05020045 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRA.CTnI2`TNI*'OItMATION,`::
BUILDING ADDRESS: LINDY ROOFING CO INC PERMIT"°05020045
OW NER'S NAME: PERMITL UE DATE
PAJkTR
ONE:
SANITARY N0. CONTROL NO.
(408) 286-9990
ARCHrrp_ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
oo LICENSED CONTRACTOR'S DECLARATION
G I Mmby affi Nas 1 am fasiucd under provisions of Chapter 9(commencing Job Description
b ilh section]a0U>or sion3of Ne Basirmas.na Proresslnnr endo and my rcerise is
oy in
fullforcefife �. ej /JyJ •REROOF W/ COMP. -
p,wj, ? Licenx Class Lic
Z F w Dam Cj.
Y�U ARCHnE 5 DECLARATION
Y 1 Prato and my plans shall he wed as public records
3 LLPmfc
O Licensed ssionel
OWNER-BUILDER DECLARATION
1 WrcM1y affirm Nal 1 amL exempt from We Contractor License law for N, 0�
p O following rtwna(Section 703 L5,Business and improve
de oli Cod,:Any tiny or county
ve which requires a permit no airs the altee i t for such
demolish,ore a sig any structure
prior m its ceased p,also myo the the applicant for such m nal's Lice s signed ahmmem
,-n (comhe me ccenxJpurstion7")ofDivisioofthe the
LiecnxLaw(Chapter9 Sq.F[.Floor Area - Valuation
FVFG Oat he is(commencing with Section and the
Division rth the alleged
Business and Professions Cnde)ser
y�� Nen he is exempt therefrom and de bwu for the illcgcd eumption.Any=of
Section]031.5 by any applicant for a permit subjects Ne eM]iCmE to a civil penalty of 3 WOI8'Q M)eTO 0 Occupancy Type
not more than rive hundred dollars(5500).
D 1,as..Or of the property,or my employees with wages as their sole compensation,
will do ore work and the swcmm is not intended or offered for sale(Sec.704d,Business
and Professions
nt
Cade:The Coram cmez License Law does not apply an owner of Required Inspections
propenywho builds or improves theldon,and whodoea suchwork himself or through his
own employees,provided Nat such improvements arc not intended or offered forsale.If.
however,the building or improvement is sold within one year of completion.the owner.
builder will have the burden of proving Nat be did not build or improve for purpose of
sale.).
D I,as owner of the property,am exclusively contmeting with licensed contractors in
construct the project(Sec.7061,Business and Professions Code:)The Contractors Li-
ns,law dors not apply m an owner of property,who builds or improves Neeson,and
who contracts for such projects with a ean0acror(s)licensed pursuanuo the Consciences
License law.
D l am exempt under See. B dk P C for Nis reason
Owner Date
WORKER'S COMPENSATION DECLARATION '
1 hcmby affirm under imuth,of perjury ane of the following deearatiow: -
I`
tificme:ve and will maintain a Cmof Conten to self-insure for Worker's Comre
pe
sto on,u provided for by Seen..370 or the labor Codc.for the peRmmance of the
work for which this Permit is issued. -
ave and will maintain Worker's Compensation Insurance,es myuimd by Section
7W or the Latour Code,for the performance of the work for which this permit is issued.
My Worker's Compensation Insurance Cartier and Policy number am:
Carrier: Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu section need not W completed if the permit is furan,hundred dollars(5100
or less.
I certify Not in the performance of the work for which this permit u issued.I shall not
employ any person in any manner so as m become subject o th,Workers''Compensation
laws of Califpsui
Applicant I - —
NOTICE TO APPLIC :If,after making this Certificate of Exemption,you should
Wcome subject m Ne orkers Competwtion provisions of Ne Ichor Code.you muse
.J 0 forthwith comply with men provisions or this permit shall W deemed ldveked.
z'—' CONSTRUCTION LENDING AGENCY
rrt I hereby affirm Nat dere is a Compunction lending agency for the performance,of
p: 7 On work for which this permit is issued(Sec.309],Co.C.)
U 0 Lender's Name,
Lender's Address
(„)Q I certify Nat 1 have mad this application and state Net theand
above information misting is
D. F building 1 agree to comply with all city and county Ordinances Of and sum laws T upon t e
CJ V movengcotioned property
and hereby auNorimldoses. tivcs of Nis city minter upon N, /�—
[61 above-mentioned I.save fmiwpcctionpurposes.
(We)agree to saw,indemnify and� keep hamlets doe City of Cupensagainst liabilitles,judgmcnu,costs and expenses which may in any way accrue,against mid City -•O
U z inconsequence Osgood. of r n.
t—' APPLICA DE D A WILL PLY WITH ALL NON-POINT Issued by: Date
SOU
Re-roofs
Signature pr'Applicam/Conaacror Dole
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant stare or handle haesudous material
Cu defined by Nc Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Code,Scc1m 25532(.)? All roofs shall be inspected prior to any roofing material being installed.
DYcs @�
Will thea fcn a or mNm building Occupant use a If a roof is installed without first obtaining an inspection,I agree to remove
pp 6 p a Air Qu or devices which
it District' dons air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
Distrix? _'' l
❑Yea yev�
1 have mad the Woodnus materials requirements under Chapter6.95 of the Califor- (//_s
nialinti"SafctyCodc.Secfow25505.25533 and 25534.1 mtknund don ifOm Wilding N.Fa' �l �q / rtr_+i
docs non curt, h atena Lda ' my ldspo^ibilaymnofry N,occupennorthe / d ! aCJ
rC, ,met ich a or issuance �CcmfTareOfOccupanp,. r s Signature of Applicant Date
owns or anmedx,d agent 7�/ / All roof coverings to be Class "B"or better
Community Development
'' '' 10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPEkTINO
Building De artment
JOB ADDRESS: 9, 103 , G � bl�"— PERMIT #O 5 O Z00`-15
OWNER'S NAME: C�� PHONE # --1 z (o
GENERAL CONTRACTOR: FAX#
I am not using any subcontractors:
I 'signature Date
Please check applicable subcontractors and complete the followinginformation:
21 SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
AM Linoleum/ Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
AdIlL
// Tile
Owner Contras or Signature Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408) 777-3228
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.
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: Z/O ;// l /tz2vv(� a p !U
LRoofing Company Name: / , 1,2
A plicant's Signature: - Date: �6 7 4S
• Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF
CITY OF
CUPERTINO PERMIT APPLICATION FORM
APN# 3 Z / d p v-3-3 Date: 2-1-71C)
Building Address: 2-1031 G/LCx n U�J
Owner's Name: � � OLILA Phone#: �?-S ?2-
7
Contractor: / Phone License#: ,
,�J
2 1
5
Contact: L-/w` Phone#: Cupertino Business License#:
c.�,..�_
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
Asphalt Shingles '9C Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings J ❑ Provide I.C.B.O.Report#
To be Removed ❑ Provide Mfgr. Installation Specs.
® I Have Read, Understand and Will Comply With Cu ertino's Tear Off Polic
Job Description: 7/0
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Deft. if
there are any restrictions: LJ
Cost of Project: Type of Construction: Occupancy group:
/5, 772 . trD
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
® S�
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