05060133 (2) CITY OF CUPERTINO 7774.
BUILDING mvlsloN PERMIT �COA£TRACTQRIIVFOItMATIQN �
l Bu1LDINCADDIiesS: LINDY ROOFING CO INC PERMIT"05060133
l� OWNER'S NAME: PERMIT ISSUE DATE
LING H
ONE: SANITARY 0. if 2 0,12 0 115
CONTROL NO.
08286-9990
ARCHITEC 01INGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
u06 LICENSED CONTRACTOR'S DECVsofClup JobDescri tion
RATION
,w 1 Wreby affirm that I am littnud under provisions of gook. 9(commencing P
Z with Section]000)of 0ivixion3 oflW Busine am Pro(cuios mc.and my license is
"L1m,
imm�faroegndeH�
ZIS j1
]y�Z LK � Le.0 REROOF W/SHINGLES
1—q y
Dae / Jj]:,�_CuDELL O oUF�Kq
—�I 1_AR2C''HITECTnDECLARATION
�y W u I understand my plans.hall he used as public rtCOrde
n
a
Licensed Professional
a w 5 OWNER-BUILDER DECLARATION /r'•1- //
.� I I Wrth afliw Ness 1 am exempt Irvm Nc Condru7ota License Law for lW
y p o
following m .(Section](OLS,Business and Nufcuiom Code:Any city or county
which myuires a wit ns cnnswcl,elwq improve,demolish.rr repair any svumum l l // \`
priormits iuuancc, w¢quims she applicant for such permit mfleasigned suwmcm
f�c
that he is licensed pas m m the provision of the Connector's license Law(Chaper9 Sq.Ft.Floor Area "Val6ton
y, Q (crmmencingwilh Secti 7")of Division 3 of Ne Business and Professions Coke)or
Nat he u exempt themfm and the basis far de alleged exemption.Any violation of
Seconn]031.]by am/i ppli t fora permit subjects Be applicam to a civil penalty of f _
not mom thanfvehundreddo ($dao). 32yEPNB�O.�'®Cr00 ��� "Occupancy Type
Ej I,m owner of the property,or employees with wages u their solo comparisons.
willdo Neamleandtheavucwmu tinandedoraRered fonak(Sec.]abs,BuLniss ` nr, t rf�� V
arta Protection cmc:The crnuacw Littre law docs not apply w an owner of Required Inspections 1V.
propenywhobuildsorimprovesoemun,a who doessuch workhimulfor through his
ownemployces.providedthatsuchimprow tsarenminendmoeo0cmdfmsule.ir,
however,the building or improvement is sold w in ane year of in mpletism the nwmn
builder will haw the immune of proving that W di t Wild or improv for purpose of
ago.).
❑1,as owner of Be property,w eadmivdy conuxti with licertaed antacwrs w
comwct IW project ISec.]Oath Bminw and Pmfesdons ode:)The Comncmts Li-
come law does not apply wan owner of property who Wilds or improves theson,and.
who contracts for such projects with a canuaetor(s)licensed pursuant w the Conuacwts
License taw.
❑I ors exempt under Sec. B h P C for this mann
Owner Date
WORKERS COMPENSATION DECLARATION
1 hereby aB'mn under penalty of perjury one of the following dechuratiom:
1 have and will maintain a Certificate of Consent w self-insure for Worate,Compere
sation,as provided for by Section 3700 of the Labor Cone,for the perfrrts.of Be
work or which this permit is issued.
1 have and will maintain Worker's Compensation Insurance,as required by Section
370O.F he labor Cook.for to performance of the work for which this permit u issued.
My Worker,Continuum..Insurance eigriieryr,.@.'.ndePolicy nyI_gbS(art:
Cannot
nMlCl'j Lg4'vM $r"' hliry
CERTIFICATEOFEXEMPTIONFROMWORKERS'
a�aw CVPENSATION INSURANCE
(This eaalo.mead.mlecompaed if the permit is forme hundred unit.($100)
or lest.)
1 certify Nm in Ne perfrmnance of the work for whicM1 Nis permit is issue.I shall nm
employ any person in my manna tf otW Wortrmi Compcmaton
taws rf Calihrsia-Dam �r��I�r�
Applicant \dM �s
NOTICE TO Ie Work IL atom making this previsions
of w Exemption,you shuug
.,Obecome subject y the Workers Cores;or this pmvisions of Itw Labor Cede you mum
fuMwith comply with such provision or this permit shall W damn revered.
'�y ONSTRURIONLENDING AGENCY
(—� Ihemby affirm (demi$acdsx lion lending agency far the performance of
(Lam thc work fur which th6p it is issued(Su.309],Co.C.)
W A Lenders Norm
jz LendrIs Address
U Q 1 ceNfy that 1 has mad Ni plication non sae Uro the above infwmaoon is U. ^ correct.l agree w comply with all city county oNimuntts and sate laws miming w
O building construction,and hereby author' prtsemalo,es of this city w enter upon the
a Wve-menouned progeny for impaction pas res
0. (We).9.touse,indemnify and keep hmmless the City of Cupertino.&aims
h liabilims,judgments,cests and expenses which may in any way action against uid City
V Z in consequence of the flooding of this Permit.
^' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:S4tDate
2�k
SOURCE REGULATIONS.
Re-roofs
Stgnmum of ApplicanBConuacmr Dae
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will IW applicant or future Wilding occupant sem or handle hazardous maenai
as&.;n I by she Cupertino Municipal Code.Chapter 9.12.and the Heald and Safety
Cede, 0Yea 33532(.)? All roofs shall be inspected prior to an roofing material beim
❑Ya �Nn P P Y g g installed.
Will the applicant or future building=upon,use equipment or devices;which If a roof is installed without first obtaining an inspection,I agree to remove
it haxsrdnw air contaminants as dcfncd by we Bay Arta Air Quality Management all new materials for inspection.
oilet?
❑Ycs J2(1-
1 have read
NuIhavmm thedeSccros,2550alsmquand nts255 underChapocr dcrow6.95rfthe Calif.,-
not
mifory
ria Halthgrrmcry Cmc,kumt.that iti my responsibility
understandeoccuc Wilding
Jon not currently M1arc a crani Net it is my rtaponibility w notilj Be mcupanl of tha
mquim,{�\nawhich most Wmet poor to issuance ofaCertificaeof 'dose Sign re of Applicant Date
CT-
Owner agent V -- I All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
Cupertino CA 95014
Its, Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPERTINO
B ilding De artment
JOB ADDRESS:00( A9 P/) PERMIT# 0/ 33
OWNER'S NAME: LIA19 C PHONE #
GENERAL CONTRACTOR p / FAX#
I am not using any subcontractors:
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
Owner/Contractor Signature Date
Community Development Department
�, Building Division
I'' �{f �� City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
UPEf�TINO 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 statte�d, policy on re-roofing.
Homeowner's Name:
Oro
Job Site Address: ( �V ()/%
Roofing Company Name:
Applicant's Signature: q�~ ( C7 �G' Date: (// �0lc6
' Greg Casteel �—
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN# 2�>2 Vl ( 16 C:) ,S
6C:) ,S 2_ Date:
Building Address: (p
Owner's Name: )) Phone
L-1 n 6 ✓�'
Contractor: ) �7 /� License #:
Contact:
C� Cupertino Business License #:
Type of Roof Covering
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ,� Asphalt Shingles
,)K Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report#
ZX To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read, Understand and Will ComZ11 With Cu ertino's Tear Off Policy:
Job escription: rVn.CXQ_ • 5 rns oC
" �
c.� 4 acres nle ! �trf �i�n a► S, ln�
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning D�pt. if
there are an restrictions: u
Costo Project: T of Cons ction: Occupancy group:
O e60
Qty. if
A licable Fee ID Fee Description Fee Grou
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
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