02110070 CITY OFCUPERTINO +�,.• �% -� �' E+"` r °
r BUILDING DIVISION PERMIT jCONTRACTOR INFORMATION" "
Bu I lifijRp.V SS AV LINDY ROOFING CO INC PERMkrt&2110070
I
® FSTEPHEN C AND LEUNG AMY Y5554 HARVARD DR APPLICATIOtSill°Tky:2002
IONS (408) 269-2025 SANITARY NO. CONTROL NO.
ARCIRTEfTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
w00 LICENSED CONTRACTOR'S DECLARATION
R o F I hereby affirm that L am licensed ander provisions car Chapter v(commenting REROOF Iz: �Is Jpo�escription
N¢w with Section7exp of Division 3 ofine Business and Professions Code and my license,is tl
Fpm titins forte ands ftt' y rr W! L4
y�Z license comm
Conbuaor N NOV 2
yY ARCIIITNuse DER�ATION OV 9
e�C< I unJctannd my plana shall be used as puM1lic records 200
ed 6,
w 3 LL�; Licensed 11..feasllmal
=Wg
OWNER-BUILDER DECLARATION BUILDING
W Q 1 hereby alirm Phot I am exempt from the Contractera License Law for the $18170'I (1'1 7 O
w p O following mann.(Stttion 71131.5.Badness and Promodions Cook:Any city or coumy 'i 1 O 1
n K$ which mquirtac a permit m construct,ale,improve,demuliah,car repair any structure
priorbt its issuance,also requires the applicant for such Permit to file a signed statement
Phil he is licensed runs mmIt,the provisions of the Contractors License Law(Chapter 9 3S(F P613I6&A&a Valuation
y�p (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
i $ that he is exempt thcmfmu and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit wbjccta the applicant to a civil penalty of PN Occupancy Type
not mom than Ew hundred dmmrs($500). 307 - INSULATION
❑ L socamer oflhe property.or mycmployees with stages 0 their mlecompcnsation,
will do the work,and the smucwm is not intended orofrutetl tarsal.(See 7044.Business By{{
and Professions Code:The Confracmr's License law does not apply m an owner of 602 - ROOF PL V WpLons
property who huilds mimproves thereon,and who dmasmb work himself orthrough his
own employees,presubd lhafsuch improwmena arc not intended or offered for We.If, 603 — ROOF BATTENS
however.the Wilding mr improvement is sold within one year of completion.the owner- 604 — ROOF IN—PROGRESS
builder will haw the burden of pmaing But he did not Wild or improve fur purpose of
sale.).
❑ 1,as owner of the property,am exclusively counseling with licensed contractors m
consumer the project(Sec.704q Busimss and Nofoesions Code)The Connotation's Li-
se law Jtes not apply to an owner of PlaperlY who builds or improves thereon,and
who contracts for such projects with a conlranor(s)licensed pursuant to the Co mucmr's
License Law.
❑1 am exempt under Sec. B&P C for this reason
Owner Dale
WORKER'S COMPENSATION DECLARATION
I hereby sprints under penally of perjury one of Be following declarations:
I haw and will methods a Certificate of Consent toself insure for Worker's Compcn-
sarion,as provided fm by Section 371x1 of the LaMx Code,I..the Performance of the
work for which this permit is issu d.
I law and will maintain Worker's Compensation Insurance,ai required by Section
TIId of the labor Gide,for the performance of the work for which this permit is famed.
My Wmker's Compewli Inlyi mralxe carrier and Its number am
art:
a �(SL/•/il<'yj�'4`4Y"A Poli
CERTIICATE OP E%EMPTI NIROM WORK[RS'
COMPENSATION INSURANCE
minswelitm nein not becompined if the Permit is fortune hundred dollars(S par
it,leas)
I certify that in the parliament one work for which this peouil is issued.1 shall not
employ any person in any manner m as m ketone Subject o the Wnrkeri Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject til the Worker's Componsmion provts of the Labor Code,you mud
O Z foMwith comply with such provisions or this pcmnilshall be docmcd revoked.
z O CONSTRUCTION LENDING AGENCY
[--�"" Ihereby snit.Nm more is a contraction lending agency lin the performance of
ly' > the work for which oris pemtit I issued(Sec.3097.Civ.C.)
W Q Lenders Name
f1 Landers Address
V C1 comity that 1 haw read this application and slam that the drew infornmewn is
W f" correct.I agree to comply with all city and county ordinances andstate laws totaling In
0 building construction.and hereby authorise representatives of fussily In enter upon the
above-mentioned property for inspection purposes.
(We)agree to saw,indemnify and keep harmless the City of Cupertino against
IHy V) Iiabilitics,judgmcnm,costs and expenses which may in any way active against mid City a. 1
U in consexpeocc of the gaming of this permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALI,NON-POINT Issued by: Date
SOURCE REGULA S.
Y2 Re-roofs
Si r a Apple . tnracmr Dam
AZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicantor future building rkcupant sum or handle hazardous material
u defined by oho Cars, inn Municipal Core.Chapter 9.12,and the llcalth and Safety
Crile,Sctoon 25532(x)9 ' / All roofs shall be inspected prior to any roofing material being installed.
❑Yes No
Will thea application,town building maul 1 use equipment car devices which If a roof is installed without first obtaining an inspection,I agree to remove
pp 6 pan quip
mihazardous air contaminants as def J by the Bay Arca Air Quality Management all new materials for inspection.
D
istrict? f1 Nu
❑Yca �7
I haw mad the harendouamaterials requirements under Chapar6oS of the Califor-
iallealmKSalaryCak.Snutions2515.25533 arta 25534.1 understand thatif the building [� (//�//] -- n
currently haw a tenant,that it is my respmsib hly m madly thetseupant of thequi• n which tic$$ na14 am }tyaComber. Party. Signature ofAp (cant Date
J� ��2`A2 All roof coverings to be Class "B" or better
wner car auomi agent Date
Budding Division '
10300 Tose Avenue
O
Cupertino,CA 95014-3255
Telephone: (408)777-3228
Pax: (408)777-3333
CUPEITINO
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.
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 V"per foot slope and demonstrate that
there is no ponding.
2. An IC.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: _,C�Yj o m 92v–x,-
Address:
U/r-
Address:
Reroofing Company Name: Z- 1 (lD
Applicants Signature: y � ✓ Date: M77
Joe Antonucci
(Chief Building Official)
6/25101