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04060148CITY OF CUPERTINO cm rrRa. Tc �i,ANFo iMn. �N't BUILmncDmsloN PERMIT v , ,,,,�-,t•-,.�.,.: BUILDING ADDRESS: LINDY ROOFING CO INC PERMIT "04060148 22535 SALEM AV OWNER'S NAME: PERMIT ISSUE DATE - CARL LITAK 5554 HARVARD SANITARY ND. CONTROL NO. NE: (408)269-2025 ARCHITECT/ENGINEER: - BUILDING PERMIT INFO BLDGELECT PLUMB MECH I� 0 0 0 LICENSED CONTRACTOR'S DECLARATION Job Descriptio P 1 herchy air". that 1 am licensed under provisions nr Chapter 9 (commencing Business and fcssiov Code,andmylieenseis �� /j+�i�� wiWS ecdo 7000)ofDiviaion3ofthe in fullfo d cffec ✓ G Clfi Dtawn� Can.Ntor r J�=-'L7F-6CTS DECLARAT// N it--r'1U JUN 2�/ 2004 1 understood my plans shall be, used as .211115 nob IS%�r BUILDING GILDING Licensed Proposal ... I ON DECLARATION 1 OWNER -BUILDER Contr the 1 hereby .(Tien. on I am exempt from the Contractors License Law 1SIYY{9 co i following rental. IIBeso Business and Code: Any city or county renta demob repair eny improve, demolish, which myuires a permit re ennswcL in. emits AAlur.pplicant statement t fi requires the applicant for amhpermiuoicnse signed statement poor at in. issuance, for such Law Sq. Ft. Floor Area Valuation ensedpalso (Cosh, lacing sed pSection7 h) the License (ChapterCub) of Divionam We exe m t Profeson. An ions Code) of s that(Cobe exempt with erafro n and m basis n 3for of Ne alleged 3 that W 6 sumps Nerc(rom and the buts for dm ellcgcd eumpdon. Any violation of 0 Occupancy Type Section 7031.5 by any appik,m for a permit Nbjecu the applimnt to a civil Penalty ofT7ero not more Nan fin hundred dollen ($50(11 ❑ I,u own" or the preparty, Or my employees with wageanthee solo compensation, Required Inspections will do the Work. and NesWclon, is nal intended of offered fofsale(Sec. 7044, Business and PmGuions Cade: The Contractor's License Law does not apply to an owner of 9 P properly who buildsmimproves Narcan, and whodoessuchw"khimself ardtrough his own employees, provided Notsuch improvements Are, notimnded oro@red forule. If. . however, %e building or Improvement is sold within one year of complcdon. the owoer- builder will have the burden of proving that W did not Wild or improve for purpose of sac.). ❑ 1, as owner of the property, am exclusively contracting with licensed contractors W Construct the pmjml (Sec. 7044, Business and prof wins Cade:) The Convectors Li. cave Law Core not apply to an owner of prnpeny who builds or improms themon. and, who contracts for such projects with a contndor(s) licensed pursuant to the Contractor's License Law. ❑ I sec exempt under See ,B&P C far Nis resson Owner Data WORKER'S COMPENSATION DECLARATION I Wreby affmn under penalty of perjury one of the following declrtations: 1 have and will maintain aCemfiesto of Consent to self-Insma far Worker's Compton. ion, as provided for by Section 3700 of We labor Code, for the performance of We rk for which this Permit is issued. I have and will maintain Worker's Compensation Insurance, as m Bred by Section IC337'�'00 of We Labor Code. for the performance of We work for which this permit is issued. yWorker's atop nsuian Inaunnfe Cartier and Poliry n mbar are: rrier. PoIIryNo.:/vire/ FICATEOFE%EMPQONPROMWORKERS' COMPENSAT INSURANCE (This aae ion need not W completed dem permit is froom, hundred dollen ($100) .'lass.) 1 Cannily that in the performance of to wad for which this Permit is issued, I shall not - employ any proton in any mamer N as to become subject o the Work"a'' Compevatlon - Laws of California, Data Applicant NOTICE TO APPLICANT: If. after making this Ccrtificale or Exemption, you should become subject to We Worker's Compensation provisions of We Labor Code, you must forthwith comply with such provisions or this permit shall W deemed ranked. CONSTRUCTION LENDING AGENCY 1 hereby Net there is lending agency f" We perfarmucc of s ed (Sao 3 work for which Nis permit b issued (Sec. J09'1, Civ. C.) w ichAffirmWin Lenders Name Le Lender's Address above information minting W I certify that 1 have recd this application and sate that Wonand l agree to comply with all city and county ordinances and atom laws minting build0. e building construction, and hereby authon p representatives of this City to enter Upon dw purposes. properly, for inspectionindemnify man-mentioned(We) U (Wc) agree to cost, indemnify and kith harmless the City of against agree against ts raj expenses which may in my way accrw agalnstmid City /&67/ in consequence of graving A consequence or Ne granting Of this permit. � APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Dale SOU7REGULATIO Re -roofs Type of Roof '! ` /.4 at Q1�—'� 4` /,� ignat re of Ap ice onuac r'� Dale AZAR US MATERIALS DISCLOSURE Will to applicant ser future building Occupant store or handle hsrardous material as defined by the Cupertino Municipal Cade. Chapter 9. 12. and the Health and Safety cods. Section 15531(.)7 All roofs shall be inspected prior to any roofing material being installed. ❑ Ym a If a roof is installed without first obtaining an inspection, I agree to remove Will the Applicant or future Wining Occupant use equipment or devices whine mit haxamous air contaminants As defined by We Bay Area Air Quality Management all new materials for inspection. I,iNict? �No C] Yes I have mad the hvamous materials mquimments under Chapter 6.95 of the Califon. ni.Hmlth&SafetyCode, Sections 25505.15533 and25534. 1 undemmnd thetifthe building !�/ docs twI cmandy hem a LLmant, that it is my anaponsibiliLY to notilY dm mcupent of the / b ( (y X / f G myuirtmen thich mu the priorwiu cc o[a Certificate of Occupancy. r Signature pplican Date y�� All roof coverings to be Class "Bo or better Cook or mmoria. gcn Date CITY OF #MkTINO 41 Buil Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Department JOB ADDRESS:. PERMIT # co OWNER'S NAME:PHONE # GENERAL CONTRACTOR: /. �,.... / FAX # I am not using any subcontractors: Signature Date Please check avvlicable subcontractors and complete the following infortnaf-inn- O�er/C tractor Signature Date 60 BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile O�er/C tractor Signature Date CITY OFI UPEkTINO 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 there -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 mispection 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: (e 7"�K ,,/ � z. Job Site Address: G ;C�3S t i>°!✓1 4v-8 Roofing Company Name: � �� /✓ ��gf j e r A plicanfs Signature: / Date:--�� •' Greg teel Building Official Revised 1/30/03 Printed on Recycled Paper 4- CITY OF CUPERTINO 2/ REROOF 0 / C) � 0� Y(, PERMIT APPLICATION FORM Z�_/ I APN #3 , ^ Z `Z 7. Bldg Permit Fees Date: Building Address: Energy BUILDING BSEISMICRE Owner's Name: / BUILDING Phone #- yd Seismic Commercial BUILDING BPLANCHK Contractor. L /) L Phone #: D License #:J e, F/ (i , 9 Contact: V �lnc Phone #: ya�-, Cupertino Business License #: t 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 # IK To be Removed ❑ Provide Mfgr. Installation Specs. I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑ 2t. Job Description:42 Residential Commercial ❑ Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if there are anrestrictions: LJ Cost of Project: Type of Construction: Occupancy group: 7. ty, i nMic ble Fee Til c__ �__-. 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