04110165 CITY OF CUPERTINO � hh" a�vk ^� '�j'�s,�,k '
BUILDING DIVISION PERMIT "ic61 ', 4TOR 11 FIAMA'�,40N
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ADDRESS: _ LINDY ROOFING CO INC PERMIT NO 04110165
n7)7 SrRNTr RT VT�
OWNER'S NAME: PERMIT ISSUE DATE
TRIATSQ'I
ONE: SANITARY NO. CONTROL N0.
(408) 269-2025
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
y O o LICENSED CONTRACTOR'S DECLARATION Job Description
1 berc fOrrn Nn'r
am IionnsW u provisions of Cbapmr 9(comsncndng P
with )o(Diviaion3of NO Bu' and Profcolons Code,end myliccnse is
inti a dcrc —�/ REROOF W/COMP.
Class — c.X
Dale Contrxmr
'fi d ler nJ pl ARC" useJo ift di/
r
LL d� I!"rmasedlimitsal
y5 OWNER-BUI ER DECLARATION �. (,�/` /j`
<f I hereby M.that I am exempt from Na Contractors License Law for the iI
i m O following mason.(Section 7031.5,Business and Professions Cade:Any city or cuddly
ndt - V
which requires s peto Construct,After,improv,demolish,Or Aped,my structure
F Z y poor to its issuance,also requires the applicant forsuch permitto file a signed stslamenl
£ � that he is licensed pursuant to the pmvisionaof the Contlacmr'sLicense lsw(Chapter 9 Sq.Ft. Floor Area Valuation
,+ (commencing with section 7")of Division 3 of me Business and professions Code)or
$
that he u exempt thcmfrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects be applicant to a civil penally of 3_9TN_ "t:r0 0 OccupancyT
Act mart than I,.hundred dollars(SSW).wilyPe
❑Lu e.,k. .d proherty,nmycmpleycu withwaguothel(Sm.eompensNon;
and dONewurk„Code: mnmAtsnU tended License aw ed does forsake apply math,B nineaa Required Inspections
and Profeulobu Code:The CO thorn e,and
Law doh not apply to an owner is 9 P
property,who buil
ds or impmvuch fapo andwha does each woh himself oor ffered
his
awn a however,
beeh,p building
or I that such improwmum vent Intended or completion,
foe mnen. L
huwews Ne hulloingorimprovementissold wdiinone Wild
of completion,Ne owe of
builder will have the burden of proving that he did not build or improve for purpose of
sated.
❑1,a owner of the propcny,am exclusively contracting with licensed Contractors to
construct be project(Sec.70".Business and Profcoinns Code:)The COntraemes Li.
cense law dons not apply b m owner or property who build&or improv thereon,and
who contracts for such orryma with a coomactor(s)IICCRYd pursuant to be Contrxtoes
License law.
❑I am exempt under Sec ,B k P C for this moon
, Owner Dale
WORKER'S COMPENSATIONDECLARATION -'
I hereby afflmt under penally of perjury,one of the following dwitraOOns:141 -
1 haw and will maintain aCCruficale Of Consent 0 xlf-insule for Worker'sCompen.
otion,as provided for by Section 3]W of the Ube,Code,for be perfom.non of the .
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,As required by Section
37W of NC Labor Code,for the performance ofthe Afor who, thispemtitislaued.
My W de s nmpe..ad..In nna ca r 'cy num /
1 L t!
Cartier. / Poliq No.:
CE IF CATEOFEXEMPfI NFRO ORKERS'
COMPENSATION U CE ,
(This section need nos be completed if the perraft is fmonhundreddolhn(SIM)
nr LaaJ ,
I Coolly Not in the performance of the work for which this permit Is issued,l shall not
employ any person in any manner an o to became subject to the Workers'Compenutlon
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,after making this Ccndicatc of Exemption,you should
become subject to the Worker's Compensation previsions Of the Labor Code,you must
.J z roMwiN comply with such proviaions or this permit shall be deemed ranked.
zi O CONSTRUCTION LENDING AGENCY
I hereby alNm that them is a consWcGon lending agency for the performance of
the work for which this permit is issued(Sec.3097,Cih,C.)
WMA Lender's Nam.
rU z Lender's Address _ V
O Q I certify that 1 have mad this application and stem that the above insonation is
V.H building I agree to comply with all city and county nNinmces this sum laws relating e -
O(•J abonngcmdoned construction,And hereby anthon purposes. of this city to coke upon the
W above-(WA)agree
properly for impactionindemnity
Apurposes.
Lbw, (We)agree to ova,indemnify and kith harmless w City accrue
Cupertino d City
,`.., rap habilM1lG,jddgmna.Wats no expenses Which may iaany way acCNe thgalaatsaidCity
fJ7 int nsegnnce of the Banling of Nis Permit.
�i AI LICANT UNDERSTANDS AND WILL COMP Y WITH ALL NON-POINT Issued by: Date
SO CERE U 6717 r
Re-roofs
Signat of Applica C anus, Doe
H DOUSM TERIALSDISCLOSURE Type OF ROOF
Will Ne applicant or future building Occupant store or r chuWousmaterial
o defined by the Cupertino Municipal Code,Chapter 9.13,end the Health and Safety
otic.Oudn as33(a)? All roofs shall be inspected prior to any roofing material being installed.
Ycs Nu
Will the applicant or fu um building acupanl sex cyuipmem Or JcviCos which If a roof is installed without first obtaining an inspection,I agree to remove
Is harardods air contaminants o defined by NC Bay Area Air Quality Management all new materials for inspection.
District?
❑Ycs eN.
Iham mad dA hmardna.255052553 t�'mments under Chepmr6.95 ofdA Califor- -
nia Health&SafctyCo .S.ctins35505,25533.d253a.lundcraund thuiflhe Wilding
docs not curtcnsly haw a tenant,Nat is u my sponsiM1m y wyotll'y Ne occopml of ah
ointments' Alberta ' rani ceofacc 'RC of Occupmry.
Signature Applic t f Date
Owner m am ariscd agent g
All roof coverings to be Class B or better
Dam
Community Development
10300 Torre Avenue
1 9 F Cupertino CA 95014
Telephone(408) 777-3228
CITY 0f Fax(408)777-3333
�UPEI�TINO
Building Department
JOB ADDRES� o O / / PE
OWNER'S N PHONE # O — r ' C'
GENERAL CONT FAX#
I am not using any subcontrac s: _
i ature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR 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
t / ,
Own er/C a r ature ate
Building Division
10300 Torre Avenue
Cupertino,CA 95014-3255
` Telephone: (408)777-3228
OCIO F= (408)777-3333
CUPEkjIN®
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
S. 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 musthave 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: /dntl e
Reroofing Company Name:
Applicants Signature: Date: /�34= d 1
Joe Antonucci
(Chief Building Official)
6/29101
CITY OF CUPERTINO
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN # Date:
Building Address: ,
Owner's Name: t Phone#:
Contractor: Phone#: 0M' License#:
Contact: hone#: Cupertino Business License#:
L /ti, < e
Type ofRoof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ,Asphalt Shingles
X 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 ertino's Tear Off Policy: ❑ ,
Job Description: i2eH,,P%
r
Residential X e5 Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are an restrictions:
Cost of Proiec ; Type of Construction: Occupancy group:
lircabl Fee ID Fee Description Fee Group
`! 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
278 77
3784