04060229 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION .
BUILDING ADDRESS: LINDY ROOFING CO INC PERMITNOO4O6O229
21890 CORTE MADERA
OWNER'S NAME: PERMIT ISSUE DATE
GIORGIO DORIN 5554 HARVARD DR 06/28/2004
NE:
SANITARY NO. CONTROL NO.
(408) 269-2025
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
app LICENSED CONTRACTOR'S DECLARATION
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wF 1 mq7 affirm that I am fB tad under p ane of Chapter 9(commencing Job Description
ZW with do ]itID)ofDivision]ofthe Busincu and$rotfcssiunsCodc.and my license is �ar., _ �j
'EE2„ NrNI dNme) / REROOF IDIV\W116 �{��
at�' License laza Lk.k (ri
IL IT
H Dau — GSDEC!
y nIonand my plena shall lac used as ru oma JUL
yYY 2004
=�U
30t; Licensed Profession)
S OWNER-BUILDER DECLARATIONBUILDING
Ls
<� 1 hereby affirm'her I am attempt from the C.Onmelofs Limn.Lawful the UI LDING
_
no following mason.(Smiwo 7031.5,Busines and Professions Cade,:Any city or county Ikd'tl�tl
K m which require a permit to consumer,alter,improve,demolish,or repair any structure $11520
prior us its issuance.also requires the applicant forsuch penniurfilcasignedsutearat
< that he is licensedpursuant the provisionafun,Contractor's lJan¢Law Chapter 9 Sq.Ft. Floor Area Valuation
w�$
(commencing examithherafrn]OW)of Division for
the
theeged coca pt professions Codc)of
Nat k u exempt therefrom and the basis for the alleged exemption.Any violation of
Section]031.5 by any applicant for a permit subjects the applicant in a civil penalty of -3 4L"w6meru U Occupancy Type
not more than five hundred dollars($500L
❑I,uownm of Ne pmpeny.mmy employees with wages azthe'v seta wmpevation,
will Professional
r Newark end Ne sticture is not i Lune,Law ed s Out weer of
and property
obu Codc:The improve,
and
law uch or apply lf an owner of Required Inspections
property who builds or improve Nemrn,and who docs such work himself m through his
Own employen,provided that
pr such improvements. not intended oronemd for sola If.
hung,, the Wilding orimprovementissaid withinone year of completion,Ne owner
builder will have On,WNcn of proving that k did not Wild of improve for purpose of e
salt.).
❑1,as owner of Ne property,am exclusively contracting with licensed conuaclort to
construct Ne pmject(See.7044.Business and Professions Codc:)The Conmclari Li
cave Law docs not apply to an owner of property who Wilds or improve thereon,and
who contracts for such projects with a cam uctogs)licenssd pursuant to the Contractors .
License Law.
❑ I ver eacmpt under Sec. .B&P C for this reason
1371
n Dale
WORKER'S COMPENSATION DECLARATION
1 hereby amrm under penalty of perjury one of the following declarations:
1 have and will maintain a Certificate of Consent to self-insum for Worker's Crimpen-
n,az provided far by Senian 3700 of the labor Cade,for Ne perf.on.me of the
for which this permit is issued.
have and will maintain Worker's Compensation Insurance,u requited by Section
of the tabor Code.far Ne pcRormance of the work for which Nis permit is issued.
Wmk,es Co pemauan In Tana carier end l' cy numbm are: )
rticr. –
CERTERET1Pf10N M ORK
COMPENSATION INSU NCE
(This section need not W completed if Be permit is for one hundred dollars($IOD)
err less.)
I certify Nat in Ne performance of Ne work for which this permit is issued,l.Nall not
employ any person in any manner an,as,to become subjen to the Workers'Compcnsa ion .
Laws of California.Date
Applicant
NOTICE TO APPLICANT:IL after making Nis CaBric itc of Eamption,you should
become subject to Ne Worker's Compcuuion provisions of Ne tabor Code,you must
.�Z forthwith comply with such provision or this permit shall M deemed revered.
ZO CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a convection lending agency for the performance,of
!Yi > Ne work for which this permit is issued(Sec.3M7,Ci,C.)
QUnder's Name
U Z Lender's Addfcss
U Q I certify Nat 1 have read this application and sue Nat the above information is
0 U auras I agree m comply with all city and county oNinvuOf and sou laws relating m
Wbuilding construction,and herebyauNon p rposes. usiws of this city venter upon du
abavo-memiun re property for emnify an purposes. J
CW ewe,)acme m ave,indemnify and kith harmless the City o Cupertino id City
U OI
liabilities.mm of Or granting of thisexpsmics which may in anyway accme against aid City
U 2 AOpLI gnenecof the granting STANDfthis per mit.
APPLICANT UNDpERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOUS�REGt/CA 10
�`'- L/� rf - Re-roofs
Signature ofA HAZA DODS ATERIA LS Dam Type of Roof -
Will Ne applicant or`fwum Wilding Occupant nam or handle huaNs trimmed
az defined by Ne,Cupenitm Municipal Case,Chapter 9.12,and the Health and Safety
We,Section 25532(a)?
❑Ye All roofs shall be inspected prior to any roofing material being installed.
Will Nc applicant or future Wilding Occupant use equipment or devices which If a roof is installed without firs[obtaining an inspection,I agree to remove
emit havardous air contaminants as defined by Ne,Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes No
I have mad the his ardous materials requirements under Chapter 695 of Nc Califor.
nia HCalth&SdfIYCode Sccuuns255O5,25533and25534.1unke .INatiflhchuilding c r I
docs not camindy haw a sena t.Nat it is my msponsihility m wuly the occupant of Ne �. ��a�t� [F/
requimmcn�ich mus c ct tLriorm issuanccofa 6rNfi"u0f Oce pancy. nature Of ppllcaq Date
owner or auN risco! c, sO,
,te All roof coverings to be Class "B"or better
Community Development
S�ffl
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
�UPEf�TINO
Building De artment
JOB ADDR IT # 010
OWNER'S N z,aPHO
GENERAL CONTRACT FAX #
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
0 /Contror Signature Date
Community Development Department
t Building Division
6 j 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.
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.
n�
I �
Homeowner's Name: Ala s2Z�Z>dfiz
Job Site Address: SCJ Q& 74 /`'/e�&leg L J-'i
r ,p
Roofing Company Name: zd r ( '
A plicant's Signature: Dater
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF o a z
CUPERTINO PERMIT APPLICATION FORM
APN# 3 / 4�� 0 32, Date:
Building Address: /
4.aN
Owner's Name: Phone#:
Contractor: / Phone#: License#:
_ 1
Contact: 45hone Cupertino Business License#:
/n
Type of RoofCovering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles � 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 W'th Cu ertino's Tear Off Policy:
Job Description: 1?.el" ".15:-
Residential
SResidential Commercia' ❑
Fire Zone: Yes ❑ No Confirmed with PI ing t. if
there are an strictions:
Cost of Prcjec • Type of Cons ru Ion Occupan group:
ed
Qtyyil�-
Apg% abl,6Fee 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