05080276 CITY OF CUPERTINO �
BUILDING DIVISION PERMIT R0NTAXGA �T'0j I1V'P'•OO�RMATION,
BUI LDING ADDRESS: LINDY ROOFING CO INC PERMIT NO.05080276
06c;9 ql4P.T,T,v ng
OW NER'S NAME: PERMIT ISSUE DAM
S UARCIA LARRY G AND Y LAN A5554 HARVARD 08/31/2005
ONE: SANITARY NO. CONTROL NO.
(408) 286-9990
ARCHITECf9ENGiNEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
400 LICENSED CONTRACTOR'S DECLARATION JobDescri tion
rj+� 1 hereby&IBM that 1 orn Ilcensed under Provisions or Chapter 9(commencing p
with Section 7000)ofDiMsion Sof the Business and Professions Code.and my license u
inmluarteanm,rc _ 2 REROOF-T/O SHAKE, ISTALL PLYWOOD, FELT, COMP
iN Zpp Lkenw Closs Lk.N
'J Date Canlrator
IIECTS DECLARATION
I undersand mY phos.lull W used u public rtrnNo
;yU
cad Licensed Professional
OWNER-BUILDER DECLARATION
.�a S 1 Wrthy affirm the 11. exempt from tiro Conusnor'e License Law for on
i O o following reason.(Saban 7f13 Ln Business and Professions Cade:Any oily or county
$ which myus u a permit re enwrtre,alte,'m fmw.demolish.ri e a sig any structure $11000
thatpriorWiu'ssmncenoent to to lW applicant for such oris rilcense signed Ntemcnt
< (co mencin wi Potationtothe provisions oflWComanss MProfLaw(Clodmr9 Sq.Ft.Floor Area Valuation
thus M is
(commencing pt sanctions
s and)M Division,far of des
Busialleged
exemption.
on.Any ns Code)of
Wt W b exempt IWrtfrom and the bub for the alleged eamption.Any violation of
Section 7031.3 any applicant far a permit subjects Ne applicant, •civil Penalty of
not more Nan live
hundrt0 dollvs(5510). C Occupancy Type
❑I,as owner of she property,or my employees wish wiles as their wk compensation,
will do Ne worir,and the macre u on,intended or offered for We(Sec.70M,Bus'trcu
and Profesions Code:The ConlssctoM1 Liaaua Law muses nut apply to an owner of Required Inspections
property who builds orimproves shoreon,and who die sah work Iemself ter through his
Own employees,provided that such improvements ate nmimendod or olfsrod for We.If. _
however,the building or improvement is sold within one year of completion,the owner.
Wilder will have the burden of proving that W did Out build or Improve for purpose of r�
talc.).u Ih
❑1, ower of the property,am exclusively contracting with licensed comactoa to u Q�I Iptry�7qtA j? ,,,;,y
construct the pmject(Sec.7044,Bmines and PrnfeWom Cade:)The Contnnoh U.
cense Law doe not apply to an owner or prepeny who builds or impruw Norton,and,
who contracts for soon project with a contactor(+)licensed peoent in Me Contractor's / +loo5
List.Low. CrP L
C l am tempt motor See .B As P C fm this reason
Owns Dote Q R°C n';�j ' y
WORKERS COMPENSATION DECLARATION t�l��`BtQ7 �'e• t� nf
I hereby affirm unroof penalty of perjury one of Ne following declarations:
'low
and will maintains Ce nemof Cohan(toel(-ImamfarWoftesCompen-
sa on,As provided for by Section 3700 of Ne Labor Code,for Ne performance of the
work for which Nis permit is Island.
❑1 have and will mainain Warker's Compensation Insurance,u requited by Section
37W of Ne Labor Cade,for the performance of the work for which this permit is issued.
My Worker's CamPenation ins esrrw end Policy n'�"'her sere:
Career. Set LX
' "Po ry Be,orc? �S
CERTIFlGOFE%EMPIONFROMWORKERS'
CO PENSATION INSURANCE
(This sttniap need not he completed if the permit is faros,hundred dollars($100)
or less.)
I certify Not in Me performance of Ne work for which this Permit is issued.I Mall not
employ any person in any manner an as to become subject to the Work,n'ComPomation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,after making this Cenifiam of Exemption,you should
become abject to Ne Worker's Compensation provisions of Ne Labor Cone.you mut
,JO foMwius amply wish such provisions or this permit mail W doemed rewked.
z ti CONSTRUCTION LENDING AGENCY -
F 1humby.M.Nat Nem is a comraminn lend'ngapenvy,for the performance of
LL'> the work far which Nie Permit is issued(Sec.3097,Civ.C.)
0 Leads,
er's Nurse ,
P z Lender's Add,*
U Q 1 certify that 1 have red Ws application end sum shat the above information is
Ig,F correct.I agree to comply with all city and county ordinances and sum laws relating to
O V building construction.and hereby salivation representatives ofthis city toenter upon done
Dd above-mentiaxd property for inspection purpnses.
I1. (We)agree to are,indemnify and keep harmless the City of Cupertino against
pL Iiabilltisyjudgmenu.costs and eapemu which may in anyway amore against Wit City
V z inconsequence of she granting of this Permit.
ANT UNDERSTANDS AND WILL COMPLY WITH L N N-POINT Issued by Date f V
OATIONg.
A URC3l
`� — Re-roofs
3 no App"can Monter Dam
HAZARDOUS MATERIALS DISCLOSURE Type Of ROOF
WIII the applicant car towre building occupant pore w luodk huArdoe materiel
As defined by Ne Cuperti
no
I Code.Chapter 9.12.and Ute Health and Safety
We.Section 25531(.)7 All roofs shall be inspected prior to any roofing material being installed.
Ye Will the applicant 'Iding ruzupsnt use equipment or d,Mca which If a roof is installed without first obtaining an inspection,I agree to remove
It haurdous air contsmin.na Rncd by tiro Bay Arta Air QmWIY Management all new materials for inspection.
atrim
❑Yes Nu If /sem /�
IhavemN the hue n.'an
let,requirements under Chapter 6.95 ofthe Califor.
MIA Health&SarnyCodc,9ectims 25505.15533 and 25534.1 understand that If she Wilding
tae not currently hoc a moon,that It Is my responsibility to notify cecapam or she
outtirem`1which most W roopdorto nauseam ofa Ccnulcom Oc Y Sig tur fApplicant Date
- ��`� 3`
Owner or anshoead agent DIM All roof coverings to be Class"B"or better
Community Development
10300 Tone Avenue
/ Cupertino CA 95014
iCl
Telephone(408)777-3228
OF Fax(408)777-3333
�UPER,TINO
Building De artment
JOB ADDRESS: Iry PERMIT�
OWNER'S NAME: LCn%4,,SPHONE # -31
GENERAL CONTRACTO . FAX # .•a8G
I am not using any subcontractors:!�4--&-% LJ4. - _
Signature �—
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
Owner/Contractor Signature Date
Community Development Department
t`
Building Division
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
C U PEkTI NO 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-199TUBGStandards-
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.
7. NOTE: If you call for a plywood nail inspection and the job is not ready,
you will be charged a re-inspection fee of$176.18. The re-inspection fee must
be paid before another inspection can be scheduled.
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: " S IAaT aCL)
Job Site Address: 5�(�� � �' ` Hi► .
Roofing Company Name: Lln �00 ` ` �.
Applicant's Signature: Date:qwpS
Greg Casteel
Building Official
Revised 11/2/04
O.inlnA nn Onnrnln.i Oenn.
GOMM CITY OF CUPERTINO
=- RFROOF
8CUP'E'kj1N0 PERMIT APPLICATION FORM
APN# Date:
3S � o z B 30 -o
Building Address:
Owner's Name: `J P one#:
k a r S pct a, c?8 -
Contractor- Phone#: License :
__�_ _ IZoo �. � . _. .
Contact: , t^ Phone#: Cupertino Business License#:
Wim^` oY�a- - 420
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles Jq' 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 C1Provide Mfgr.Installation Specs.
• I Have Read,Understand and Will Com 1 With Cu ertino's Tear Off Polic ❑
7 b escription: ou°- '��``st"`�j at roo an 4W. 0
n
� 3o�f 14 rvnn& and- ai cbm005i1i al Vh, �¢ �°�. C3 y� S`/UareS�
Residential Commercial ❑
Fire Zone: Yes El No ❑ Confirmed with Planning Det. if
there are any restrictions: IJ
Cost of Projec Type of C nstructionY' � Occupancy group:
Qty. if Fee Grog
A licable Fee ID Fee Description
BPERMFEE Bld Permit Fees BUILDING
BENERGY Energv BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING