04040118 (2) CITY OF CUPERTINO %-
BUILDING DIVISION PERMIT C01�TRACT�nRINFQRMATIQN:
BUILDING ADDRESS; LINDY ROOFING CO INC PERMIT N004040118
OWNER'S NAME: PERMIT ISSUE DATE
PAULA MENDENHALL 4
ONE: SANITARY NO. CONTROL NO.
(408) 269-2025
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDO ELECT
900 PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
e ce 1 hereby affirm Ihm 1 am liccmutl under provisions of Chap¢r 9(commencing Job Description. �np t�,��m
?yea with Seetien](Nllgof Division 3 of the Business and Pmfe,sions Code.and my license is OY WALEE23
^�h in fall force and effect. REROOF
2 Liccnu mss Llc.p
Data LmaW dl MAY 1 2004
S=,J ARCHITECTS DECLARATION
W u 1 understand my plans shall he used as public records 11 99
�G
;oG BUIllara®Y Licensed Professional
S OWNER-BUILDER DECLARATION
X 1 hereby affrm that 1 am carman room the Cuntracmr's License Law But the
00 following tenant.(Secfiun 71131.5,Business and Professions Coca:Any city or county
K m which requires a permit in construct,alter,improve,demolish,or repair any structure
yZi Prior to its issuance,also requires rte applicant forsuch permit to lilea signedstatement
£Z< that be is licensed pursuant o the provisions of the Contractors License Law(Chapter 9 Sq.Ft. Floor Area Valuation
Fct Nm
(acmmcing with Section 7000)of Division 3 of the Business and Professions Code)it,
he is exempt domfrom and Ne basis for the alleged exemption.Any violation of
Section]031,5 by any applicant for a permit subjects the applicant to a civil Penalty of 321P148mjiiT� Occupancy er00 Occu Type
not mora than fire hundred dollars(S500).
P Y YP
❑I,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044,Business
and Professions Code:The Contractor's License Law does not apply to an owner of Required Inspections
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for sale.If,
however,the building or improvement is sold within one year of comrbohn,the owner- _
builder will have the burden of proving Nal he did not build or imprevo for purpose of
ssle.).
❑1,as owner of the property,am exclusively contracting with licensed contractors to
cOmoract the project(Sec.7044,Business and Professions Code:)The Cmmracmr's Li-
cense Law dues not apply to an owner of property who builds or improve thereon,and,
who contracts for such projects with a contractor(s)licensed pursuant to the Contractors
License law.
❑tem exempt under Se ,B&PCfor this reason
ion
Owner� -Date
W TRiS MWIDIMCfFSOECLARATION
I hereby alfr6i under Penalty of perjury one of the following declarations:
I'll Lave and will maintain a Ccnifcme of Consent no self-insum for Workers Compere
antI...as provided far by Section 3700 of Ne Labor Code,far Be performance of the
work for which this permit is issued.
❑1 have and will maintain Worker's Compensalban Insurance,as required by Section
37M of me labor Code.for the Performance of the work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number are:
Carrier: Policy No, _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This uclion need not he completed if the Permit is for one hundred dollars(SIM)
or lass.)
1 certify than in the performance of the work for which this permit is issued.)shall ma
employ any Person in any manner an as to become subject to the Workers Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:IE after making this Cenifele of Eacmption,you should
become subject to the Worker's Camrcemioe Previsions of the Labor Code,you must
.J z forthwith comply with such provisions or this permit shall he deemed revoked.
LziO CONSTRUCTION LENDING AGENCY r
[—t I hereby affrm Nat there is a construction lending agency for the perfurnsum of
el > the work for which this permit is issued(Sec.3097,Civ,C.)
W� Q Lender's Name
z Lender'a Address
U 1 certify Nat 1 have read this application and auto that Ne above information is
fL Fr toren.1 agree to comply with all city and county ordinamees and state laws relating to
pU building construction,and hereby authorise representatives of this city to enter upon the
0.W, shove-ms,judg dproP rtytest fond inspection purposes.
(We)agree to save,indemnify and keep harmless the CO,of Cuporlino agai nat
rJZ inconsequnce of ta,the coarsing of this expenses which mayinany way accmc against said City
(„) z APPLICANTC NDERrantinguf this permit.
^' APPLICANT UNDERSTANDS AN WILL COMPY W ALL NON-POINT Issued by: Date
SOURC E I,ATI S.
'x - ° Re-roofs
Si a ore o pati an Contract Date C /
HAZARDOUS MATERIALS DISCLOSURE Type of Roof ( Q C
Will the applicantser future building aceupant score of handle havam us material
Six defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
ode,Seaton 25531(.)?
❑Yes aK-- All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
11 hmardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
stria]
❑Yes Nn
I have read the havanlous materials requirements under Chapot 6.95 of me C.lifnr
nit HelW6 SafetyCalle,Seeduns25505,25533 and25334.[understand thtifthe building
does not currently have a Imam,that it is my respuns µµyy m nndly the restrict of the r I C
to care
s hich be met ural issuanc aCcodfcam of Occupancy.
C Signa ore o� plic nt Date
' All orf coverings to be Class"B" or better
�/ Owner or anthonaeFent i �'
aclor
Community Development10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
Fax(408)777-3333
UPERTINO
Building Department
JOB ADDRESS: PERMIT #
OWNER'S NAME: PHONE #
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors:
Signa e — 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
AhFSheet Metal
Sheet Rock
--Tile
Owner/Contractor Signature Date
Community Development.Department
Building Division
l id City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
CUPEDTINO 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:
Job Site Address: 6&I/z,
Roofing Company Name: ,n, lL/�l�A.
hA plicanYs Signature: Date:
�y
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF
4CUPEkTINO PERMIT APPLICATION FORM
APN# Z o6 Date:
G _
Building Address:
G� ,� e c,
Owner's Name: Phone#:
Contractor: Phone #: y01&r- License#:
/
Contact: + P one#: z14 � Cupertino Business License#:
F mak' _
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles Q--�Asphalt Shingles
X Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report#
XTo be Removed ❑ Provide Mfgr. Installation Specs.
7I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: El
Job Description:
Residential Commercial E]Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: LI
Cost of Project: Type of Construction: Occupancy group:
ac
Qty. if
Applicable Fee ID Fee Descri tion 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
D 10