03100150 (2) CITY OF CUPERTINO 3
BUILDING DIVISION PERMIT CONTRACTORJNFORMATION s
BUTLDINGADDRESS: LINDY, ROOFING CO INC PER"IT"ID 3100150
OWNER'S NAME: 5554 HARVARD DR FERNUTISSUEDATE
H LLIMON MARSHALL H AND ROBERT 10/21/2003
IF"E: (408) 269-2025 SANITARY NO, CONTROL NO.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
00 LICENSED CONTRACT'OR'S DECLARATION
?�� 1 hereby affirm that I am li=med under provisions of Chbpmr 9(commencing lob Description
with c wn7(%%q of Division3 orthc Business aM Profcssiwns Cndc.and mylicense is
ecu, Lie reeaWer t. REROOF/REMOVE SHAKE AND ISTALL 1/2 OSIS AND 50
;q3 sea m a Liaru COMP SHINGLES
D,a,¢11 ' Cwnmumr rA"1
iF �/lu ra�an pla Ra Hl used E cods ��1��®�
CCJ
;iV
ao Licensed Pmfcainna NOV
OW NER-BUILD R DECLARATION _ 2003
<q I hereby affirm that 14m exempt from the Contractor's License Law for the
'N p O following reason.(Section TO 1.5,Business and Profeasions Code:Any city or county
� which requiem a presort to construct,alcor,improve,demolish,or repair any souctum
a��n prior Lo its issuance,also requires the applicant for such Nrmiuo rile a signed statement
ego that he is licensed pursuant to the ptnvinions of the Contractor i License law(Chapter9 Sq. Ft. Floor Area alua 100
(commencing with Section 70M)of Division J of the Business and Professions Code)or
3 $ hat he is exempt shemfmm And Ne basis for he alleged exemption.Any vin4lian of
Section 7031.5 by any applicant for a permit subjects the applicant a civil penalty of or Occupancy Type
not more than Rve handrail dollars(8500).
❑1,u owner of the propeny,or my employees with wages u inch sole compensation,
will do the work and the swctum is not intended or offered for sale(Sec,?M .Business
and Professions Cale:The Contractor's Littman law dors not apply to an owner of Required Inspections
Property who builds or improves themon,and who doessuch work himaclf wrthmugh his
own employees,provided that such improvements an not Intended or offered for sale.IL
havens.the building or improvement is old within one yam of completion.the owner.
builder will have Be burden of moving than W did am Wild or Improve far purpose of
ale.).
0 h as owner of the properly,am exclusively contracting wish licensed contnstnrs to
consumer the project(Sec.7044,Business and Professions Code:)The Contractor U.
cense Law docs not apply to an owner of property who Wilds or improws thrown,and
Who contnca for such projects with a contractor(a)licensed pundsm to the Contractor's
License Law.
❑ I am exempt under Sec. B&P C for this moron
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury oro of the following declarations:
1 have and will maintain a CcniO=m of Consent to xlf--imam for Workefs Cumpcm
salon,As p,.video far by Section 3700 of the Labor Code,far Ne perfsomu¢e of the
work for which this permit is issued.
❑1 have and will maintain Workefs Compensation]mum=,As teyuimd by Section
3700 of she la Wr Code,for Be perrormame of she wok our which this permit is Issued.
y orkcr'cC pgtsetionl sunnee;Trio andPoliAn Wrart:
rttcr: �,`vp Poli`,N
CERTIFICATE FE%EMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not W completed if the permit Is foram hundred dollars(SIUt)
or los.)
I certify that in the performance of the work for which this permit is issued,I shall not
employ any person in any manner so as to become subject to the Workeri Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:It.after making this Car ificm4 of Exemption,you should
become subject W the Workers Compensation provisions of the limn,Code,you must
O forthwith comply with such provisions m this permit shelf W deemed mvuked.
Z y CONSTRUCTION LENDING AGENCY
I hereby=Rum shat there its mosame m.lending.gamy I.,de perfmonamm of
].a the work for which this pernit 4 issued(Sec.3097.Civ.C.)
a1 QLcnder's Name
3.
3. ,Z U.der'.Add.
C) 1 cenify that I ban mad this application and sum bear the above information is
y F correct.I agree to comply with all city and county ordinances and sum laws relating to
DU building commotion.and hemhy auhorinmprenotatives of thio city to enter upon the
N a above-mentioned property for inspection purposes.
(We-)agree to ave,indemnify and keep harmicw the City of Cupertino against
rA liabilities,judgments,coats and expenses which may in anyway accrue against said City
m� APPLICANT UNDERSTAND ND WILL COMPLY WITH A NONPOINT Issued by:34tQ�64 Date
SOURCER G A'CONS.
Re-roofs
Signature of pplieanU ante Data
HAZARDOUS MAERIALS DISCLOSURE Type of Roof
Will tieapplicant to to,..buildingoccupanuom or handle h,a mm;amacrlal
As derincd by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
We.seadeazssJz(a)7
Yea All roofs shall be inspected prior to any roofing material being installed.
�
Will the apPlican mum buil doe"paml arc equipment or devi=s which If a roof is installed without first obtaining an inspection,I agree to remove
It heratdnus air c mine..a recd by the Bay Arca Air Quality Management all new materials for inspection.
c left
❑Yes No
I have mad the hasNnus materials¢yuimmcna under Chapter 6.95 of the Calif., w,A `
nix Hcolt currently haw
Cw at en 01.3.1 It My tesnd7.5534.1 undcrsmnde om,.M Willing ��/Va /�O
doesnotc&S.1fy hawason r,Nat0, 553find 25ions,534,1 annotifyd t ref III, ilthe ___WWWfff """aaarrr
m i cn i`must cipeor as..Our fOccupan % Signature Ap Ica Date
Owner or mhodud=gen Da/ 0 All roof coverings to be Class "B" or better
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
UPEI�TINO
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) h1-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.
i
Homeowner's Name: Ile ��! �✓+ (,7 N
Job Site Address: Z A P.d/Ofin
Roofing Company Name: L / Drj (1D'
Applicant's Signature: Date:
• Greg teal
Building Official
Revised 1/30/03
Printed on Recycled Paper
J3 / oaiSQ
CITY OF CUPERTINO
REROOF
CUPEI�TINO PERMIT APPLICATION FORM
APN# �� 6 Date: _
Building Address:
&� L O[rn
Owner's Name: Phone#:
Contractor: Pho e#: License#:
WL6D - S
Contact: 4hone#: Cupertino Business License#:
/H
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
X Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings_� ❑ Provide I.C.B.O.Report#
XTo be Removed ❑ Provide Mfgr. Installation Specs.
• I Have Read, Understand and Will Comply With Cu ertino's Teg Off Polic E-1Job Description: 2 , co, SL1,,e , .e S ` 9, - a N `
r �
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are an restrictions: LI
Cost of Prcjec 7, '! Type of Construction: Occupancy group:
Qty
A 1' a e 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