06050043 CITY OF CUPERTINO �"'" "" �
BUILDING DTVI SIGN PERMIT CONTRACTnR INFzQRMATION
"L. x�` pc., r,
BUILDINGADDRFSS: LINDY ROOFING CO INC PB'LMITNO'06050043
21962 WOODBURY DR
OWNER'S NAME: PERM1IIT MUE DATE
JACK & BETTY CROSS 5554 HARVARD DR 05/04/2 06
TARCH:M:�=:NGINEER:
E: SANITARY NO. CONTROL NO.
(408) 286-9990
BUILDING PERMIT INFO
PLUMB MECH
LICENSED CONTRACrOWS DECLARATION
1 hcaby affirm Nal l am licensed under provuiam of Chapter 9(commencing Job Description
jxtion]gMl)al Division 3ofdse BudnessandREMOVING THE EXISTING WOOD SHAKE ROOF. INSTALLI
j> Conuawr 0 1/211 CDX AND 30LB FELT AND 32 SQUARES OF 30 YEA
ARCHfrECTS DECLAAA N COMP SHINGLES, CLASPIWLE
f¢< I u cmanJ my plans shall he oscJ u puNic rtcnrds /��®®®
Stu rg/
°d 3 Licemed Professional .
OWNER-BUILDER DECLARATION
3 i 1 hemhy affirm Nm I am exempt from the Conuumfs License Law for the
p O following moon.(secuon]0313,Business and Professions Code:Any city or county u
<m which requiem a Permit m conmroct alter,improve,dcmoike.ar repair any stnacame lot
i y print to its issuance.also inquires the applicant for such permit an Bk a signed assessment
< thmheulicenscd femsehataNe provisimbafam Convacmh License Law(Cleapsm9 Sq.F[. Floor Area Valuation
eFG (eommencingwitsSceuon]000)ofDivision3afdmBusinssandProfnsimsCadc)ser $13000
i $ Wt W u exempt mwfrom and the basis for the alleged pd..Any violation of
Section 70313 by my appliant for a permit subjects dse applicant o a civil penalty of APN Number Occupancy Type
rot main Nan five hundred d.11.(5500).
❑L u owder of and
gapmmure is wployces with wags u dw,'v(Sec.
wnpewtion,
will do recants andthe ies Condnmbtmrdee Law
dosed fans a(SaAOan Business Required Inspections
and Pmfessiam Cade:The Canvacmfs License Law does not apply m an owner of q '
propertywho h.pmvir d a,mthin,aM=h mnotink himself arWr hu
however.me buiprovided prsuch rat is sementsinne cot fcmaRemd thato owner-
builder
however.Ne building or improvement u salt within one yam or improve
for the purpose
of
builder rN love the drdrr of proving that k did not dull or improve far purpose o!
sale.).
❑1,as owner of the progen,am aelmively convening with licensed anaamam to
comuntt the projem(Sec.70aa,Business and Nafetions Code)The Conuamor's U.
come law dins not apply to m owner of property who builds or improves thereon.ant
who contracts for such projects with a conmcter(s)licensed pursuant to the Comncmr's
License Law.
❑1 w evempt under Sec. ,B A P C for Nu mason
Owner Dam
40 WORKERS COMPENSATION DECLARATION
1 hereby affirm under Penalty of perjury arm of the following deciaratiom:
❑Ihave.ndwillmammm.CenlOamol Canunsmself-insumforwoheY.Cumpen-
sation,as provided for by Section 3700 of the labor Code.for the performance of mat
wady for which this pmai,is issued.
❑1 have and will maintain Worker's Compensation Insm um,as inquired by Section
3700 of the labor Code.fm the performance of the weak for which this permit is iumd.
My worker's C,mp(e.S'on race artier and Puliq•nyb��rrrssvga-���
Cartier. •1 E Policy- VS �JiJ
CERTIFICATE OFE EM MON FROM WORKERS' -
COMPENSATION INSURANCE
(This section decd net becwpkmd if the pe.I,is forms,hundred 011.(SIM)
or less)
1 certify but in the perfurnme.of the work for which this penal,is issued,1 shall not
employ any pcmmn in any ma term u m become mbjcct m the Woh Compesas m
Laws of California Data
AppBwnt
NOTICE TO APPLICANT:If.after making this Cci iCsam of Emanation.you should
become subject b she Worker's Compemedon provisions of the Labor Code,you arose
.J O forthwith comply with such interisland,m Nu be
pemit shall deemed re
voked.
M
ECONSTRUCTION LENDING AGENCY
M E
)har w .frim mat them is a comvucti0o landing agency for me performance of
work
the fm which this permit u issued(Sec.309'/,Civ,C)
Leashes Name
0.
�Z l.cnder's Addm<.
U O 1 anify that 1 have read this application and show,Nm the above information u
LL., F coma I agree to comply with all city and county ordinances and state laws missing to
DU Wilding emsvunian,and hereby au,hari>e mpresenutiva of this city to enter upon me
r G .hove-mentioned proper"(o,impeeuon Purposes
(We)agree to save,indemnify and kap hamlets the City of Cupentna against
rte•.h liabilities,Judgmcros.costs and expenses which may in any any acwc against mid City
U Z tnPP L ICANT UNDERSTANDS ANDOf the goorting Of WILLWWILL COMPLY WITH AL 0 -POINT Issued by: Date
CE RCS{1r,ATfOw�' ..� 5 y o .��
Re-roofs
Gligusiark or ApplicashrOcneurewrHAZARDOU eek Type of Roof
HAZARDOUSMATEaIALSDsumor URE T
Will the Cupertino
forumbuildingaapantmartm handle Heatdommaterial
az refined by dm Cupertino Munici al Cods.Chapkr 9.13.and me Hcelm and Safety
Code,ectionM33(a)? All roofs shall be inspected prior to any roofing material being installed.
Ym u
Wilt mea lieam or lam baildin mea If a roof is installed without first obtainingan inspection,I agree to remove
Pp g pall'use equipment It devices which g
emit harardnm air collum' u skfined by the Bay Arta Air Quality Manegemcnt all new materials for inspection.
District,
❑Y Nu
Ihave mad Ne heard*,•materials rtquimmcnts unhr ChePtm6.95 arum Califon. / r{�
rias.1cosafesyhaveaSecumashea iti my mend35334.1 ut mairndthmifthcm,of g
Jam trot cumndy base a tenant dor it u my responaibiliry m notify tin orcupen,of the
mgaikmswl,icn/muv be ince,priarmissuana ora crtiRaw,pt Oca �/ r_ Sig re of Applicant Date
All roof coverings to be Class"B"or better
owner orittd agcm ' Dam'
San
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
SUPEkTINO
Building Department
JOB ADDRESS: PERMIT #,
-2tco-,) 60,e 0 6o So d cr rs
OWNER'S NAME: &L-- SS PHONE # -At�� 2 ,O—CVJ61-0
GENERAL CONTRACTOR: Ca FAX #
lam not using any subcontractors: ��'t
Signature Date
Please check applicable subcontractors and complete the followinginformation:
65 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
Building Division
City of Cupertino
010300 Torre Avenue
CITY OF Telephone: (408) 777-3228
C U P E kT 1 N 0 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.
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
stated policy on re-roofing.
Homeowner's Name: .S A CV-- �t�4' cr-0 155
Job Site Address: �I ( C( � l4-)60&Lur
Roofing Company Name: Gc�
Applicant'sSignature: W11Date: 3'
• Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINO
w-m 2 of 2 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 32639020 . 00
DATE ISSUED. . . . . . . : 05/04/2006
RECEIPT # . . . . . . . . . : 34242
REFERENCE ID # . . . : 06050043
SITE ADDRESS . . . . . : 21962 WOODBURY DR
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : JACK & BETTY CROSS
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : LINDY ROOFING CO
CONTRACTOR . . . . . . . : RUMFORD, LINDY LIC # 3921
COMPANY . . . . . . . . . . : LINDY ROOFING CO INC
ADDRESS . . . . . . . . . . : 5554 HARVARD DR
CITY/STATE/ZIP . . . : SAN JOSE,. CA 95118
TELEPHONE . . . . . . . . : (408) 286-9990
*FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 13 , 000 . 00 201 . 96 0 . 00 201 . 96 0 . 00
BSEISMICRE VALUATION 13 , 000 . 00 1 . 30 0 . 00 1 . 30 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 203 . 26 0 . 00 203 . 26 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ---- ------ --------
CHECK 471 . 92 1716
TOTAL RECEIPT 471 . 92
•
CITY OF CUPERTINO �� 5
REROOF
• CUPERJT NO PERMIT APPLICATION FORM
APN# 2n , ^ _ � _ �n � Date:
Building Address:
Owner's Name: Phone
7G ClC �' ( 2 ro S S
Contractor: Ph6 License-9-
Poe
icense p8 c --2992 a/581
Contact: hon #: Cupertino Business License #:
09i(3-BCo�RO 3C(2-11
Type of Roof Covering:
Existing: Proposed:.
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles -'I< 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 ❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Polic ❑
IF Job Description: Y�v%ou e Woo +G2 v ocs /n 11 n
I
'it '36-11- -6"_-4+ A r+
Residential Commercial ❑ C c P �, l3
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project: Type of Construction: Occupancy group:
1 J� bUa �.� rrxrF S'i' GL
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
•