02120001 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTORINFORMAT10-
BUJIF10-ID901FsMERRIMAN RD LINDY ROOFING CO INC PERMIT N(02 12 0 0 0 1
OWrMIGN, ABE MICHAEL A AND JOYCE 5554 HARVARD DR APPLICAT1412lfb(`IY2002
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ZONE: (408) 269-2025 SANITARY NO. CONTROL NO,
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
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I hereby affirm That I am licensed under provisions of Chapter v(commencing REROOF p
F. w with Section](NNp hf Uivision3of the Business dPnResvinns Cndc,and. license is
m in full fine andy leen.License �h /�
F,y H n Date Comment �1�A o
�oaa lull .and my plan.Rshal lx.uscdDas puhlicrt nods ,
3w°
Licensed Professional JAN 2 2003
OWNER-BUILDER DECLARATION
eZ <f I hereby affirm that 1 am carbon foam the Contractor's License Law ler the �11
i�OO following reason,section 9131.5.Business and Professions Code:Any city or county $3700
`WILDING
x 2� which requires a permit to obstruct,alter,improve,demolish,or repair any structure
tto-ZN prior m its Issuance,also mconerthe applicant for such Permit it) a signed statement
< that he is lice had pursuant to the provisions of the Contractor's License Law(Cbaomo 9 3 2FFY.fl7nb®A109 Valuation
J�Q (Commencing with Scnion]INN)of Division 3 of the Business and Professions Code)or
y that he is exempt location.and the basis for the alleged exemption.Any vir latino of
Section]031.5 by any applicant for a permit subjects the applicant to a civil penally ofPN'N Occupancy
not more than five handled dollars(5500). 307 - INSULATION p y Type
D1,as owner of the property,or my employees with wages u their solo compensation,
will do the work,and the structure is not intended or offered for sale(Sec.]OW,Business �'p7�}r
and Professions Code:The Contractor's License law does not apply to an owner of 6 0 2 — ROOF P 2/Y V nSP6Cti0ns
property who builds or improves thereon,and who does such work himself or through his 1gkc LI
own employees,prmided that such improvements are not intended or offered for sale.If, 603 — ROOF BATTENS
however,the building or improvement is sold within one year of completion,the owner- 604 — ROOF IN-PROGRESS
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
D 1,as owner of the property,am exclusively contracting with licensed con.elk rs to
consumer the project(Sec.7(W4,Business and Professions Code:)The Commelor's Li-
cense Law does not apply to an owner of property who builds or improves former.and
who contracts for such projects with a cuntramor(s)licunsed pursuant to the Contractor's
License law. t
❑ 1 am exempt under Sec. .B&P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of Ne following declarations: ,
I have and will maintains Cenifeme ofConsenr to self-insure for Worker's
satas provided for by Section 3]W of the"her Code,for rhe performance of the
work for which this pennin is issued.
❑1 have and will maintain Woimmis Compensation Insurance,as required by Section
3]q)of the Lnhnr Cade,for the performance of the work for which this permit is issue.).
My Worker's Compensation sumuce Cartier and Policy number me d
Caricr%� Policy RO ORKnR
TPI ATE OF BXEMPPON FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars(Sla)
in
I certify than in the permonance of the work for which this permit is issued.I shall not
employ any person in any manner sit as bh become subject to the Workers Cobocnsarinn
Laws of California.Dane
Applicant
NOTICE TO APPLICANT:If,after making this Cenilicate of Exemption,you should
become subject ah the Worker's Compensation provisions of the Labor Code,you must
OO forthwith comply with such provisions or this permit shall he deemed revoked.
z CONSTRUCTION LENDING AGENCY
F I hereby affirm that there is a conswetion lending agency for the performance of
�i the work for which this permit is emed(See.3097,Civ.C.)
Q.1 Q Lemer'a Name
jz Lenders Address t
V I certify that 1 have fend this application and state ihnt the above infomadi n is
cortic'.lagoee to comply with all city and county ordinances and state laws refiring to
QU building emislamion,and hereby authorise mprescrokoves of Nis cityit,aam,upink the
Lkl above-meminned prnpeny for inspection purposes.
G (We)agree to save,indemnify and keep hamdese the City of Cupertino against
p3 liabilities,judgments,costs and expenses which may in any way acme against said City -r /
V z APPL CANTurrequioweUNDERSTANDS of the gromfing of IAND his Permit.
L COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE GUL NS.
Re-roofs
Signa ren Ap he on acro ' Date
HAZARD s MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant stare or handle hamolous material
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
DYrs 9^11
Will the applicant nr future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
until has dam,air contaminants,as defined by the Bay Area Air Quality Management all new materials for inspection.
Died,I
D Yes kin
Ihave,&Safmad me Cook.SNousmam05.2533 lk and 255ras underdersmdthatefthc Callinr.
g a
his HcaW&S:dby Gve a tenant tht 5.25533 and 25534.1 understand marybera uparri building ` /t,I
Jrcs not currently have a tenant Nut l is my respuni 'liry m netify the Occupancy nl nl the !� (Lf `/ LG/ 1.1
requirement which mu ren oissuancc aCcnifhca¢of Occupancy. �_ /
Signature of Appli I Date
nor or awhorizcd m Dam
All roof coverings to be Class "B" or better
r
Building Division '
10300 Torn Avenue
D '0 f2 Cupertino,CA 95014-3255
LSD Telephone: (408)777-3228
4O 2 ZOO Pax: (408)777-3333
CUPC,EkTINO _
By_
Buildi Department
Subject: Reroofing policy for the City of Cupertino.
1. Prior to permit issuance,you must agree to comply with 1997 UBC Standards
and manufactures specifications on reroofing.
2. ,New roof coverings shall not be applied without first obtaining all inspection
Wand written approval from the building inspector.A final inspection and
approval shall be obtained from the building inspector when the reroofing 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) Preinspection 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 that the
proper City inspection can be performed.
IMPORTANT:
1. Plat roofs must have a minimum of Y"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 of inspection.
We understand the above policy on reroofing and will comply with this policy.
Homeowners Name: Cly
Address: '/ �? 11&7 -,d I)
Reroofing Company Name: i p
Applicants Signature: Date:
Joe Antonucci
(Chief Building Official)
6/25101