02090172 (2) CI BUILD(G DIMS OM1NOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
21716 COLLINGSWORTH ST LINDY ROOFING CO INC 02090172
OWNER'S NAME: APPLICATION UB DATE
JOANN LIN 5554 HARVARD DR 0925/2002
( PHONE: (408) 269-2025 SANITARY NO, CONTROL NO.
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mZARCHITECT/EYGINEER:
0Q / BUILDING PERMIT INFO
e:d FF BLDG ELECT PLUMB MECH
y" LICENSED CONTRACTOR'S DECLARATION
Z S N z 1 hereb (Rrm that I am licensed under p g Job Description
pz_o provisions of Chatcr9(commcncin
fREROOF
yf-m with Scnion]000)of Division loRhe Busmcs dPmfessions Cod ❑mylicense
rcx�� Lalofa Oe t. ,iJ �./5�� �
a O 6 V License __ z 4 Lic.p a/� f� p
Dae ContmctZ
it a.fn � p All ITECr'S D�CL�gghTl p @9
h- AA unders _my P17 ar c s (l
ppO
Licensed Protestants] OWN R-BUILDE ECLARATION OCT 1 0 2002
='lIi I hereby affirm,hat 1 am exempt from the Commetor's License Law for,he
z< following reason.(Section]OI LA Business and Professions Code:Any city or county $11895
I€D which requires a Permit to construct,alter.improve,demolish,or repair any swcmrt p
pri t to ssuanca also req res the applicant for such,errant filesigned statement
- B
- ,hat hk isr omed palladium thi th-c pro stops of the Contractora License Law(Chapter 9 t A"'tL valDa[IO❑
(co cg th Sauon1000AfDivismn3ofthe BusmessendPMess,ons Code) i`, '(',5, 35'CY31'/V7Y�rl/U",a 5 /tis,
or that heir exempt therefrom and the basis for the alleg&I,e«mpiion.Any violanon ` "' } (' S" '' tilt'is d I 7,10
t.,i I
of Section 703 1.5 by any applicadt for a pnmit subjects the npplu am m a civil penalty
of not room than five hundred dollars SSW). 305AQN pia:;r.JI: ' Occupancy Type
❑l,as ms no,of the property.ar my employees with wages a a dmir sole compensation, 307 - INSULATION '
-.IR-do The wmV.-mad the'ummurre'is or intended or offer-1_ :alr(S ]out 6 O1 - ROOF TE'n �
Re
'Bn Th
usums aind Professional code: e Commcwrs License Law dues not appy m an a gQFM Inspections"
owner orpro,eny Who builds or improves thereon,and who dues such work himself 602 - ROOF PLYWOOD NAIL
or through his awn employees.provided that such improvements an not intended or _ __ ..,--_,T-,-.-,,„,„,,,,,,,„__._-_,_,..__,.-__.,.._
�compleffered for sale.IL how di l have
t or um en of prat n sold th one year of -- -- _603--_-
completion,me owns n Id will hove the burden of proving that hdal not Wild or ROOF BATTENS �."rr>E' �'t' . .
improvermpuryoseoreaR.). 604 - ROOF IN-PROGRESS
----.._ -.._...._.. __.___ _.__._. _ `I
❑1 as owner of the pmpeny am exclus lycontracting with licensed contractors m - ( _N,"i"t INrc,
construct the pro ect(Sec ]OAC.Business and Professions Code)The cieral or's
License law does nil apply to an owner of property who but Ids or improves themon, i ' -”
and.who contracts.for.such.project with.acontroctm(s).licensed.,. aanrto the -----._-..--. -.___ ...._ I
Cc va mI License La rs .— -._._.____ _____.._
'_ ❑1 ,r' `pt uiMelSec Lam'^' _�sB&PCfor tho niton
Osr e. .Dat
WORKER'S COMPENSATION DECLARATION
,
-1 hereby affirm under Penalty of
perjury_one of the following declarations:
L ❑ I h.4and'will mainnim.'eirfificso,of Comical I. self nsure for Worker's
Compensation, as Provided for by Section 37M of Ne Labor Code, for the
pert n f the work 1 _which this Permit is ISSued..
❑1have and' ll ran Woke tiCo pe to I rinse m
1111�� req red by S ,
fJ"I f th ISbd-Cod f the fix f e ricra k i h h'hispc� 1 _.>_ ....__..., .. - .. ...__ ...._._.,..
d MY W k Co.pen , 1 -i nc c e Policy trunitherace.
tt 11 <p ii oc ff
r EtT ICATIONOFEEXXEIM ( FROM WORO C Ad'.lr-` 1.i el, ,� .er v,Y s�.e'.i17�1..'r( t. 'v:l,•,L(..I,1
COMPENSATI NSURANCE a';
f' "• (Th a sekann need not be ccmPlcmd if the permit is for one bumlmd dollars • 'a '' - - - _ - -_ (l'=l .1 "'t 1'.t.' ----
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,(SI0(I)m mesh)
Irl In
ya - _ :.._v._ -.._e.� ..ar.. ..✓ an •gym. L. .,ae+.. ._ v.. ...........v...._.-
I t fy.th,m theperl rte of ther«for which th perm i'in i.s d 1 -T
shall t employ apY a n n ny manner so s m hecom b) t m the Workers '.G: ... „
'rmi1pe m iii Laws of California' .Dam ”. - .•.. ' : .
}NOTICE
subject
OAPo the WoTIf C making nfcmepfEe pi yo 'hmust
Z bcc s mopl i Wuch C im." p '.'ofeM1 cbo Cal you must
Z Q forth th comply with such
p a."his Permit Ill.][bed teed rt ok d.
.F 1 a - __.._._. - - -
of thew hereby wh,�c CONSTRUCTION LE1 1.NDING AGENCY
a:y -nil that the t.i construction dung agency for the po forion e
I hereby D h th s Asim t ¢sued(S c J09]Civ.C) `
p
i
a.� Lnders Nam
?Z Isnd i 11 - t
r I erepity fY th tlb d
ere his pplist and.wt thot he bo oficrommust is
E ' cal I agree to caroply,with all city and county ordinances andstateI t ng
U t Wildingenswno dh by autno ae,epresemmves f'his city m enter upon
. �,r� theabove-momimma property fpr.inspection proposes:__...
t.0: (Wo)
gree i sd ndemnify and ke p h lessthe City of C pen n�against
(n liabilities,judgments,cost nd expenses which may.in any way eg nst said
U.Z City c nsequencc of the
'noting
t gdf'hi permit
Uv
APPLICANT N
UNDERSTADS AND WILL COMPLY WITH ALL NOY POI\T
SOURCE REGULATIONS r ll Issued
.,,SaC,s o�ddneeafwrSW¢d 1i1b gfYtonAth3p'ae5pP5l CPJcIua3¢Han(aAnnn)CZt oAroyRrttfrh1Dux2lwNOutrcnoUSb N pMal'ld'AC'tT"a'gEd R«IACl Lhp�S ADtt°esISY'o9 C�I1p3 Sa�hUnI'dRra dNE le nHV3 e I1N "' w-
sl by
'tipl I '. Ji Oy7l.
Date
f ;
4/A
ooRe-r $
ofooType Rf,
and Safety .
j4
AII roofs .
_I
e. f
shall inspected pnoraD.any roofing-material being.installed. ___
• wu to ,,runt f t rc b Igmg« p t . e wh n roof
nater ala forwithout
'it hamrd ter cant ants dined by N<B yA qA Q IryM agenic t first obtaining an'ulspect' ' 'I'-'"" , to remove
Diimm , If
p
11. A pllcan[understands and will ycomply with_s,
all non-point source regulations t 7 . ,,-i iltita
1 h reaE Ne hazardo s mate'al req ms nd r Chapt 6 95 of the
Cobf m in hh s of ty a de Sea' n 15505 t it
d to I dent J that
f th bu Wing d rn currently h mnam'th t t s y reran s b 1 tY t notify
ora tof drc su faCnifcat 'f - -
Oce nc I
' Signature of Apo]' ant ate
p qu e t < must be et P i s
own rOra.mo,re A]I roof coverings to be Class `B"dr,be[ter.
ate
. . - .. ._.. .--OFFICE-...
Building Division
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
Fax: (408)7773333
CUPEkTiNO
Building Depai6ent
Subject: Reroofing policy for the City of Cupertino.
1. Prior to permit issuance,you must agree to comply with 1997 UBC Standards
and manufactures specifications on reroofing.
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 reroofing 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) Preinspection 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 that the
proper City inspection can be performed.
IMPORTANT:
1. Flat roofs must have a minimum of 2/4"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 of inspection.
We understand the above policy on reroofing and will comply with this policy.
Homeowners Name:
Address: l ii l o�
Reroofing Company Name: G
Applicants Signature:
Date:
Joe Antonucci
(Chief Building Official)
6/25/01