04050123r CITY OF CUPERTINO
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INFORMATION
BUILDING DIVISION PERMITCON'�=RACTOR
Bu1LDINGADDRESS:
LINDY ROOFING CO INC
PERMITN004050123
OW NER'S NAME:
PERMIT MSMDATE
PETER PARK
ONE:
SANITARY NO. CONTROL NO.
408 269-2025
ARCHITLCT/ENGINEER:
BUILDING PERMRINFO
BLDG ELECT PLUMB MECH
0 0 t� l�
LICENSED CONIRACOWS DECLARATION
Job Description
1 hereby affirm that I am licensed under prevision of Chapter Y (commencing
with Section 7") of Division 3 of the Business and Profusion, Code, and my licuu is
in full force and eflsctri g 1 s I
License clan f•� J
REROOF
Dau n 5
A. A
1 uMcnund my plans aNll he used as public memel
swill
Licensed Pof.uo nal
OWNER -BUILDER DECLARATION
1 hereby affirm that 1 am comp, font tits Convectors License law for the
following reason. (Section 7131.5, Business and Professions Code: Any city Of county
which require. a permit t. cnnurne4 alum, impose, demolish, ar rePull say .toc,urc
prior In its iuua.e,alts reyulrra the applicant ror...h Ptmolm Ruaiignedsutement
Il islianudpuMInLIO epmvislonsorftConmser',IAreneclaw(Chapterp
Sq. FL Floor Area
Valuation
(commencing with Section 70W) of Division 3 of the Businusand Profusions Cnle) ser
that he Is eompl therefrom it doe basis far the alleged exmmpllon. Any violation of
^�� e10 0
Occupancy Type
P Y YP
Section 7031.5 by any applicant for a permit subjects the applicant m a civil penally Of
..,mart than Bw hundred dollars ($500).
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❑ I,asowner of the pop.ny, ar my empl.yue wish waguutheir sole compena,Ion.
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I ,. i �+a„ Required Inspections
willdothcwort.and Neswctuubw,inundedwoffcred for le (See 7044, Bes-7
and Pretentious Code: Conuecure License law dose not apply lf an owner
ywho is
propemploy b, pWorid
mpr uchimprowmeha d.asneuordeworughWe his/
own employm,povided that such impowments art notinunded oro@rctl for We. If
me or
diedroffred for
however, the gurimprowmentumld wllhinot year of Improve frNe
Wilder will lose the burden of proving that W did not Wild or Improve for purpose of
awth
`l
(I
0 1. as Owner of the property, am exclusively contracting with licensed contractors IO
1
c a code:) The
coni. of and
not (Secapply
'
Law flywoProfession
cease law dose.Supply b m owner of property who Wilda or imprases thereon, and
nee es a an owner m Woman. sad
who conbacu for each pojem with a conlrxuKO licensed pursuant b Ihe Contractor's
License Law.
❑taro eaempl under Sea ,Bd:PC rate this mason
Owncr Data
WORKERS COMPENSATION DECLARATION
,
1 hereby &M m under penally of perjury ane of the following dulan0ou
1 haw and will mounted a Certificate ofcome., to ul4inmu for Workers Camper.
.tion, u provided far by Section 3700 of see labor Code. for W peRarmence of the
work for which this permit is issued.
I hew and will maintain Workert Compensation Insurance, as acquired by Section
W of the labor Code, for the performance of the work for which his permit is issued.
My Wor rs CampeoWon lnmrardce canier and polity nugher are:
Cartier: - Pollry No.: L IOI12.�
aCE
FICATEOFFJCFMPrION FROM WORKERS'
COMPENSATION INSURANCE
(TMs seelinn..deal W completed Etta Penult lsfarone hundred dollars ($100)
'
or Ica.)
1 unify that In the performance of the work for which this Permit u issued. I shall nut
employ any union in any manncrm as he become subject to dfe Workers' Compensation
Laws of California. Data
Applicant
NOTICE TO APPLICANT: If, offer making this Certificate of EacroPtioa, you should
become Subject to the Worker', Cion cumum provisions of the lady Crack, you run
fOMwitid comply with such provisions or this Pandit shall he dermad revoked.
CONSTRUCTION LENDING AGENCY
1 hereby a111. feet dart is a ooduwctinn lending agency far the perfu rat. Of
Ne work for which this permit Is issued (Sm. 3097, Civ. C.)
Lender's Name
Lenders Address
I ttnify that I low mud this application ambo eau that toe above Intonation, is
bonding I agree to comply with all city and county aNina.es and sou sews r up ing u
retatin&
building construction, and hereby wthon u rposeunutivu or Nit city u enter upon du
sheve mee)O.d for Inspection
keepus.
(W.) ague 1. saw, indemnify and trap harmless the City of Cupertino egaVut
40 sea
lubilitiu,Judgments,cos god tapenva whi In any way,acerue agaiulseia City
In conseq.nca of Ne lin of w
APPLICANT UN A W N N� INT
Issued by: Date 7((!
SOURCE RE �yr�
Re -roofs
Type of Roof
Signature of APPIicanPCoO Data
HAZARDOUS MATERIALS DISCLOSURE
WIIl tutuni bpal Co aceupant
9A2, oaMu health material
as do. the Cupertino ani r
y bre C put Code. Chapfer 9.13, and Ne Nealth and Sa(cry
oipai
Sed io
da. Section 25532(4)7
All roofs shall be inspected prior to any roofing material being installed.
❑Yu
[011
If a roof is installed without first obtaining an inspection, I agree to remove
Will the appiicm. future Wilding ocs: 16 use equipment or deaices which
hazardous air can ts he Jc, by th. Bay Arca Air Quality Management
all new materials'For inspection.
Disuic0
❑Yes No
Ihawmad the Wasrdoum ou
55(f5. n533 anal51U4.IrCeramul thrifue Wilmot
nia HcaW&rrmly, Codc.Sectiau 253(13, 25533 am12553d.IundersuM WHcuere the
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Jou trot eurtentiy etenan4 it' reaponsi' dYuntjplY the aceupant of dw
of
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requirements wh uatW d vanec of nifi u ( eupan
8. i /
Signature of d _ iiia., Date Ty
f°Dh/
All roof coverings to be Class "B" or better( t'
Owner ized
or smha agent
FROM ; Lindy Roofing FAX NO. Nay. 16 2004 10:30RIII PI
I
05/1612004 00;22 5195363282 LCVLITM�' INK e01
10VY)TfvmAv2m)b
C44CA OS014
TeleDbcne 777-3228
Fox (468) 777-3133,
Building Department
Fj —cs —"5W A N I PERMIT #
G C,RACTOR, FAX 0
am not.us4ny subcontractors:?4-W
Sipature Datc
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-s CONTRACTOR
-PUSINESS NAME
BUSINESS LICENSE #
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/Contractor Signature
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CITY OF
UPEkTINO
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Building Department
Subject: Re -roofing policy for the City of Cupertino
Telephone: (408) 777-3228
Fax: (408) 777-3333
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 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:
Job Site Address:
P-0 7 91 617,
Roofing Company Name:
.pP, ze ,A
A p'icant's Signature: ?J Date - t/ O
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
01TV
CUPERTINO
CITY OF CUPERTINO �DSDIa�
REROOF
PERMIT APPLICATION FORM
APN # 37 D M -�7
Bid Permit Fees
Date: F ` D 41
Building Address 7%1
/Lt.ux,
Owner's Namff��t / VPhone
f �
BSEISMICRE
2 ,$7 - Z 127
Contractor:/ Phone #:
BSEISMICOM
License #:
610 2_k1,
-'?9 9 o
Plan Check Fee
Contact: Phone #: /
BUSLIC
Cupertino Business License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built -Up Roof
❑ Asphalt Shingles
Wood Shakes
❑ Wood Shingles
❑ Other (Specify)
Number of existing coverings /
V To be Removed
❑ Built -Up roof
Asphalt Shingles
❑ Wood Shakes
❑ Wood Shingles
❑ Other (Specify)
❑ Provide I.C.B.O. Report #
❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job scripti
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Residential 1' Commercial ❑
Fire Zone: Yes ❑ No ❑
Confirmed with Planning Dept. if
there are any restrictions: Lf
Cost9f Projectbo Type of Construction:
T, Oa
Occupancy group:
Qty. if
AoDlicable
Fen 7TH
FPP TIPCPT�TYIAA
roe r_.
BPERMFEE
Bid Permit Fees
BUILDING
BENERGY
Energy
BUILDING
BSEISMICRE
Seismic Fee Res
BUILDING
BSEISMICOM
Seismic Commercial
BUILDING
BPLANCHK
Plan Check Fee
BUILDING
BUSLIC
Business License
BUILDING