05100027 (2) CITY OF CUPERTINO
BUILDING DIVISIONPERMIT ;.CONTRACT,OR41NFORMATION
BUILDING ADDRESS: LINDY ROOFING CO INC PERMIT No.05100027
LEAF PT.
OWNER'S NAME: PERNUT ISSUE DATE
JNAN NAYAK 5554 HARVARD DR 10/0(;/200S
NE: SANITARY NO. CONTROL NO.
(408) 286-9990
ARCHITEC iENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
10o LICENSED CONTRACTOR'S DECLARATION
de G I hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description
U wlN Scnion]Of1U)uf Divi on rMo Businca�an �n c ce,endo license is
in ren roree and arc — t D� y REROOF-T/O SHAKE, INSTAL L .
n g= License C s Lic.I
4Rn DdIC Can IVL
�'J' ARCHITECTS DECLARATION
1¢ I uMcrwnJ my plans shall he used u public recnrgs
�cU
g C) �Lkcnug Pmfcssional
D 3 OWNER-BUILDER DECLARATION NOV
ZOO 1 naso .Isere on 1 1. cacmpt from he Contractors License c ty O for the �oo
ip0 (Allowwhichin,unson.(Scrit to I]1.3, t.me,unprovss and e.diians Code:Any city orooumy ,1729
7—w ! J•
$ which squire a permit m conmru a alma improve,de Permit
t ter a pair any umaner, 820000
—ii Ptiormits issudnce.alsu rcquifv Ne applicant for such pcfmiuofilcasigrcJ smtemcm ,
$ matneisfigensedPrtsaammNCProvisinn,nfNeCnmrumr;Lh<ntel,w(Chapter9 Sq. FLFIoorArea (�Vs� ion
YFG baIn,I...with Sation70W)of but$n3of thecgcd Cass And Any
yvilation
Q Nes io I.exempt therefrom and Nc basis it Ne alleged esemptian.Any violation Of f+ s
Section]031.5 five
any applicant for a permit subjects Ne applicant m a civil penalty of
nos mom Nan Ove hundrtd dollars(5500). rU0 Occupand�Type
I,As owner of the property,in my employees with wages ss their sole compensation,
will do Ne wark,and uheswctum is wt intended wagered formic(Sec.7044,Business
and Professions Cadla
e:The Conamemes License w does m not apply an Owner of Required Inspections
property who builds orimproves thereon.and who docs suchwarkhimself wuhrough his
own employees,provided Nm such improvements are not intended crolfereal forsale.If.
however.Ne W iWing of improvement is sold within arc year of completion.Ne owner-
builder will have Ne Wrden of proving Nat M did not Wild or improve for purpose of
sale.).
❑1.as owner of the property,am uclusively convecting with licensed CAA=l rs to
construct the pmjcct(Sec.7044,Business and Professions Cade:)The Conmcmr's Li.
cave Law docs not apply to an owner of propany who Wilds or improves therton.and
who contracts for such pmjccts with a comracmr(e)licensed pursuant An the Canvaaah
License taw.
❑I am exempt under See. ,B&P C for Nis reason
1301M
wner Date
WORKER'S COMPENSATION DECLARATION
I hereby affim under pevlty of perjury one of the following declarations:
1 have and will maintain a Certificate of Consent m self-insure fur Workers Compen-
ion,u provided for by Section 3700 of the labor Code.far Ne peRafmance of the
wk for which Nis permit is issum.
1 have And will maintain Walk,',Compensation Insurance,As m9uirod by Section
m Ne labor Cade,far the performance of the work for which Nis permit is issued.yWorkerC'L+-Compensation 1vuNOCAmrierandPolicynmera —a' 'YiT JfA4Ls•4PCRq No.:
I�ODID3 (O
CERTIFI TEA�OFFXE; P IDN FROM WORKERS'
COMPENSATION INSURANCE
(Thu uedan need not W crmpieucd if the permit is forma hundred dollars(Slaw)
in less.)
I comfy Nat in Ne perfMon-nee of the work for which Nis Permit is issued,)shall not
employ,any person in any meoner so As An bccvmc sobj,c,in Ne umrkni Cwnpevation
Laws or Califomia.Data
Applicant
NOTICE TO APPLICANT:If,after making this CAME,=of Eaemption,you should
become subject in Ne Warner's Compensation provisions of Ne labor Code,you must
0z foMwiN comply with such provisions or Nis Permit hot]W deemed revoked.
Z2
CONSTRUC ION LENDING AGENCY
(-+ I hereby affirm that Vert is aconswninn lending agency In,the performance of
a 7 the wad fur which Nu permit is issued(Sec.7(19'1,Civ.C.)
W Q Landers Name
az Lender's Address
V C) I comfy Nat 1 have read this application and sank Nat the above infwmatiun I, -
lg, fir coned 1 agree m coprply with all city and county endurances and suite laws relating in
V building convection,and hereby authoum repreunuitimat of this city to cater upon dte
W shove-menunned propcny for,exNa an purposes
,r py (We)agree m save,indemnify And keep homeless Ute City of LLPenino against
uj in
of
rousing of thisrswhich may in any way accrue against said City
V z in carnequence rf the granting of this permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL ON-POINT Issued by: Date
RECiULAT10N 1J `_
—�--- "�-• 11+ p Re-roofs
Sig f ApplicmuUnnfanor Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicmn m future building occupant mom or handle hvallov material
u defined by ft"Cupertino Muni I Code.Chapter 9.12,and Ne Health and Safety
Code,Orton 'C-
All roofs shall be inspected prior to any roofing material being installed.
Yca Nr
If a roof is installed without first obtaining an inspection,I agree to remove
Will the app or or fumm W'IOing Occupam use equipment or devices which g p g
7Diairicl
narardous aircontaminants fined bytheBayAreaAir QualityMmAgcnlenl all new materials for inspection.
❑Yes Nul have reml Ne hvaNtwsmateriais nA,.M ,aAadrChapter6.95 ofthe CiliforxH.IM&SafnyCade.Sectimv25305,25S77 and 255X.l undcrsund thatifthe Willingt cuncmly have a tenant,Nat it u my rcspovihili y m nosily the cupant of Ne
uim sew ;r.°eem``p�°`wL�f'C`"'"""tfp `y' ig ate IApplicant Date
n rate >caagent Dam All roof coverings to be Class "B"or better
Community Development
J 10300 Torre Avenue
F , . Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
OPUPEkTINO
Building De artment
JOB ADDRES : PERMIT #
/oaf o c"-r r4.
OWNER'S NAME: TAQ., q/a <— PHONE # (—
GENERAL CONTRACTOR ACU, FAX # g(0—Q ?
I am not using any subcontractors: ;Ln.(.JQ.�, —,(`v y OSS
Signature Date
Please check applicable subcontractors and complete the following 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
-n a..)Q, ,..._ , Uh—S—a 5
Owner/Contractor Signature Date
Community Development Department
Building Division
City of Cupertino
• t'CITY OF 10300 Torre Avenue
Telephone: (408)777-3228
C O P E IST I N O 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.
Homeowners Name:
Job Site Address: Jr/ QG/L�L-4 a-P
Roofing Company Name: LI ncly YC 110 l�/1 KJ.
Applicant's Signature: ')'1 LJL _ - _l Date: /d^s6�
Greg Casteel t///
Building Official
Revised 11/2/09
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF
• CUPEkTINO PERMIT APPLICATION FORM
APN # / ' 5 Date:
Building Address: /oo✓�-q 00 Kletw , /0/-/0/- aim
Owner's Name: TAS �n'I/a aK qO9- (o— 7y7
Contractor: c/ Phone#: License #:
�..r ' l2ou�i' ' Cv . yog•a8G�r4,a ��581�
Contact: Phone#• 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 Polic :
Job Description: moa , in gyy,a„
rCoal a s`Fier - /to m4 PI-LLO acC Uses c s
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are qnv restrictions: LJ
Cost of Project: Type of Construction: Occupancy group:
� llUa 2- /ZUU�y`p cS l/1
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM I Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
J-
27
-
27�' S-�