINT°
•
Issued by: Date / (�
y'
.
URGE' ,IfLATI dS' —e
. . - •'.- t .. , Dam...:".
Signature tADDlaan arm
' Re-COOfs..
LS DISCLOSURE
HAZARDOUS ATERfA-"
:.`a WII lhcapplicnot or future Wilding occupant some or handle 'hoard materiel
.. Type.of.Roof T
asdfned by the C.pootin. Municipal CodeChapter 9.12.ad the Health oil5fety
25532(s)s:e
tt.__
j. Fgr 3;t�'('t' l� ° s i� .I •• ",
f't I'l. hi 9L,
Cddc,Seeuon P.. •' .n7 Lh"'^.qf', 3,
._OYa""' ,.,.:❑Noll `.r. .._ �.: 1,_.,
e_•, t10. .'. .a ♦.,, .':
All roofs shall be inspected to. any- roofing.materialbeing. installed.__._
-
Will the applicant or'iuNre a Wilding occupant use equipment or devices which
.-. -prior,
If a roof is iristalled'wi[hou[ first obtaining an inspection, I'agree.to'iemove
mit hanusbervis air coulturnicand, as defined byth Bay AmaAir Quality M agement
Dismal - .,
new materials for inspection,_ Applicant understands and will comply with
- ❑Yo - 't 'ONo ,�-
1.
_all
-allnon-point source regulations.
'l 1 have'read the'M1azardous'mmcrials requ remenis under Clothe, 695 of the
255 a
i7Nulth&Safety Code, Sections 25505;25533 and 23534:.r undersand met!a Ha
does-orteurrcndyhavean,
responsibilityasandymet
thin5 is
of the requirements which must bem I prior to ismance'd a Ci ificate of
n`y'' 'Ll
f
Signature of Applicant Date
Its -
All roof coverings to be Class r`B" or better
or aKA.
nge Date
er ,.
... ,.
OFFICE-
Building Division
10300 Torre Avenue
"/ Cupertino, CA 95014-3255
��'.., 408 hone: Tele 777-3228
P ( )
CITY OF 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 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 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.
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 of inspection.
We understand the above policy on reroofing and will comply with this policy.
Homeowners Name: 4-1
Address: <�ele �,,,
Reroofing Company Name: � r—l;,e
Applicants Signature: Date: //— , e -4 -
Joe Antonucci
(Chief Building Official)
6/25/01