05100028 (2) CITY OF CUPERTINO2 '* -�
BUILDING DIVISION PERMIT UC-ON§TRACTOR3INFORMATION'-t'
BUILDING ADDRESS: LINDY ROOFING CO INC PERMIT N0.05100028
ec;66 CT.TF ORT) DR
OWNER'S NAME: PERMIT ISSUE DATE
AM DOUGLAS CHEN 5554 HARVARD DR 10/06/2005
IF
NE: SANITARY NO. CONTROL NO.
(408) 286-9990
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
� ' 0 �
u00 LICENSED CONTRACTOR'S DECLARATION Job Description
I hereby affirm that I am licensed under provisions of Chapter 9(commencing p
with Section 7")of Division 3 of NC Business and Professions Code,and my license is �s9
Laren tome am erze¢p . 215�( REROOF-T/O COMP. , I 71 NGLES
jai LicenmCl Lien d��
nl-� Date�Camruwr
s CHITECTS DECLAR ON
I ndc...d my plans shall W used as public rtcards
nCT "6 2005
�p� Lin:nsd Professional
3 OWNER-BUILDER DECLARATION
P 1 hereby affirm that I em exempt from the Contracmis License Law for the _.,� v
0 O following retina(Section 1031.5,Business and pndessions Code:Any city or county Aga_ 'i
5 m which acquirer a Permit ,,construct.elm,improv,demolish,or.,at,any sw<.m _ I 1 ti�a Y`nl t4 e�sv $6000
prior m its issuantt.also.quirestheap,licans fafsuch pesmitw Rlcasigncd sa¢mens 1, rara
< that W is licensed pursuant to the provisions Of the Comras:mr's U..Law chis
Sq.F[.Floor Area ``Valuation
y�G (commencing with Section]000)of Division 3 of the Business and Prafeuions COO)or
y $ that he is exempt therermm and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicanno a civil penalty of r 0 0 Occupancy Type
not mote than five hundred dollars(5500).
❑I,as ownerk,and
pestracture is,mmyimiam iewith Brad air sole campcnvtion,
will do Newark.indthuu Controm's Litt orowdoco.1 apply]0 owner
of Required Inspections
and Ptnfesh ons Code:The Comamon.License Law deet ret apply m an owner of q P
property who buildsvi imprnwsch improvements
and who Radressuch
not in work himself ed through his
ownemployee,provided pr such improvementsarc not intendedorleered for sale.owner.
howevm,Ne building or impmwment is sold within one year r completion,theposeof
builder will have Nc burden of proving dust W did not Wild a improv for Purpose of
tam.).
Q 1.as owner of the propeny,am exclusively contracting with licensed contractors to .
construct the project(Sec.7144,Business and Professions CWc:)The Canuacwr's Li.
anise Law does not apply to an owner of propcny who Wilds or improves thereon,and
who contracts for such projects with a eomacsor(s)licensed pursuant 0 Ne Com ucto's
Lke.law.
❑1 am exempt under Sec. .B h P C for this mason
Owner Date
70311WORKER'S COMPENSATION DECLARATION
1 hereby at<rtn under Penalty Of perjury ars of the following declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's Compcn-
W
ion,as provided for by Section J]00 of the Labor Codc,for the perfannancc of Ne
rk far which this permit is issued.
I have and will maintain Waukee,Comperassi Insurance,az required by Scction
of Ne lab.Codc,for Nn performmtt of Ne work for which Nis permit is issued.
Workc�r'a Cmm�p-efnesmime 1`y`tranice artier and Policy nump,rtier. -�1/�11 1"z'=
N/ALU X-a--iolicy O.:� )
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu taction need not be completed if the Permit is for hundred dollars(51011)
nrlcsa.)
1 cenlfy Out in the performance of the work for which this permit is issued.I shall not
employ any person in any manner s,as w become subject to she Workeri Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If,after making Nis CersEe m of Exemption,you should
become subject to the Worker'a COmpensmion provisions of the Labor Code,you must
0 O (arOwilh comply with such provisions or this Permit shall W dcem<d.vokcd.
z N CONSTRUCTION LENDING AGENCY
f~� Ihereby affirm Nat thea is a construction lending agency for performance of
Ne work fur which this permit is issued(Sec.3097,Civ.C.)
LLI Lender's Name
Z)z LeaderLeader'.Address
U
U Q 1 ttN(y that 1 have mad Nis application and sure Out the show Information relating is
W U correct,1 agree ct comply with all city and county ordinentts and sum laws r upon t e
Q(, albowngeonemuetionand forebyectionm.Presematixcs of Nis city mcnmr upon the
Y' ahovc.(Weioncil.,m propertysaw,for inspection keep
I"gy
(We)agree m coat,indemnify and hcep hay in m dte City of Cupertino against
y inconseq Judgments,casuang expauemay in any wayaccrue againseud City
fJz in APPLICANT
of Nc RSTA got this Permit.
^� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT sued by: Date
_ S%IgCE REGULATIONS.
Re-roofs
Signa pplisanarCamncmr Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Nc applicant or tutu building occupant State or handle hvallous na mdal ,
az defined by the Cupenino Mum al Codc.Cha,.,9.12.and the Health and Safay
ode,pati 2553, -? N" All roofs shall be inspected prior to any roofing material being installed.
Will the applic/ or few. ailamg occapant sac egaipmem ar devices which
-If a roof is installed without first obtaining an inspection,I agree to remove
mit hazardous air contaminants dcfneJ M1y Nc Bay Arca Air Quality Management all new materials for inspection.
District?
Cl Yes No
I have mail the hazardous materials mquirements under Chapter 6.95 of be Califon-
muH Safcty Codc.Sccdmu %5.25533md25534.lund O=dOmiftW Wilding
d not eta by haw a tenant Nat it is my respmuiality m natily de ac antf the
. w.me"tsw cnmaaetpd°` .i me°f'cv rtf�`f (O `� Og t of Applicant Date
Owner tau dyad agent Date All roof coverings to be Class"B"or better
Community Development
COpO0 Torre Avenue
rtinoCA 95014
" 4 Telephone(408)777-3228
CITY OF Fax(408)777-3333
J&UPERTINO
Building De artment
JOB ADDRESS: (Q5�+ t4q�0�Qh PERMIT #
O Ovv2<
OWNER'S NAME: ro66$ PHONE # &J�K�s fr
GENERAL CONTRACTOR: j ` CD. FAX # er0 b
I am not using any subcontractors: lb-5-65
Signature Date
Please check applicable subcontractors and complete the following information:
60 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
10300 Torre Avenue
Cl OF Telephone: (408)777-3228
U P E IST I N O Fax: (408) 777-3333
Building Department
Subject: Relroofing 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 andthe 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: ` UGI L A S Ckcri
job Site Address: lA� L4PCVY—CA Dr .
Roofing Company Name:
Applicant's Signature: Date:
v
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF
• CUPEWTINO PERMIT APPLICATION FORM
APN # 3 / 7 -L(( 6 3 Date: `O
Building Address:�E; Vj^f? p -Dr.
Owner's Name: �esly Phone#:
Contractor: ` CO . -Wd_fn 0�Phone ( License #:b C"CJ�P o� cS 9
1
py
Contact: Phone#: Cupertino Business License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
X' Asphalt Shingles y Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings_� ❑ Provide I.C.B.O. Report#
V To be Removed ❑ Provide Mfgr, Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ,R__
Job Description: 1—e , oue }„�5 cc.�M roo-F,, x-14
Cwtr.( of yqwJ Cen d f Gn Sh InS ✓e5 f�a. h=2Se��es
Residential Commercial ❑
Fire Zone: -Yes ❑ No ❑ Confirmed with Planning Det. if
there are anrestrictions: [5
Cost of Pro'ect Type of Construction: Occupancy group:
�0 0ri0 -fvr)c cs1 Ce-- res,
Qty. if
Applicable Fee lD 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