06010043 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTQR IN '®RMATIO '
BUILDING ADDRESS: LINDY ROOFING CO INC PERMITND'06010043
10491 GLENVIEW AV
ER'S NAME: PERMIT SUE DATE
OWN
ALANA HOWELLS 5554 HARVARD DR 01/09/2006
)NE: SANITARY NO. - CONTROL NO.
(408) 286-9990
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
PBLDO ELECT PLUMB MECH
�0 R - D O
o o LICENSED CONDUCTOR'S DECLARATION ( t'L
I hcmby mu irm that I am licensed under proviso,of Chapter 9(Commencing Job Description tr
aJIN Seeman 7")of Division 3 or Oe Business 14110 eMmyliecvcis
inmR(omaenee (� REROOF--T/O SHAKE, JNSTALLq$�H1INNG��OS�
LL License 1 Lk.N
1-. DBM Ga."An"m
ee q RC all Ac u'S DECLAR ON OKI
ryp`�p
Y I u nand my plain shall he used u public records IrNl`ff/M/pfr I/ DING w (((sill/`I J/1' ���ssjyyA p,,sem
mO
Licensed Pmrwionaly V
Oat I am BUILDER DECLARATION ConuaON it f\t\\.7r_//
ZOO
S hereby.(Hein on I em exempt from the Canon Cas License city
o for the
i ll o following rcmoa arch t 71131.5,Busioeu end Profdcm u Code:Any city s county
Z$r which reyubes a permit re ammc4 after.improve deme)W.o repair any structure $`1 0 0 0 Q
-Zg pat heir issued pursuant
theapplicanto for aoehpctor's icenifilem ned statement
aw(Chapurr9
FF thathepunuan in the of Division 3 mehe nuxmr)ummelaCodla9 $q.Ft.Floor Area Valuation
Y€$ (commas exempt
Sagan 7000)ofDivision for oflhaegeBusiness;empt Profession,Ctionof
Section et r campy thortfrom end or aper far Oro cts the exemption.Any l pennon of
not than five
airy applicant for a permit subjects the applicant a civil penalty of
not mart Nen Rve hundred dollars($500). r Occupancy Type
❑I,umwofuiepmperty,amyempiryeuwimwagesumehanlacmnpcwdon,
will&tite work,and demomum tsant Intended orortertd bargain,(Sec.70641,Busircas
and Prefenioa Cade:The Contractors Lianse Law does not apply to an owner of Required Inspections
property who builds on improe,mereen,and whodoessuchwork himselforthrough hr
own employees,provided that such Improvements art not Intended unaltered foraek if.
however.the building or improvement issold within one year ofoompledon.The owner.
Wilder will have the burden of proving that M did ncr build or improve for purpnse of
Asia.).
❑1.es Owner of to property,am esclutively contracting with licensed contraction;to
construct the project(Sec.7064,Business,and Professions Code:)The Contractor's Lt. _
arse Law docs not apply to en owner of property who build.or improves memon.end,
who contracts for such projects wits a convacur(0 licensed pursuant in de Contncme.
Lkeue Lew.
❑Iamuamplunder Sec .B&PCfmlhjmo%- a
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby alliin under penally of perjury ane of the following declarations:
I hue AM will maintain a Cenifiateer Come.to self-insure for Wokers Cmmpcn.
70311W"
oe.u provided for by Section 3700 or ate labor Code.for 070 performance of the
rk for which this permit i.issued.
I have and will maintain Worker'.Compensation luuance,u mquimd by SeNoe
of the labor Code,for de performance of W Werk ror which this permit is Wood.
Workee.Ca peatian Insurance aria and Polity numbCc'r em:
rim. I ST Polity No.: S J O P I
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thr wcdoe need eel Wcompleed if the permit Is fmmlchundred dollss.($100)
or I=)
1 certify,that in the Performance of the work for which this permit it Issued.I shall nor
employ any Person in any manneran u to become subject to m)Workers'Compeuetion
Laws of Calif o..In,Data
Applicant
NOTICE TO APPLICANT:IL after meting this Cenificem of Exemption.you should
become subject m me Worker'.Compensation provisions of me laboe Code,yen mum
.J 0
forthwith Comply with such provisions or this Permit shell od deemed revoked.
'Z..I t" CONSTRUCTION LENDING AGENCY
[-x wN-, I hereby affirm that mem Is construction lending agency for the Performance of
a the work for which this permit is Issued(Sec.3097,Civ.C.)
a Q finders Nsmc
.7,Z Lenders Addrw
V Q I cemly that I have mad gala application and sum that the above information is
{T.f Correct.I lame m comply with all city and county ordinance and sou laws relating m0
O C.I building construction,and hereby sutbedae MPmsemetiws of this city to cntrs upnn the
yabovomenuoned property for Inspection purposes.
(W))agree to save,indemnify and keep hamtkst the City of Cupertino against
cn Ilebiliuu,judgments,cans and expenses which may In Any way same against said City
V 7 in colvegoencaofdc gnn0ng ormis permi4
Fl APPLICANT UNDERSTANDS AND WILL COMPLY WITH LL ON:P61NT Issued by: Date
S07F REGULATION♦� ,i iso
�� I�-tf/ Re-roofs
Si of licanu'Comeacmr Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will ft applicant or fu am building occupant mom or handle huardous material
u defsrted by me Cupertino Municipal Code,Chapter 9.13,sed the Health and Safety
ode,Se❑c0on 23533/x)? All roofs shall be inspected prior to any roofing material being installed.
Yc No
Will the applicant or future building occupant use equipment or deviaa which If a roof is installed without first obtaining an inspection,I agree to remove
it hewudnw air arlaminanLL good by tho Bay Area Air Quality Management all new materials for inspection.
uiet7
❑Ya Nu
(have mW the hili oatsmatemar requirements under Chapter 6.95 ofine Ulifor•
err HcalthBSafcty Cade.Swd=25305.25533. 25534.ImdcrmmdthmiflM Wilding
dao nct curremly hews tete inn It r my mspomibility m eoufy de uPans err tie
requirements which mum be met prior m inuancc ofe Certificated tic up $1 sure of Applicant Date
�~ `~l All roof coverings to be Class"B"or better
or of thorlud agent Dam
�• Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
UPEkTINO
Building De artment
JOB ADDRESS:`O�R Glan vl.� DI-7PERMIT#
O 60 / oo C-r3
OWNER'S NAME: PHONE# E?
GENERAL CONTRACTOR L tnido 6 FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and com Tete 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/Contractor Signature Date
Community Development Department
Building Division
{ City of Cupertino
10300 Torre Avenue
Telephone:
CITY OF Fax: (408) 777-3333
OUPEkTINO
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 T
comply with the above stated policy on re-roofing.
Homeowners Name: 7- I an1GL. TD WPB. `s nn
Job Site Address:
Roofing Company Name: LIr1 d R004
Applicant's Signature .lam Date:
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINO v6 oU ,
REROOF
CUPEkTINO PERMIT APPLICATION FORM
APN # Date.,
o I -(a
Building A dyes : G 1,--n Vi-tom Dr. .
Owner's Name: t�UPhone#:
l� I p
A-1ana, l 1v S LjO3 -off 55' loZ�7Z
Contractor: Lt j� / P)Io_>�8# ,�Q�_��Ra License #:�1 5 8
Contact: r -tom Phone#: SCJ , Cupertino Business License #:
.e
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
Asphalt Shingles 2r Asphalt Shingles
'filC Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report#
J_ To be Removed ❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: t" - 'exI Sri"c7 r-zra r s un
QI x, cc qh a.S �28) Squa `S
Residential Commercial ❑
Fire Zone: Yes ❑ No [' Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project: Type of Coptruction: Occu ancy group:
�
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
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