05080135 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION""",;
BUILDING ADDRESS: LINDY ROOFING CO INC PERMITNO.05080135
n681 TA RODA DR
OWNER'S NAME. PERMIT ISSUE DATE
ELLEN MARTIN 5554 HARV 0811612005
)NE:
SANITARY NO. CONTROL NO.
(408) 286-9990
ARCHITECDENGINEEK: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
u0, LICENSED CONTRACTOR'S DECLARATION Job Description
w 1 hereby id to that 1 am Bestowalunder provisions of Chapter 9(commencing
Z with Section 70M)" Division Jof the Business andPessiuns Cade.ind liccnu is
infalifaaande9 L1C REROOF-T/O SHINGLES, RESHEET 1/2" ,
yvtI? License Claz
;tea Dam Coal 30 YR. COMP. SHINGLES
Lpp ARCHITECTS DECLARATION'
eC-a I understand my plans shall W used a public records
ga(n Licensed Professional
5 OWNER-BUILDER DECLARATION R
q 1 hereby anon Nat 1 em exam,,from the ConuactoYs License taw for tWY:.; J
p o following mason.(Sactiun](131.5.Business and Professions Calc:Any city or county p /"
E m which inquires a,e.is m construe,,¢loaf,improve,demolish,or repair any amaum Ste"
°ia prior In,its iauance.also requires the applicant for such permit m file a signed statement
< that heisuansedpursuant tothe proviamn,nfthe Contractor's License Low(Chapter 9 - Sq.F[.Floor Area ^�a Uau t��I70
��3 (commencing with Section 7")of Division 3 of the Business and Profusions Coae)or J
— Nat W is uempt thcrtfrom and the Eau for on,alleged exemption.Any violation of
Section 7031.5 by any ispplicvtt for a permit aubiecsa use applicanun a Civil penalty of r
na,mare 0.five hundred dollar,(s50y. Number Occupancy Type
L,a owner of ro 36933050 . 0 0 667
❑ p surmount
myed employees withtage compensation,
ss
and Pordo newons C d e:TheC Contractors tors Litems, aw doesad not apply an owner of Required Inspections Nk^.�'
and arty wh ore Code:The ma Brennan.
Li who Law does not apply ff an owner of q P
progeny who builds or improau,chicon.and who dao such work himulr or Brough his
own employees,provided door r rev rr improvements are not ear of
moRercd for Ola If.
however.the buildingftCarimprovementis sold within ane year or completion.reeowrmr-
saleI. will have race burden of proving Na,he did m,Wild or improve for puryou of
salt.).
❑1,as owner of the property,am exclusively contracting with licensed convectors to
consumer the projcn(Sec.7044,Business and Professions Code;)The Contractors Li-
cense law does not apply in an owner of property who Wilds or imprimis Merton,and _
who Contracts for such projecas with a contractor(s)licensed pursuant to the Conuactoes
Lien.Law.
❑I am attempt unser Sc,. .B&PC for Nis rtazon
..... .Owner Dam
WORKER'S COMPENSATION DECLARATION "s'' - - "�_ •
1 hereby affirm under penalty of perjury one of Be fallowing dulamim e IC3
IharcandwillmainuinaCcnifiateOf Continuo self-insure for WOrkefS COMNn-on,az provided far by Section 3900 of doe laWr Cade,for Be performance of Nerk for which Nis permit is down.
1 have and will maintain Worker's Compensation loon,az required by Section
0 of the La Wr Code,for the performance of Ne work for which Nis peonit is issued.
Worker's Compenstion Insunae Carrier and Policy number arc:
rier: Policy NO.:
CERTIFICATE OF EKEmirnoN FROM WORKERS'
COMPENSATION INSURANCE
(Thu section need not Wcoun and ifthe permit is form=hundred detiam(SIM)
loo)
1 anify Out in the perfummanee Of the work for which this permit is issued.1 shall not
cmployany parson in any mplt� ann mW TbjOCN.the Workers COmpensadmi
Laws of Calif ��(.
Applicant
NOTICE TO APPLIC NT:If.after Wd0nF Nis Ccniftcaue of Exemption,you should
become sdoritt m the Worker's Compensation provisions of me Labor Code,you muss
.J z foMwim rom,I,with such pmvisimu or Bis permit shill W deemed revoked. -
'Z O CONSTRUCTION LENDING AGENCY
'rn� IWreby affirm ma,Bert is a coastrucdon lending agency for Be performance of '
E
Bc work fur which this permit is issued(Sec.3097,Cr,C.)
W Q Lender's Name
D. Lcnderi Address
Jz
U Q I ttni(y Bat 1 have,cad this application and sum Bat the above information Mining to
0 U burtctt 1 agree to comply with all city and county oNinaaS Or and sure laws¢lacing e
U building construction.r and hereby authonparapmaenmtivcs of Bis city mcnterupon Bc
r W ,hove-(Weianeapro peaty far inspection keepha.
CL (We)Came to save,indemnify and keep harmless the,City of Cogent against
UZ li conaeajudgments.co¢o of th which may in any way accrue against said City
Uz S URGE cncc of Br mit r(%%�
^ APPLICANT U RSTAN ILL CO LY WBIH ALL )ON-POINT Issued by: Date O /O
SOURCE
*;6A=
Re-roofs
Signature of Applicant/Contractor I Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will me applicant or future Wilding occupant store or handle havallous mammal
az Ik%d by doe Cupenin0 Municipal Code.Chapter 9.12,and be Heath and Safety
Cade. Des 2592(,)? All roofs shall be inspected prior to an roofing material being Dyes ❑Na P P Y g g installed.
Will the applicant or future building Occupant uec equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
i,hazardous air Conmmi isons a darned by dte Bay Area Air Quality Management all new materials for inspection.
isait"
OTCs E:)No
Ihave&Safe Naha,&Co sma505. 553ls 3 itenuunwr4.1u Chapter
tand 0.if he Wilding n
or
nia Neal B&Sa(it Cade,tenanns255115.25y rand3s5JhuylecrsundeoiflM Wilding \`-'-i'-""_'J(_ Os
does not cuncndy h ro a tenant,Bat is i y rcspoat 1I'ny m nutily tW rccucanm nr Bc la
rcgairtmana wn' aa;bcm n a' anac or CaNrreatC Car Occa Signature ofA licant Date .
Owner Or autbonactl aFcnt D,L All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
� Cl OF Fax(408)777-3333
UPEI�TINO
Building IVartment
JOB ADDRESS: ��w DoERMIT#OWNER'S NAME: HONE # aS2 - 6V 8
GENERAL CONTRACTOR: {� AX #
I am not using any subcontractors: r k ie&
Signature Date
Please check applicable subcontractors and complete the followin 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/Contracto ignature Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
C�1 ���!�'I V® 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.
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 comply with the above stated policy on re-roofing.
Homeowner's Name: C / /
lob Site Address: l e l0 87 4 az k0 A_
Roofing Company Name:
Applicant's Signature: Date:
Greg Casteel
Building Official
Revised 11/2/04
CITY OF CUPERTINO
Val - REROOF
11CUPERTiNO PERMIT APPLICATION FORM
APN# 3 ` y _ 3 -3 — O S D Date:
Building Address/U
Owner's Name:��'p t� Phone#-2�Z G d 7 8
Phone #: License#:
Contractor:/ - 6 ' r1 rl t! v - --2-! -
Contact: p Phone#: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt ShinglesAsphalt Shingles
C3 Wood Shakes O Wood Shakes
-y— Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing covering ❑ Provide I.C.B.O.Report#
�( ElProvide Mfgr.Installation Specs.
To be Removed
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Polic :
Job escription: Q� 3v 2
To GJs O�
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Det. if
there are any restrictions: IJ
Cost of Project: 9� Type of Construction: Occupancy group:
/S /7o
Qty. if Fee Description Fee Grou
9licabl
e Fee ID
BPERMFEE
Bld Permit Fees BUILDING
BENERGY Ener BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING