04020164 (2) CITY OF CUPERTINOC+' Os°�NTo RAC' TT-O+•�RINPBUILDING DIVISION PERMIT TV'. M '
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BUILDING ADDRESS: LINDY ROOFING CO INC PERMIT NO 04020164
OWNER'S NAME: FERMIT L$UEDATE
HENRY
ONE:
SANITARY NO, CONTROL NO.
_J408) 269-202S
ARCHITECTIENOINEE
08 269-
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDGPL
ELECT UMB MECH
t� 0 0 0
LICENSED CONTRACTOR'S DECLARATION Job Description
mC I thereby affirm de
that I am licensed unr previsions of Chapter 9(commencing
UZ with Suction 7010)",Division3af the Bummer and Pmfessionu Cade.and my he..or
'e% inrdLmaxande"e 3 Lic S /4 REROOF
j�z License Class
Zg'c Dam T/O COMP. SHINGLES/INSTALLY —C-QTMP. SHINGLE
I
I upu
ndcnJ m plans shM u p hlicAall used records
3 u t; Licensed Professional
03 OWNER-BUILDER DECLARATION APR 14 2004
<I 1 hereby strum Nat I am exempt from the Committees UCtnsc Law for 1M
O O following fusion.(Section 7101.5.Busioems and Prefeesium Cods:Any city m county
$ which tequira s permit m eomm.1,atm[impmvc,demolish,or repair any suumuro Plissis
Fi< pnorto ita issuaace.alm requires theapplicant forsuch promilto file a signedomment
thsthe u liccnsW pursuant to the provisions of Ne Contractor's Liccnu Law(Chaptn9 Sq.Ft. Floor Area Ire t1�g1000
(cammcncing�th Scction7000)of DiAsion3ofthc BusinmwdProfassionsCM)err
WI he la exempt thaufroan and doe baso for the alleged mareption.Any violation of
Section 7031.5 by airy applicant for a permit subjects the applicant in a drll'Petal ry of APN Number Occupancy Type
not mon than An hundred dollen($5110).
0 1.p owner of the property.or my employees with wages as their sok compensation. 3 6 91 1 O 5 4 . 0 0
will do the work,and and structure is..launched or utilized for We(Sec.70a,Business
and Professions Code:The Conaaclor's Lic ons,Law docs not apply m an owner of Required Inspections
propany who bull N or i m prow Narcan,and who does such work himself or through his
ownemployw,provided that such improwments an,notimmraded oraRered for We.if,
however.the building or improvement is sold within one year of completion,the owner,
builder will have the burden of proving Nat he did not Wild or improv for purpose of
.It.)
.
❑I.as owner of the property,am c.elusively contracting with licensed contractors in
construct the project(Sec.7044,Business aM Poland.Code:)M Contractor's U.
cen a Law does not apply m an owner of property who builds or improv thereon,and
who contracts for such projects with a contracmKa)licensed perwanno the Contracteh
License Law.
❑Iameaemptunder Sec .BAPCf.tPd' ,m
Owner Date
WORKERS COMPENSATION DECLARATION
1 hereby&Rom under penally of perjury arc of the following decimations,
I haw ard will maintain aCenifiam of Covenuoulf-insum for Worker's Compere
prion,
as provided for by Section 3700 of the labia Code,for the performance of the
for which this partial,is issued.
1 have soon will maintain Workees Compensation Insunna,ar required by Section
3700 of the labor Code,for the perfomuMe oldie work for which this permit is issued.
My Work Co It Ire ftarm�a 'cPoliey number9 am: /—
Caaier.�9/7R_.rd�J /./f//YG =No.: / 0//Z-
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Missecdon need not W complcmd Irthe permit is reform hundred dollars(5100)
or leu)
1 certify that in the performance of be work for which this permit is issued.l shall not
employ any person in any manner an,as in become mbjwt to the Workeri Campcocsidem
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,after making Nu Centrale of Exemption,you should
become subject in the Worker's Compensation pmvisimta of the Labor CMc you muse
.J O forthwith comply with pub provisions or this permit shall he deemed mwkad.
Z ` CONSTRUCTION LENDING AGENCY
ce I hereby cathi Net these I,.co(See. n lending agcrcy for the perfurmamc of
a the work for which dire permit u issued(Sec.3097,Civ.C.)
'a Iandeh Name
]Z Undoes Address
U Q 1 unify that 1 haw fad this application and sum that the above information is
It, F coned i ague to comply with all city and county onlinen¢s and slow laws relating in
Q U building construction.and hereby amhoriw reprsematiw of this city to enter upon the
D.1 shove-menuaned propertycosts
for Impactionexpenses
purposes.
gy (We)agree m move,indemnify and keep harmless the City of Cupenima against
F'fA Iiaco"m,judgmcn¢costa pdexpensa which may in any wyaccme against said City
U z in cevcqucnu c8pntinB fthi it.
^ APPLICANT DE WILL C PLY NITH ALL 00th-PpENT Issued by:9 Date
L o Re-roofs
Si,...of ApplicanVCampctm & m
HAZARDOUS MATERIALS DISCLOSURE Type of ROOF
Will the applicant or future Wilding occupant mom or handle hanAous material
assjp dmrrml by the Cupertino Municipal Code.Chapter 9.13,and the Health and Safely
cone.s:] es 5532(')T All roofs shall be inspected prior to an roofing material beim
❑Yea eda� p p y g g installed.
Will the applicant or future Wilding occupant=equipment er device whim If a roof is installed without first obtaining an inspection,I agree to remove
7Dwict7
hazardous air contaminants ss defined by the Bay Arta Air Quality Management all new materials for inspection.
❑Yes
1 hausIced thehvadwss 2SM5.s5533 itnuunderdomm¢r695iftheWildingnidi&Saf0 Code,to ri355n5.255J3 and 25534.1 tohHund Naticup Wildingmol curtcntiY h a;mt.Nat i,' rospomih ity to Imtify the asupant of Ne ZIremcnu wh esu pure uancc of 'R..*a roccupancy.
Signature of Applicant Date
Owner caraathadrea agent Dam All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
Cupertino CA 95014
1 Telephone(408) 777-3228
CITY OF Fax(408)777-3333
�UPERTINO
Building De artment
�
JOB ADDRESS: PERMIT #
03S a
OWNER'S NAME: PHONE #
GENERAL CONTRACTOR: , 1 p FAX #
I am not using any subcontractors: I , I 6 0
�;ignatgrf ate
Please check applicable subcontractors and complete the following ' ormation:
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
Ow er/ ontractor Si ature Date
10/28/03
Community Development Department
Building Division
City of Cupertino
MO
10300 Torre Avenue
pCICTY OF A' Telephone: (408)777-3228
U f C kT I I�I® 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: ii/t / Y
Job Site Address: /D 3 S//Y /S
Roofing Company Name: Z'- 4
A,eAI,,catls Signature: �• Date: S/eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF
CUPEkTINO PERMIT APPLICATION FORM
APN# 34 Date: „ / _ ! y
/ vS o
Building Address:
103 S IF Q,4_�
Owner's Name: Phone#s
01 496 - 3i(o1
Contractor: Phone#: License#:
-9490 2 [ 5811.
Contact: / Phone#: Cupertino Business License#:
h u 9� V� rz�
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
�9 Asphalt Shingles ;aL 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 Policy:
Job Descriptio/
o ,0,4L . 62AW .Son
Residential ❑ Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Projecko Type of Construction: Occupancy group:
/ OOv
Qty. if
A licable Fee ID Fee Description Fee Group
/ BPERMFEE Bldg Permit Fees EBUFILDING
BENERGY Ener
I BSEISMICRE Seismic Fee Res
BSEISMICOM Seismic Commercial
BPLANCHK Plan Check Fee
BUSLIC Business License BUILDING