04110109 (2) - CITY OF CUPERTINO • - - "K '
BUILDING DIV I SION.. _ ...-PERMIT -.., "XIC1 RAk0-TO�RXI k�R t�.'�.'I4 '
_ BUILDING ADDRESS: LINDYROOFING CO .INC ERMITN X4110109
10413 'MERRIMAN RD
l
OWNER'S NAME: - PERMIT ISSUE DACE
MAUREEN FISHER 5554 HARVARD DR 11 /17/2nO4
' ONE: -. _ . ,
SANITARY NO. CONTROL NO.
(408) 269-2025
ARCHITECT/ENGINEER: -BUILDING PERMIT INFO -
. LDG YELECT PLUMB MECH '
upp LICENSED CONTRACTOR'S DECLARATION Job Description
ZV I hereby affirm Out l am licensed under previsions of Chapter 9(commencing
w with cra.70fludof Divimon3of B MnmmdProfeuitma Codc.andmylicenwis
n Ifome ane free. '' �' REROOF
Dam -
' A HITECI' DECLARATIOI
oder my ah l d u Puhlic records -
C Lice
oWw
OW RBUILDER DECLARATION
I,mem affirm that 1 1. exempt from On ContnsCo License Law for the
O O following mason.(Section](131.5,Bluffness and Pofeasiuns Code:Any oily or county
$ which requires a Pconh m construct altar,improve,dcmnitsh,or repair any structure - -- --
_ m prior m its issuance.also requires the applicant for such Permit o file&signed sutamenl - - -- - _
F C
Out WI,Holmes pursuant to the provisions of me Contractor's License Low(Chapter 9 Sq.Ft.,Floor Area... . O'./Valuation
ac (commencing with Section 7")of Division 3 of the Business and Professions Code)or 1
WWI Out he is exempt therefrom and the buts far the alleged exemption.Any violation of
Section 7031,5 by any applicant for a Permit aubjocs me applicant to a civil penalty of e 0 Occupancy Type
not more than five hundred dollars($500).
❑h anowner of the property,or my employes with wages u theirmle compensauan,
will do Be work,and me swctuce is notimen had reoffered Peraak(Sec.7044,Business
' end'PmRvmais Calm:The Commcmrh Limn.Law dors in apply in an..or of - ''Required Inspections
property who builds or imprown thereon,and who does ouch work himseif or trough his
own employees.provided that such improvements are oat intended reoffered forsak.If,
,.„. howaveq Ne building or improvement is mid within one year of completion,the owner- -^ - - ^-^-r•- - - - _-
- builder will have the burden of proving Nat be did not Wild or improve for purpose of — •--« .. _..-_.. __._
uk.). -
❑I.as ower of the property..B exclusively and
convecting with:) no Ccanwcmn to
close La the project(Sec,o in weer of antl Py,who ns Code:)The Caahemen.Li'
'
con.law dot fnot or such
ply m is owner of property,who sed ts purr improve themoq an'it
s
who conmes forsuch projects with econuacmKU licensed pursuant in Ne Canlrecmr's
License Law.
❑I an exempt undo,Sec. ,B&P C for this moon
137M
wner Dam
WORKER'S COMPENSATION DECLARATION
I herchy affirm under,penalty of perjury oe of tit following decimations:
1 have and will maintain a Cerufem,of Consent to self-insure for Workm's Compen.
tion,u provided for by Section 3700 of me labor Code,for me performance of the ._ _... .�___t_....-..
ork for which this permit is issued.
ofmc LobarCmmIllir the Performance
roacuiormilewark farwhich tis permit is iuucd.y/Workcl CnmPensauon I d Pnce canicr end Policy numor am:
v G
IF ATE OF EXEMP170NSGFj WORKERS'
COMPENSATIONIN RANCE
(Thissection need not becompleu l if the Permit is fnronehunmed ddlsn($100)
or lcm.)
I certify mol in the performance of to work for which this permit is issued.l shall net
employ any person in any manner an u to become subject to the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If.aRcr making this Candles.of Excmptian.Yeu should
became subject to to Workerb Compensation provisions of me labor Cade,you must
.J O forthwith comply wish such provisions re this Permit shell be deemed revoked. -
Z M CONSTRUCTION LENDING AGENCY
(..l I hemby affirm mat mere is a construction lending agency for the isolmmmce of
C the work for which this Permit is issued(Sec.3091,Civ.C.)
W A Lender's Name
jz Lender's Address -
U Q 1 certify that I have mad this application and state Nan me move information is
W E' correct I agree.comply with all city and county adinanms and state laws relating to
�U building construction.and hereby authorize representatives of this city to entre upon the
>d .have-mentioned property for inspection purposes.
(We)agree to save,indemnify and keep hummis the City of Cupertino against
o-Fi y
Liabilities.judgments.costs and eepeum which may in any my accuc against mid City
(J z in Consequence of the gaming of this permit
APPLICANT UNDERSTANDSAND L COMPLY WITH ALL NON-POINT Issued by: Date «t _
SOURC REGU
Re-roofs
ig'-U. o 1'an Con r Dam
xAZARDous MATERIALS DISCLO Type of Roof
Will the r ll -Imardousmamrial
as defined by dm Cupertino Municipal Code,Chapter 9.12,and me Hao and Safety
ode,section 2ss32(.n '/ All roofs shall be inspected prior to any roofing material being installed.
❑Yes 171 Na '
CCC If a roof is installed without first obtaining an inspection,I agree to remove
Will to applicant or future Wilding occupant use equipment or devices which
mit hazardous air c oularmans u defined by Ne Bay Area Air Quality Management all new materials for inspection.
District?
❑Yeses
1 have mad the ha pious materials requirements under Chapter 6,95 of the Califon
nom HcaW&Safety Code,Stelios 25505.25533 and 25534.1 mokneadmd if lbe Wilding
docs not currently haw a mart,mal it,s m ro mility m nodl'y tbe occupant of the
myuile is
u met prior on
c .CenificateofOcc cyy. nature ofAp Date
Ower also ve agent Data 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 Department
JOB ADDRESS: i PERMIT #
MP. kAl
OWNER'S NAME: Mp,r, PHONE #
GENERAL CONTRACTOR: ` FAX #
I am not using any subcontractors: AJ17 /K -�'/
ignature Date
Please check applicable subcontractors and complete the following information:
63 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
;�, _
%Contrac or ignature Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
OCITY OF Fax: (408)777-3333
UPEkTINO
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). Sp7k.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: . 1%fyS E 5 Loa
,Job Site Address: y
Roofing Company Name: i.a�/ .tom Fi r Lao
Aplicant's Signature: t Date:
Greg eel
Building Official
Revised 1/30/03
. . Printed an Recycled Paper
CITY OFCUPE�RTINO
CITI'�OF CZE ROOH'
�CUFIZiT NO PERMIT APPLICATION FORM
APN#� 2 Z Date: //
/
Building Address:
'
e
Owner's Name: P { Phone#:
Contractor: i Phone#: /fid License#:
- /5
Contact: hone#: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles Asphalt Shingles
Wood Shakes ❑ Wood Shakes
❑ Wood Shingles _ ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ 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 Policy: ❑
Job Description;
�. Z
Residential ommercial:❑ /
Fire Zone: Yes ❑ No Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project: Type of Construction: Occupancy group:
A c 1 Fee ID Fee Descri tion Fee Group
MBPERNT
EE 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