04030241 (2) CITY OF CUPERTINO g'' " �� (�� `gyp 7�l��f'�f� "'R
BUILDING DIVISION PERMIT `S tVT•� ^"T gv ^'^ ,^¢h" s`„ �'
BUILDING ADDRESS: PERMIT NO.
' LINDY ROOFING CO INC 04030241 '
OWNER'S NAME: PQtMTT ISSUE DATE
ONE: SANITARY OL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION — - - ' Job Description
- -
1 hereby affirm Nn 1 me littnud umlcr/IProvulons of Cheptr 9(commencing p
A¢ with Sec' )ar Diviaion3oftM Bu' Lad Profcuium Cape,' Ocense is
. O m in full fort`d affectw� Lia / — ER 'F
ZDatnu a Coni r 0 a�
Oe{q- A CHI7ELTS D ATION `/o/
Y 3 1 uMcrNand my plana¢hall M wed as Ic retards
:h�
Licensed PnNeuinnal ��
OWNER-BUILDER from
DECLARATION
f 1 hereby.floc that 1 1. exempt from J r Comnctofa License Law for the
p O fallowing moron. emit t A13 sru Business and w,de imts Code:Any city or county
x$ which requires a e..it re conawcL aaltar.pplicant
improve,dcermitt fi repair any Samoatenement
t"a prionnits censedaalso requires Jmapplicant for a.hpermi'W ficous,Laedmkmcnt -'
�s�s<
that
mecingwiit pursuant 7to theM)of Divisionf the eBusiness LlttmelJW(Chapter 9 Sq.Ft. Floor Area
ValUt
irFO thommene xempth Section s and of Basi forn 3 aftheeged exemton.AyviolaWe)of
that Section
0 exempt therefrom and the beau far the alleged exemption.to Any violation of
not
nby any
undredcanusr500). mbjetBme.ppntmtm.m.n pen.ur of 3 �per00 Occupancy Type
not mom tun fiw hundred dollars($500).
0 1,as owner of the property,or my cmploycu with wages at Neir.a campenutlon. `
will do lhework.and dmawclum is mobunded oroifered for.dc(Sec.7066.Business Required Inspections
and Profeathers Code:The ConuacWrt License Law does not apply W an owner of q P
properwW buildsorimproves Nemon,and whodoessuch work himselforthrough his
own employcca.provided that such improvemants art nolinumded oroRercd foraale.IL
however,du building or improvement Is mid within am you of completion.Ne owner.
builder will have Me burden of pmving Nu he did not Wild m Improve fm purpose of
sale.).
0 1.as ow.r of the progeny,am exclusively contracting with licensed contnclon to
constmet the pmject(Sec.713,14,Business and Professions Code:)The Conuactr's Li.
me Law dors not apply to an owner of property who Wilds or improves thereon,and
who contracts for such projects with a commensals)limntd pursuant W Ilse Contractors
License Law.
O lamexemplunder Sec. ,B&PCforthismuon
Owner Data
Ak WORKERS COMPENSATION DECLARATION
I hereby eRia s under Penalty of perjury o.of the following ch damisma:
I have end will maintain.Cunificeteof Conant to ulf-intim for Worker'.ComNn-
urian,as Provided for by Section 371M1 of Ne Labor Code,for the performance of Ne
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,as required by Section
3700"Me labor Cod,forty performmce of Ne work for which this Permit is issued.
My Worker.Cn pe cion ¢u Qcamicnnd Policyn mbar see:
Cartier: Policy No.:
ERTI^CATE E) MON FAO WORKER
COMPENSA7 INSURANCE
(Thu section need notbe,muplcWd if the Permit is faro.h n.drtddollars(5100)
Or lest.)
1 certify that in the perAmeemce of the work for which this Permit It issued.l shall nm
employ any person in any mannerso as be become subject W the Workers.Compeltsation
Law,of California.Dat
Applicmt
NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should
I became subject to Ne Worker'.Compensation provisions of We labor Code,you must
,JO foMwith comply with such provisions or this Permit shall W deemed revoked.
„Z,I y CONSTRUCTION LENDING AGENCY
fY.E (hereby affirm that there It a Construction lending agency for the performance of
,7 the work for which this permit is issued(Sec.3097.Co.CJ
W�Q Leader'.Name
Z z Lenders Add.
U Q 1 ceNfy that I have read this application and stat that the above Information is
I,, E' correct.I agree W comply with all city and county oNinacea and some,laws relating W
0U building construction.and hereby authodm representative,;of this city W enter upon the
Above-mentioned property for impaction purpous. `
LL (Wt,)agree W cove,indemnify and kith may
In an the City of Cupertino ageism
U4 Ilain coisequnce of a loaung and es this penit. may In any my come againaneid City
U T7i APPLICANTeUNDE�TANDf AND WILL CO BLY WITH ALL NON-POINT Issued by: Date
SOURCE U
Re-roofs
mum of AM an moschor Data
L HAZARDOU ATERIALS DISCLOSURE Type of Roof
Will Ne applicant or future Wilding occupant store arhandle haasrdom material
as defined by Ne Cupmine,Municipal Code.Chapter 9.12,and the Health and Safety
Code,Stttion zss3z(an A. All roofs shall be inspected prior to any roofing material being installed.
�Ym fhNu
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
mit haanrdour air contaminants as defined by Ne Bay Area Air Quality Management all new materials for Inspection.
District?
❑Yet V.
I have read the WvsMnus materials reyvimmcn¢undcrChaptr A95 of the Califor-
aiaH.I"safelyCo&,S do.25505,25533md25534.lun&nwdthatifNc building
docs not cumently ha Cement,Nat it is my respovihility W nouty Jt occupant of the
require u`hich bemet orru issu t f'a Ccaificat Or Occupancy. Signatyr of App ' an[ '///yyy// DatC
/Date All 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
�UPEkTINO
Building Department
B ADDRESS: PERMrr_4 01
OWNER'S N PHO Q -/
GENERAL CONTRACTOR: - 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
,O�1 ontr ctor Signature Date
Community Development Department
F .
Building Division
City of Cupertino
10300 Torre Avenue
qCITY OF Telephone: (408)777-3228
UPER,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.
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: Si�X
Job Site Address: i %�`�� �? �„(! o /ilkt7 L.--e
Roofing Company Name: -
Aph nt's Signature: 7 Date:'—�f
• Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO 7��
REROOF 0030
° 3 `� 2 l
CUPEkTINO PERMIT APPLICATION FORM
APN# 3 / Z (2 a / Date:
Building Address:
S N
Owner's Name- t Phone#:
S L 6
Contractor: I Phone#: 'License#:
L. C - O
Contact: 1 Phone#: Cupertino Business License#:
Type of Roof Covermg:
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 coveringsProvide LC.B.O.Report# 2 C-2
❑ To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read, Understand andWill Comply With Cu ertino's Tear Off Policy: El /
IJ Job Description: �. /� Li /Q lal'^ 4e /i /e �- �p?� d� t e �%
Residential F-17 Commercial7� ❑ //
Fire Zone: Yes ❑ No ❑ Confirmed with n' g D t. if
there are an st 'ctions.
Cos of Project: Type of Cons ct— n: _ Occupanc gro r
® J(i �
Qty"if
A fic4b14 Fee ID Fee Description Fee Group
B RMFEE 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
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