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05090096 (2) CITY OF CUPERTINO '� BUILDING DIVISION PERMIT ICON RAOMORANFORMATI®N BUILDINGADDRESS: LINDY ROOFING CO INC PERMITNO05090096 10640 CASTTNR AV OWNER'S NAME: PERMIT LSSUE DATE ROBERT HARDING 5554 HARVARD D 09/14/2005 ONE: SANITARY NO. CONTROL NO. (408) 286-9990 ARCHITECr/ENGINEER: - BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 °00 LICENSED CONTRACTORS DECLARATION m❑ 1 Imeby affirm that I am licensed under pmvivons of Chaplet 9(commencing Job Description �iW with Section lath)of Division 3 of Ne Business and PfofeasiursCde,and my license is inlet frmeaodefreJ �� 1 REROOF--T/O SHAKE, INSTAI`LlISHINGLES- a�? License Class –t—Lk,k (I 1, L\ I o Dau ctmoa� II.�,.r� J l\.�f ~raj ARCHITECTS DECLARA7IO Ss,w 1 undersand my plans shall M used u public meords u.oG Licensed Professional 2005 3 OWNER-BUILDER DECLARATION sy 1 hereby affirm that I am exempt from Oc Contractor's License Law for the O O fallowing moon.(Section 7031.5.Business and Professions Cole:Any city ser county p\ u $ which mquim a permit to construct, rove Muf,imp ,dan emalksh,or miser y structure 11 Q Q Q N IJ _Zy prior to its issuance.also squirm the applicant for such Permit to file a signed statement V. P�D,�I� < that he is licensed pursuant 10 the pmvisiomnfOnConnector's LicenseLaw(Chapter 9 Sq. Ft. Floor Area U Valdatioril %Fn (commencing with Section 7000)of Division 3 of the Business and Professions Code)or i Oat he is emmpt themfoom and On bass for the alleged exemption.Any violation or Section 2031.5 by any applicant for a permit subjects the applicant to a civil penalty of AtIA er Occupancy Type not mom than five hundred dollars(SSW). 0 I.u owner of thc property,or my employees with wages as thcio file compensation, will do Oe work,and On swcture is not intended or offered for sale(Scc.?041,Business and Professions,Code:The Connector's Liana Law does not apply m an owner or Required Inspections Portnoy who builds or improves thereon,and who does such worth mself or Orough his own employees,provided that such impraemenu am not intended in offered for ale,If. however.the building or improvement is sold within one year of completion,the owner, builder will have the burden of proving that M did not build or improve for purpose of sale I. 0 h as owner of the pmpcny,am reclusively contracting with licensed contracmrs to conswct the project(See.2014.Business and Professions Code:)The contractor's Li. erose Law docs not apply to an owner of property who builds or improves themon.and who concocts for such pmjccu with a contlaoor(s)licenced pursuant in We Contractor's License taw. 0 I am cmmpt under Scc. .B k P C for Ois mason 1371,00 ner Date WORKER'S COMPENSATION DECLARATION 1 hereby afMn under penalty of perjury one of the following declarations: I hs vc and will maintain a CcNrnte of Consent m self-insure for WorkersCompcn- on.o provided for by Section 37W of On Labor Code,for On perfrnvna of the rk for which Or,permit is issued. 1 hast and will maintain Worker's Compensation Insurance,o required by Section ordu labor Code,for Oe performance of Ne work for which she permit is issued. yWorkds Compensation lnannee Trtieyr''q/tdPolicy num berme /� Qssie,: 'e"Palicy,N7"IM10� E TIFI MOPE EMPf10NFROMWORKERS' COMPENSATION INSURANCE (Dissection need not uncompleted tithe permit is for one hundred dollars(91010 or los.) I CCmdV Nat in Oe performance of Oe work for which this permit is issued.!shall not employ any person in any manner an as to become subject o the Worker'Compensation Laws of California.Date Applimm NOTICE TO APPLICANT:If.after making Ois Certificate of Exemption.you Ouuld become subject to Oe Worker's Comper ation provisions of Oc tabor CodC,you must �p forthwith Comply with such provisions or Ois Permit shall the,deemed revoked. 7-'r CONSTRUCTION LENDING AGENCY the b affirm Oat them is a construction lending f" hereby 8agcncY for the performance of the work for which this Permit is issued(Sec.3091,Civ,C.) Lender's Lcndcri Add Address L)Q I certify that 1 have read this application and sum that the above information is [4 correct.I agree to comply with all city and county ordinances and sure laws relating to UU building construction,and hereby auNorite mpmsenmives of this city to eater upon the W move-mentioned property for inspection purposes, (We)agree to ave,indemnify and keep hasmlea the City of Cupertino all .�,,, 7 Iiabilities.judgmenu,costa and expenma which may in anyway accrue againslsaid City U j APPLIqucncc of thrgrahtin SA permit �^ APPLICANT UNDER A SAND WILL COMPLY WITH ALL N *POINT Issued by: Dale SOURCEREGU TI ( Re-roofs Signaturco'Appli AZnuaaor a ARDOUS MATERIALS DISCLOSURE Type of Roof Will the,applicant or future building ueeupa a store or handle havardous material as defined by the Cupertino FlYes )? ON.Municipal Code.Chapter 9.13,and the Health and Safety alo . yes zss3z(aAll roofs shall be inspected prior to any roofing material being installed. Will On applicant or future building Occupant use equipment 0,devices which If a roof is installed without first obtaining an inspection,I agree to remove it harardnus air contaminants as defined by the Bay AreaAir Quality Management all new materials for inspection. District? 0Yes 0 N I have read!the haasdoo ma 1;.esmquiumnu eunderChapter6.95ofOCGlifor- niaHealth&SafetyCode.Seed 25 15.25533 and 25534.1 understand tel if Oc building does not currently hate a Mr, 4 O itis my mapmuiuility m notify the aces t of the requirements which must t ' res issuance ora CC.rrateaf Orcupan Signature of Applicant Date Owner Orauthori,edagent r IptufAll roof coverings to be Class"B" or better Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 UPEf�TINO Building De artment JOB ADDRESS: 1�� iii S�v i PERMIT # D S U �/00 1;6� OWNER'S NAME: o ar 1 PHONE GENERAL CONTRACTOR: Lie\dq KdofItIC4 IFAX # I am not using any subcontractors: Signature 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 �— Owner/6 ntractor Signature Date Community Development Department Building Division City of Cupertino 10300 Torre Avenue CITY OF Telephone: (408)777-3228 4UPEkTINO 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$176.18. The re-inspection fee must be paid before another inspection can be scheduled. IMPORTANT: 1. Flat roofs must have a minimum of 1/4 " per foot slope and demonstrate that there is no ponding. 2. An I.C.B.O. report is required to be on the job site at the time on inspection. I understand and will comply with the above stated policy on re-roofing. Homeowner's Name: PJo t a cj In C l Job Site Address: I D(.0Lg0 G aS4v)-e_ /,IV e— Roofing Company Name: L ry c(c..l Applicant's Signature: -_1A l� ��- Date: * 10.5 Greg Casteel Building Official Revised 17/2/04 Printed on Recycled Paper CITY OF CUPERTINO REROOF CUPEkTINO PERMIT APPLICATION FORM APN # > 2% y�� ,� Date: Building Address: Ave— Owner's ve .Owner's Name: \ I Phone#: Contractor. L k �C)� co rLfU: ag�� License #:alsC) Contact: l WPhne#: Cupertino Business License#: w� [o$ -aac0-qqo Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles X Asphalt Shingles Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other(Specify) ❑ Other(Specify) Number of existing coverings ❑ Provide I.C.B.O.Report# p/To be Removed ❑ Provide Mfgr. Installation Specs. jo�l Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: 0— Job Description: V'cmove eys sh S c . SIe tl LIV' 12cjtc,)4rater plywWd, -� l1 unckyetrnen+ cl ZR S Uc re o4� 50 r L�Wv a�sla cam( ccw o5, hG s+4 c�leS Residential Commercial ❑ Fire Zone: Yes ❑ No ❑ Confirmed with Planning De t. if there are any restrictions: LJ Cost of Project: Type of Construction: Occupancy group: 9-e -2.po-� �1 V1 C2.. g__a5 L c(-n 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