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04070027 (2) CITY OF COPERTINO �=s'7!�� {��1'" f{� BUILDING DIVISION PERMIT - CO""�aWj^ ^,v, �� BUILDING ADDRESS: LINDY ROOFING CO INC PERMIT NQ4070027V 21947 OAKT.T?AF 21 OWNER'S NAME: PERMIT ISSUE DATE DAVID CHUI ONE: SANITARY NO. n r7 2 CONTROL NO. (408) 269-2025 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 _00 LICENSED CONTRAC'IUR'S DECLARATION - - V p I thereby affirm that 1 am licensed under previsions of Chapter 9(commencing Job Description C5.2 with Section 70NO (Division 3oflhc Business and Prufcasians CoM,and my license I- j�ia mu farce anderfen. 1 j REROOF _ Licenari lazg _ LIC.g ��e Dam Comncmrl' ! ARCHITECTS DECLARATI �( �i I understand my pima shall W used as public records DyV � Licensed Professional 3 Oat I a.aUILDER DECLARATION I hereby affirm tiro 1 am exempt from the Contractor's License Law for the p O following mama.Permit t ](131.5,Business and w,de io demolish, Code:Any city or county k m which requires a permit re cnawct alter,improve,demolish,nr repair any tatement _ prit es iniensedpa]uanttar o res thovisiosoftcant he Contractor's kensle a.signed(Chapter ant (c ahe meslicenad pursuant 7 the of Disioaz oftheLicense ii.n Cbap4r9 Sq.Ft.Floor Area /1 - ValUarlOn s�� 'at he Is attempt with cmim]000)of Divisiof r the, the Business and Prif.on.Any Code)or �/ ey.. that he V exempt therefrom and d¢bels for the alleged Gumption.Any violmlon of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally of ?�'NI EtSet0 Occupancy e not mom Nan five hundred dollen(5500). p y Typ ❑I.as owner of the property,or my employees with wag.a their$ole cichimma fin., will do the work end the structure ism[ or offered for sale(Sm.]09q Business and Profusions Code:Th.Contractor',Lima.Law dos not apply to an owner of Required Inspections propeny who bui Ids or improves Ihermen.and who dos auch work hi mseIf or through his .we employees,provided Nm each improvementa art nalionemI d aro@red fora]..If. however,Ne building or improvement is mid within one year of completion.Ne ownw- builder will have the burden of proving that he did not Wild or improve for purpose of salt.). 0 1,as owner of dm property,am.elusively contracting with licensed contractors to construct the project(Sec.7044.Business and Profusions Code:)The Comutor's Li. cense law dos not apply to an owner of property who Wilds or improves themon,and who contracts for such projects with ammnemr(U licensed pursuant o the Contractor's License Law. ❑Iamexemplunder Sec. ,B&PCforthismaon Owner Data WORKER'S COMPENSATION D RATION 1 hereby affirm under penally of perjury one of Nt following deciaaelions: I have and will maintain a Certificate ofConsenuo self-insum for Workch Compote satian,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑1 have and will maintain Worker's Compensation Insurance,as required by Section 3]00 of the labor Code.for the perfornmom of the work for which this permit is issued. My Worker'aC nlpensetio InsurT.enrtin atl Policy number a2: ' Cartier: Policy No.: CERTIFICAnn OFEXEMP ION MOM YORKERS' COMPENSATION INSURANCE (Dissection ecad notheompletcd finite permit isfaronc hundmaidollsrs($HXE or less) 1 certify that in the performance of the work for which this permit is issued,l shall not employ any person in any manner an as in Wcome subject to the Werkeri Compensation Laws of California.Data Applicant NOTICE TO APPLICANT:IL after making Nis Conificam of Eamption,you should become mbjol to the Worker a Compensation provisions of the Labor CSM.,you must .JZ forthwith comply with such provisions or this permit shag he deemed revoked. z CONSTRUCTION LENDING AGENCY (ti l hereby ofrum that Here is a construction lending agcnry,Or the Performance of CG> the work(ser which this Permit is issued(Sec.3091,Ci,C.) Q WILeader's Nam. 6.0L z .ndera Address U Q 1 modify that 1 have read this application and site that the above information is D. cored I agree to comply with all city and county ordinances and state laws rotating to C) building construction,and hereby authorise misommauthes of this city to enter upon lW r W above-mentioned property for inspection purposes. gi. (We)agree to aro,indemnify and keep harmless the City of Cupertino against ti h liabilities,Judgments.costs and expenses which may in any way accroo against aid City C)z APPs permit. LICANTnsequenccUNDERSTANDSof Uic granting ofIAND WILL COMPLY WITH ALL NON-POINT Issued by: Be SOURCE REGULATIONS. Re-roofs Signature of ApplicaHAZA Dem HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or(Maui iptitling ocupanl store or handle Health and Safety a defincd by TI Cupeninn Municipal Code.Chapter 9.12.and the Health and Safety ode,Section 25532(,)] ❑V. All roofs shall be inspected prior to any roofing material being installed. �Nu Will the applicant or future building occupant use equipment or devises which If a roof is installed without first obtaining an inspection,I agree to remove mit hasardnus air contaminants as defincd by the Bay Arca Air Quality Management all new materials for inspection. Diwrin? ❑Yes }fo Ihave&SaCi the WafdllMamamrialsrequirement5 under Chapmr6btOrthe Calding doa.(marod,have.uman 255115,255)��oorad 2S534.lundcrsmnd Occup rid the f/�.L.`t �O Jars not curtcn0y have a rename can it u �f.popsihtlity m notify Om ocupanl of the requirem�which mu be upon,m' f aCcrdT¢am of Occupancy. Signature of Appllcalll Date owner ear aMthons ant DO 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 f UPEkTINO Building De artn,.ent JOB ADI?I ESS: PERMIIT# �/9�/ 09 / &-/0 700 i OWNER'S NAME: PHONFV _ --' GENERAL CO CTOR: eC' FAX # I am not using any subcontractors: 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 AN Tile e ontror ignature Vate Community Development Department Building Division i City of Cupertino 10300 Torre Avenue CITY OF Telephone: (408)777-3228 U P E kT 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. 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: JSe v�(�u Job Site Address: Roofing Company Name: L i�� g C p- AplicanYs Signature: l Date: 06 Greg eel Building Official Revised 1/30/03 Printed on Recycled Paper CITY OF CUPERTINO REROOF tet' 7d " Z7 ITUY4CUPERTINO PERMIT APPLICATION FORM APN# 3 2 j? 6 G IJ Date: O / L Building Address: /6 ,/I Phone Owner's Name: C� #: � � _yob Contractor: Phone#: 1/67License#: / Contact: f Phone#:'Vp.V Cupertino Business License#: Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt ShinglesAsphalt 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 ertin 's Tear Off Policy: Kr Job Description: C-4 �i ii eS/' Residential Commercial ❑ Fire Zone: Yes ❑ No x Confirmed with Planning Dept. if there are any restrictions: LJ Cost of Project: Type of Construction: Occupancy group: Qty. if A l Fee ID Fee Description Fee Group BPERMFEE Bldg Permit Fees BUILDING BENERGY Energy BUILDING BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING