04060170 n CITY OFCUPERTINO r "Faw'N.Rt #✓°Laer '%� /'�•"•gk` '` ..� �.
BUILDING DIVISION PERMIT NCONTIUCTBOR TNNFpRMA.T70N
BUILDING ADDRESS: LINDY ROOFING CO INC PERMIT ND04060170
22309 STEVENS CREEK RT.VD
OWNER'S NAME: - PERMIT ISSUE DATE
DENISE LESONDAK 5554 HARVARD
ONE: SANITARY NO. CONTROL NO,
(408) 269-2025
ARCHITEC TINGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
p C= o 0 0
+10 o LICENSED CONTRACTOR'S DECLARATION
I hen:by.frim thu 1 am IlameO unMr provitiom n(Chapter Y(commencing Job Description
WWSed..7")of DIAOon3of Ne Buri uud Pmfeutom Ca ,andmylimnmit
> in fullfarce oad AIT REROOF W/COMP. SHINGLES
S ya 2 LI<c Clw _ — Lk.I
L Date Conu.cbr
A,shall used
I N
1 unMrstend mY plum shell be uuc u public mcnrN
313
,y� Licensed Professional
OWNC'emOER DECLARATION
0 E I beaky.(Sere that[Earn1. exempt from the Conion&Co :Anyc Law for the
00 which ventures
moon.permit
t 703 1.5,contract,shm. and Prome.do all Cove:Any city nr county
$ which its hoes a permit re usthe .Item imPmw,demaavh,ri mash ed structure
prior mitsi nscudpm.aluntto the the app0cul fornsucthe,Commune's
mune'bimn=le a Law(Chapter
t{F<
that
commincingsMpuection7 the00)provision.nfNeComsiness ndProtUw(Chapler9 Sq.Ft.Floor Area Valuation
6z$
(commencing with Section o t basis for
rth al Business antiMyvi Code)of
IC thu h u 31.5 b awry.ore and dx hues fm the alleged exemption.to Any violation of
norBon than nuryreddontfmapemthubknsNeaPPlicuuoadvllpcnalty.f (g Occupancy Type
not mom Nm Ow hundred dollars(5500).
0 I,a owner of the property,or my employes with wages as their sok eompew0on,
will do the work,and the strunum is not intended or offered for sale(Sm.7011,Bueineas Required Inspections
W Profwlom nu
Cade.The C. ubfs Llama Law don no apply W an ownsr of q P
pmpwy w ho bull da or improves themon,and who doess uch wmk himself m thmugh his
own employe s,provided that such Improvements are not intended aro@red fasidERA /
however.the building.,improvement is sold withiame year Of mmpladon,the.ware- NU
builder will hew the burden of proving Nn he did not Wild Or Impm n for purpnu of
ukJ. Ir -0 1,u gamer of the property am enclu iwly communing with Ilca.1 unnaracmn to t
consume[the pmjee[(Sec.7041,Business and Profession Cade:)The Crahtwcmr's L1W
came Law darn not apply to an owner of property who Wilds or improvei tbemul.an
who contracts for such projects with a e.muubr(n)licensed punuam m the C'onmaciw
Licenu U-
0 l am esempt under Sm. .B k P C fa this moon
Owner Dem
WORKER'S COMPENSATION DECLARATION
I heaby.I Tom Yoder penalty of perJYry.11E of NC following dalNtl.M:
I low end will mainain.CerOlcateof Comets u ulf-inure for WorkerSCompen-
own,as provided for by Section 3700 of the Labor Code.for the performance of ft
work for which this permit Is issued.
0 I haw and will maintain Worker Cooperated..loomme,Is,tequired by Section
3700.E the Labor Cad..fm Ne performuee of Ne work forwhich thin permit I.issued.
My Worker's Co cation In nm mier end Policy numbenmJ:
Cartier:.! � ¢ Policy No.: d�/ ,
CERTI•CATE OF (EMPTION FROM ORKERS'
COMPENSATION INSURANCE
Crussection wed notbecumplmN If tbe ycmml,Is forone hundred dollars(SIM)
or las.)
1 certify that in to performance of the work for which this permit Is issued,I than not
employ any person In any mannerw In to became subject to the Worker'Compwa0an
Laws of C.Iifomle.Da¢
Applicant
NOTICE TO APPLICANT:ff,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provision of the LaMar Code,you must
,JO f.MwW comply with such provisions m this permit shall be deemed remand.
Z ti CONSTRUCTION LENDING AGENCY
(.r I hereby affirm that Nem is construction lending agency far the performance of
�i
the work fes which this permit Is tsued(Sec.309'1,Civ.C.)
Lender's Name
z Lam m's Addrw
U0 I amity Net I haw read this application and tub that the.hove information is
it, F apex I agree to comply with all city and county main.me.emission lows mladng 1.
�U building convection,and hemby amhorim neprasewtiwa of Nis city W enter upon the
fd-t abew-memioned property for inspection purposes.
(We.)agree to save,indemnify and kap hannlw the City Of Copcfthm Against
vI liabilities,judgments,casts and exponent which may in any way serve.against ald City
U Z In mommieme of the granting of not atmil.
'-' APPLICANT UNDERST DS AND WILL C MPLY WITH ALL NON-POINT Issued by: Date
SOURCE REOU TIO dZ G QA:?;/
Ff Re-roofs
Signature of Ap)IiM ne[m A Dam
N RDOUS MATERIALS DISCLOSURE Type of Roof
11911 Be.applicant or future Wilding occupant sham or handle harammus materiel
u defined by Ne Cupertino Municipal Cade.Chapter 9,13.and the.Health sad Safety
ode.Section y5531(e)? All roofs shall be inspected prior to any roofing material being installed.
❑Yn pp no
Will the applicant or home
Wilding occupant us,equipment or devices which If a roof is installed without firs[obtaining an inspection,I agree to remove
It havamaus air contsmimnu an calmed by the Bay Ates Air Oualily Management all new materials for inspection.
District?
❑Yes
I have.mere the hammousmateriats mqulmmcnts under Chapter 6.95 of the Glifor. _
nia lkmth B SafmyCodc,SecBau 15505;35533 and 25334.I understand!dam Ilene Wilding
Own vel currently haw a tenant that It is my min in,to madly the occupmt of Ne
rcqulmmcnu hiphm hem priortoissu or coifcau:ofOcapury� Signature A plicant Date
Owner or .gem Dom All roof coverings to be Class"B"or better
Community Development
1 J 10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
Cl OF Fax(408)777-3333
�UPEkTINO
Building Department
JOB ADDRESS: ,);7_10V 57Tverts cRQek X/k'� PERMIT #dyd ro 0 40
OWNER'S NAME: 1,P-g4k164k I PHONE #
GENERAL CONTRACTOR: LiaK e , I FAX #
I am not using any subcontractors: AIV
Signa a 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
Ask Tile
Owner/Contractor Signature Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
OCITY OF Telephone: (408) 777-3228
UPEkTINO 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 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.
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: A.9 144 1 c.9 L c ie yr • ,G
Job Site Address: ,;2 2 517 Q PP /
Roofing Company Name:
Aplicant's Signature: Z.Iob Dater U�
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINOo
REROOF U U ?
87 CUPERTINO PERMIT APPLICATION FORM
TPN—# � ,I'—� Date: / _��—
Building Address:
Owner's Name: Phone#: y
>e,vls2 4�o0-7eZk 5�
Contractor: p Phone#: yp01 / License#:
Contact: 29
Phon #: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles )K, Asphalt Shingles
X Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings Cl 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: ��,
Residential ❑ Commercial rl
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project: Type of Construction: Occupancy group:
Qty. if
Applicable 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