02100030CITY OF CUPERTINO*
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'CONTRACTORINFORMATION "°'
BIRLDING DIVISION PERMIT
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Bun. :.
A DR: R PL
LINDY ROOFING CO INC
PERMrrN(02100030
owi,P13RRMAN ELAINE M
5554 HARVARD DR
APPLICATIT"/'1/2002
ONE:
4 — 2 0 2 5
SANITARY NO. CONTROL NO.
ARCHIDECTIENGINEER:
BUILDING PERMIT INTO
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
JOb Description
Job P
I hereby affirm Nm I an licensed under pnvilmas of Chapter 9 (commencing
with Section 700(h of Division J of the Businccs and Professomi Code, and my license is
in lulllirtcc and clfc,p Lic.�s /�/T—/ /11
lar 'Eari.um�s ffOOr is/ 9/
UarnmED
�a p■
FIR A—
ARCHITECTS DECLARATION
I understand my plans shall M used as public records
^ asoo�
OCT 2 4 L
Licensed Professional
OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for theBUILDING$
7 7 0 0
following reason. (Seddon 7031.5, Business and Professions Code: Any city or county
which mquitres a permit to construct, altar, improve, demolish, or repair any structure
prior to is outcome. alm seyuires the applicant for such permit o file a signed statement
3uj R3.2Ut3�)@A1439
Valuation
that he ishomsed pumu.a( to the provisions oflhe Contmetar:s Licence law(Chaptery
(commencing with Section 700(h of Division 3 of the Business and Professions Code) or
Nal he is exempt therefrom and Nc basis for the alleged exemption. Any violation of
pN`N
Occupancy Type
Section 7071.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more dean avahundred dolmra(s500).
307 - INSULATION
L as owtrer of Ne property, or my employees with wages as their aoie compensation.
p�,+'C
6 0 2 - ROOF P IPPV n�Clq_n$
will Jothework, andthe suuctureisnutintendedn Lawdofs..Ia(Sec. 11 an anon I
and Professions code: The Contrxtor's License taw docs nut apply m an owner tar
property who builds m improves thereon, and who does such work himself or through his
own employees, provided thatsuch improvemcnmamnol intended oroffered formic. If.
603 — ROOF BATTENS
however. the building or improvement is mW within one year of completion, the owner.
604 — ROOF IN-PROGRESS
builder will have the burden of proving Nat he did not build or improve for purysrse of
sale.).
1, as owner of Ne property, am exclusively cummcting with licensed contractors m
oche[ the project (Sec. 7(W4. Business and Professions Code:)The Contractor's Li-
Come law Jens not apply to an owner of property who builds or improves thereon, and .
who contracts for such pogcc. with a contrecu rod licensed purmanuo the Contractor's
License Law.
1 am exempt under Sec. . 8 cit P C for this reason
Owncf Dar
WORKER'S COMPENSATION DECLARATION
I hereby allism under Penalty of perjury one of the following declarations:
O [have and will maintain a Cenificate ofC.a.nt to ael6irmum for workers Compcm
surion, as provided for by Section 378(1 of the labor Code for the Acro mmnce or the
work lot which this permit is issued.
1 have and will maintain Worker's Compensation Insurance, as required by Section
37M of ate "We Code, for the performance of the work for which this permit is issued.
My Worker's Comperem l Nance carrier and Policy n�oore�r�am/a��(�
Carrier. PION Na:(/may J�
CERTIFICATE EXEMPTION FROM WORKE S'
COMPENSATION INSURANCE
(This rection need not becompleted if the permit is for one hundred dollars ($110)
ass.)
1 eerhy that in the performance of the work for which this permit is fatted. I shall not
employ any person in any manner so as to become subject to the WorkersCompensation
Law' of California, Date
Applicant
NOTICE TO APPLICANT: 11, alter making this Cemilicar of Exemption. you should
hesrome subject to the Workers Compensation provisions of the What Code. you must
forthwith comply with such provision' or this Permit shall Is, deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby allirm that Caere is a Conswction lending agency for the Performance of
the work for which this permit is issued (Sec. 3097. Civ. C.)
Lmohr's Name
Lendcda Address
I certify that 1 have read this application and some that the shoe information is
correct 1 agree to comply hitt all city and county and state laws relating
ordnthliy
,prex .sof a
building construction. and hereby pectoris rpo..¢nlalives of this oily 10 enter upon the
pmpeny far inspection keep ha
above- (we) agree
(we) ogre Io coed, indemnify and keep harmless the City of Cupcnsts against
l//�/Cl
V—
liabilities, jnceI)]hecowand expenses may inany way a¢mc against said City
this
ppp ,S
of Permit.
permit
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NONPOINT
A PLIC consequence of UNDERSTANDS
APPLICANT
Issued by: Dale
SOURCE REGULATIONS.
Re-roofs
Type of Roof
Signature of ApplicaADam
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or (Mune building occupant sued or handle havaNnuxety
,
as defined by the Cupertino Municipal Code, Chapter 4.12, and the Health and Safety
Code, Section 255320011
Yosn
All rooks shall be inspected prior to any roofing material being installed.
❑
If a roof is installed without firs[ obtaining an inspection, I agree to remove
Will thea applicant tar future building occupant use equipment m devices whim
pp g pan quip
mit hvarJous air contaminants as Je(incd by the Bay Area Air Quality Management
all new materials for inspection.
Diurict7
❑Yes �fJo
Ihave Ne Cali fon
[Code Sectio mum05,2ls cquimmcnts under Chapter
rldChd if building
ffi J2S53i.Iunektsy
nix & Safet
l7
hawca tenant. Oat it [ e E,Cup
reqs not eunenlly have a roan[. Nul iI is my res msiM1ility oe nndly the eceupam nl Nv
s not Currently mil
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t
rcyuiamentawhich ssss//MMMM// Jpry o sw cof tificaleofQcupancy.y�
SlgnalUrC O Cant Date
p,;�`-'
Al roof coverings to be Class "B" or better
Owne>�lired(/
&CITYO
r .r ,
Building Division
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: (408) 777-3228
Fax: (408)777-3333
Building Department
Subject: Reroofing policy for the City of Cupertino.
1. Prior to permit issuance, you must agree to comply with 1997 UBC Standards
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:_ j�/y� 4V4* 49 � h
Address:
Reroofing Company Name:
Applicants Signature: Date
• 'Joe Antonucci
(Chief Building Official)
625101
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:_ j�/y� 4V4* 49 � h
Address:
Reroofing Company Name:
Applicants Signature: Date
• 'Joe Antonucci
(Chief Building Official)
625101