06050042 CITY OF CUPERTINO �
BUILDING'DIVISION PERMIT CONTRACTOR INFORMATION �":
BUILDING ADDRESS: LINDY ROOFING CO INC FERMITNU.06050042
21992 WOODBURY DR
OWNER'SNAME: PERMIT ISSUE DAM
ROBIN GARY D AND SANDRA K 5554 HARVARD DR 05/04/2006
Ir NE:
SANITARY NO. CONTROL N0.
(408) 286-9990
ARCHI EC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
!Op LICENSED CONTRACT'OR'S DECLARATION Job DCSCnpClOn
i w❑ I Wmby affirm that l am licensed under provisions of Chapmr 9(commencing
6 wiflif n7000)ofDivision]ofJeB nss naLPr`�ia�� namYlken is REMOVING EXISTING WOOD SHAKE ROOF, INSTALL 1/2"
Z,Dim full fares and dfc
:n� a"L Lk'a CDX 30LB FELT AND 37 S ARES OF NEW COMPOSITION
H q Dak Comracwr
's As shall CTSDECIA A ION SHINGLE ROOF CLASS A O A��® �j®
1 m� 1 unmrstanJ my plans shall W used as public records ,v L`
E.
.aG Licensed Professional 1a..
OWNER-BUILDER DECLARATION b a
ra
1 herehy affirm that I am exempt from tire Cantrador's 1-manx Law far the �� 2UU6
act following reason.($ration 70I.S,Business and Prufmiom Code:Any city of county C
<m which term.a permit 1.anar mi,alcor.improvm
e,deolLN.nr repaan
ir y strtrdme
primtoitsi¢uancc.alwrequimathe.,diCant forsuchlmrmitmfmlcasignedsommcm
- that he is licensed pursuam to the provisions of me Contractors license Law(Chap d,9 Sq.Ft. Floor Area -V luat'on
r�ro (commenting with Section 7000)ofDivision 3 of the Business and Profesions Crum)or 9000
that he is exempt tlmmfmm and the basis for the alleged c e pdm.Any violation of Rim ni
Lin
Section 9031.5 by any applicant for a permit subjects me applicant an a civil PEOURY Of APN Number c ahey'Type
not more dun fixe hundred dollua(SAID).
0 1,ss owner of dae prepoty,a my wploym with wages u mhekmk eompemadm.
Add Pr the wm's and the mComment
omusnt License Lam ed fo not apply 90 N.Badness Required Inspections
propAdd errywhobu Cade:TW Conmcmrs License Law dors not apply da an owner is q P
Earn amplowmas,
who builds i improvesthereon,andwho docasuAmmo chwmkhimselfedthrough
ort If.ownver.th m,provided improvement is
tendedwagered for sale.TL
however,the building or improvement w rola withinoro year oyear of rnmple fElse aner-
huildd will have the burden o
f proving drat K did not Wild or improve far puryo¢or
sale.).
Cl 1,AS awned of the property am emlusively contracting with licemed comnemrs m
construct the pmjed(Sec.9064.Businm add Profeeaes Cade:)The Convenor's Li-
cem Law does not apply m an owner of property who WHEN or improves daemon,and
who contracts for such projects with a contranar(s)licensed pursuam b that Conan toh
License law.
0 1 ren axemp underSec. .B d P C for Nu rcut
Owner Dau
WORKER'S COMPENSATION DECLARATION
1 hereby aRrm under penalty of perjury am of dm following declanuou:
1 have and will maintain a Certificate of Co..,an self-hssum for Warkera Cc mpen-
mdon,u provided for by Section 3700 of the Labor Cade.far the perfurmanm of She
We&for which this Permit is issued.
0 1 haw and will maintain Woicid,Compemtion Insurance,as required by Section
37M of that Labor Caat far dm performance of dm wore for which this permit U issued
My Wmkds Compensation lnsu `artier and Policynu
Cartier. �'Te 1 V.V/1 Policy Na.: �M ^2.6)0
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
rlTRmcdan need trot W complemd if Ue permit is foronc hundred dollars(SIM)
or lass)
1 certify that in the performance of the work for which this Permit is mu d,l shall nut
employ any Perron in my mmmrw as m become subject to the Workers Compemdon
Isws of California.Dam
ApPliesta
NOTICE TO APPLICANT:If,armr making thus CeniOeam of Exemption,you should
Weonm mbjm m the Worker]Compamdan provusimts of the Mbar Code.you masa
.J O forthwith comply with such provisions or this Permit shall be deemed new hard.
Z y CONSTRUCTION LENDING AGENCY
[-+ I Araby of i m Our dire is a construction kndin{a{army lenthe performance of
!Y > the wort for which this Permit is issued(Sec.309'1,Civ.C.)
aQ Lenders Name
2 Lenaeh Address
U Q 1 certify Net 1 haw read this application add sum Lou dae aWw information is
Iy t'^ coned.I agree in comply with all city and county onlinances and sum laws mlating to
O V building convection,and hereby authorim represenmivu of this City to enter upon the
.have-menuuned property(or inspection purposes.
fes^'y (We).9.m saw,indemnify and keep hmmlm the City of Capenlna against
VV) Iiabilides.judgments.emu and expenses which may in my way amuse against sod City
z A APPLICANT
UNDERSf the TANDS
of this permit Issued by: Date 3' t/,- e
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL N N-P INT
OGRICA RBLU'ATIONS. 5 0
ww�� �J" t�� �`—' ✓ Re-roofs �� .
Slisaadme of AppliuntlCamwaror Dem
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will dm appliant or fuuue Wilding aaupmtsmre m hardlc havallou martial
As deRxd by the Cupertino MuniypaI Cade.chapmr 9.13,and the Heslth and Safety
Conn.titian x5532(6)9 / All roofs shall be inspected prior to any roofing material being installed.
Tea �(�(fJ�'Nu
If a roof is installed without first obtainingan inspection,I agree to remove
Will the applicmt Tum¢Willing accupam tax equipment or mvim which P g
emit hnuNnua air con mets AAdEdived by the Bay Area Air Quality Managcmem all new materials for inspection.
District?
0Y.
Ihave&Safel Cadhe vmclous S=60on 5.25yviremcntsunmr LTapmrd.95ofthe Califon
nice Health&Safety Cada Sections 23SU5.255JJ mJ 25534.Immntand mmifthc Willing
does nm currently haw a moms that it u my mapamibility m nmll'Y me croup t of me _
requirements which maatic,met poorusumce of a Cmilam arca Sikrrrure of Applicant Date
o er amodred.sem �- 5 DamAll roof coverings to be Class "B"or better
e Community Development
g 10300 Torre Avenue
1' Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPEkTINO
Building Department
JOB ADDRESS: R l� oa ^ PERMI�0 -S-00 L<
OWNER'S NAME: ct 6;, �",� PHONE # 1 6
GENERAL CONTRACT FAX # Pj
I am not using any subcontractors: -
ature 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
. Tile
�s-3-6S-
Owner Contract rSignature Date
Community Development Department
Building Division
s City of Cupertino
. � 10300 Torre Avenue
• Y, ^
Telephone: (408)777-3228
CITY OF Fax: (408) 777-3333
CUPEkTINO
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 wi11 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 LC.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: C::::)C,( P-o b I n
Job Site Address:, 9 bay�UOLV
Roofing Company Name: �� ��— C6.
Applicant's Signature n �'1 l ✓ f Date: S- 3 CJ
•
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINO
•em 1 of 2 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec: Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 32639019 . 00
DATE ISSUED. . . . . . . : 05/04/2006
RECEIPT # . . . . . . . . . : 34242
REFERENCE ID # . . . : 06050042
SITE ADDRESS . . . . . : 21992 WOODBURY DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER ROBIN GARY D AND SANDRA K
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 19, 000 . 00 266 . 76 0 . 00 266 . 76 0 . 00
BSEISMICRE VALUATION19, 000 . 00 1 . 90 0 . 00 1 . 90 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 268 . 66 0 . 00 268 . 66 0 . 00
•
CITY OF CUPERTINO ao05W4g-
!CC - REROOF
OT
OF
UPERINO PERMIT APPLICATION FORM
Date:
ENP - 3Q- 0101 5 - 3 -0�
ddress: a 19 9 W�r-1 �r
ame: hone#:
GCki q05 s a -(a(-r
Contractor: ) `n� ROO� co
'ho #� a��-9Q�O icense# X58/
Contact: L Phone#: ! Cupertino Business License#:
U6er,, o(a) 08(�-4CIC CD
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑�/ Asphalt Shingles W, Asphalt Shingles
7 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.
Have Read, Understand and Will Comply With'Cu ertino's Tear Off Policy:
❑
is ,ob Descri tion:R��O u
�� G r d 37 e of rl¢o om ,4tayl Shncj (,_ ALodT
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning De t. if
there are any restrictions: LJ
1 Cost of Project: Type of Construction: Occupancy group:
)L
VN
Qty. if
Applicable Fee ID Fee Description Fee Group
6 BPERMFEE Bldg Permit Fees BUILDING
,4, BENERGY Energy BUILDING
'oe ( BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
a