04060058 (2) CITY OF CUPERTINO �,
BUILDING DIVISION PER ! UQN RACTOR'INFO'12MATION
BuaolNC ADDRess: LINDY ROOFING CO INC PERMIT NO.04060058
OWNER'S NAME: PERMIT WUEDATE
WILLIAM HY
NE: SANITARY NO. CONTROL NO.
(408) 269-2025
ARCHITECDENGINEER: BUILDING PERMIT INFO
BLDG ELECT' PLUMB MECH
o o LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm IA 1 am ftlm B.under provisions of Chapter 9(commencing Job Description
i with Scaion]itMl)of OlWsion Sof NC Busilmsaend Profcssinna Code,end myliccnu is PHYAw
� in full forte and efts p®p
toenu a� �— a lmctar . Q� REROOF t�
Da CemrECL JUN i']
e ARCHiIELTS DECLARATION aI
1 unticrmand my pl....hall he used a public records ZOO4
�y
3Q 9a
Licensed Professional
OWNER-BUILDER DECLARATION BUILDING I I masa alum on 1 am exempt faro Me Commences License Law for the V
i O o fallowing mason.permit
t ](131.5,Business and Profusion Coda:Any city iacounty
e$�i which uquima a permit m construct,slue improve,Demolish,no repair any swctutt
'nZsi° prior it)its issuance.alts requires the applicant(arsuch permit to file a signed statement
-££F� That he is licensed pursuant In Me provisions of Ne Connector's Licene,Law(Chapter 9 Sq.Ft. Floor Area Valuation
yF$ (commencing with Section 7000)of Division 3 of the Business and Professions Coot)or
that he is exempt Mandarin and the basis for the alleged exemption.My violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 AHI�ACIBer 0 0 Occupancy pry'
not mom Nan five hundred dollars MM), p y +'pe
0 1,as owner of the property,or my employees with wages a Muir role compensation,
will do the work and Ne structure isnot intended or offered for sale(Sec.7044,Business
and Profession.Code:The Connector's Liam Law does not apply to an owner of Required Inspections
parperty who buildsorimpmens Ihearon,and who doessuch work himselforthrough his
own employees,pmvided Nm such improvements are notimmnded at offered tarsale.If.
however,the building or improvement is sold within one year of completion.the awned
builder will have Me burden of proving that he did not build or improve for purpose of
sakJ.
0 1.as owner of Me property,am exclusively contracting with licensed contractors to
connect Ne project(Sec.704.Business and Professions Code:)The Contractor's Li.
case law docs not apply to an owner of property who builds or improve.Menton,and
who contracts for such fattiness with a contncmr(s)liurand pursuant m the Conwctoes
License Law.
0 l an exempt under Sec. ,B&P C far Mls mason
Owner Date
WORKER'S COMPEbISATION DECLARATION
I hereby affirm under penalty of perjury one of the following acclimation:
I have and will maintain a Caniflcase of Consent to self-iaum for Warker'sCompen-
ation,as provided far by Section 37M of Me labor Code,far me porformanm of the
work for which this permit is issued.
0 I have and will mainlain Worker's Compensation Insurance,a required by Section
3]00 of Me labor Code,for tiro performance of Me work for which this rural,is issued.
My Wor�k'e/r's C�omfeaadon Ineran (caner and Policy number mc:
Canier..ViY�in i� �f R.✓ Polity Na.:9&9117./_
ERTIFICATE OF EX PnON FROM WORKERS'
COMPENSATION INSURANCE -
(Thissection need nothecompated!fine Pewit is for onehundmddollars(SIM)
less.)
1 ecrdfy Mat in the performance of Me work for which this permit is issued,I shall not
employ any person in any manner an as on become subject to the Warkma Compar adon
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should
become subject in Me Worker's Compensation provisions of Me Loan Coda you must
.J Z forthwith comply with such pmvisioa or this permit shall be deemed nevekcd.
'zO CONSTRUCTION LENDING AGENCY
rN
F I hereby ch do,
iss issued
0lending agency I'nr the performance of
gL Me work for which Nis pewit is issued(Sec.3(19],Civ.C.)
0.Q Lender's Name
D Z LendersAddress
fJ 0 1 certify that I have mad this application and stste met Me shove intermittent is -
[tr F coned.l agree to Comply with all city and county ordinances and stale laws misting to
O V building connection.and hereby authorize representative¢of this city to enter upon Me
61 I hove-mcnudgm properly fond expenses
pe nses purpose¢
C (We)ague to save,indemnify and keep harmless Me City of Cupertino against
I,,) iln abilities,judgments,gratsing ex pencamit. may in any way acrnmagainst said City
(„)z A APPLICANT
of Me granting of this permit.
APPLICANT UNDERSTANH ALL NON-POINT Issued by; Date
SOURCER ATI DS ND WILL COMPLY WITH
Re-roofs
Signeturca Appli for Date
ARDOUS 4 ATERIALS DISCLOSURE Type Of Roof
Will Me applicmt or future cc
building occupant store orhandle hardeus material
a defined by du Cupertino Municipal Code,Chapter 9.12.and Me Health and Safety
oda.Section 15531(a)a All roofs shall be inspected prior to any roofing material being installed.
❑Ys No
If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or furore b ildidg occupant tau equipment or devices which g
in hazardous air contaminants a depend by the Bay Area Air Quality Management all new materials for inspection.
ab 7
❑Yes �u
I have rad the hvallou.materials requirements under Chapter 6.95 of Me Califon
nia HcalLh&SdctyCodo.Secdom15505,7S533ud M53d.lundcrsund Metifdrc building V/mss /J
docs um contently how a tenant as
is is my rcspon ility m muly dm mcupms of Me /2/- -.,
mquim.5ynwnleh ,xm ' r iaaanc ac neamoramp ter. g ature plicae Date
Owner or aatharize a, Da,e All roof coverings to be Class "B"or better
Community Development Department
Building Division
' City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
OUPEkTINO CITY OF 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: 44fei,Z//A/ //
Job Site Address: ���� /��f�C/L� dV
t t
Roofing Company Name:
r
A plicant's Signature: Date:
Greg
ti
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO v 6
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN# _?26,
l t d Date:
Building Address:
Owner's Name: Phone#:
;2 V
Contractor: t Phone#: License#: _
96
Contact: Phone#: 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)
umber of existing coverings ❑ Provide I.C.B.O.Report#
N
To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑
Job Description:
Residential Commercial
Fire Zone: Yes ❑ No Confirmed with Planning Dept. if
there are an restrictions: U
Cost of Project: Type of Construction: Occupancy group:
Qty. if
Applicable 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
J
7