03110084 (2) CITY OF CUPERTINO BUILDING DrvlsloN PERMIT 0 , ,,CTC)R INFORMATION ,''
BuaDINO ADDRESS: LINDY ROOFING CO INC PERMIT N003110084
X20044 PA IFICA IDE
OWNER'S NAME: PERMIT ISSUE DATE
FFREY & ADRIAN STINWINDEL 5554 HARVARD 11/17/2003
NE: SANITARY NO. CONTROL NO.
(408) 269-2025
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MICH
0 o LICENSED CONTRACTOR'S DECLARATION
.5 1 her b'
arGrm that I am licensed underpovisiona of Chapter 9(commencing
lob Description
f U wiNSecr 76E:]fDivision3of Ne Buainc{a'ansyirof�((io��ns�'Code,and my license is
jo. Loma canter( ._ c a_ U�Y REROOF FINALE®
71 on License CI s Lic.p
F 0 Dam Contra
e£3 ARCHITECTS DECL A' - f7 s�
CU tun rstanJ my plans¢hall he used mpuhlicr FEB 2 al 20t)4
6
ii Licensed Professional
g OWNER-BUILDER DECLARATION
'�<I I hereby affirm Santo
I am exempt from Ne Contractor's License Law for the ��'�®''v.\M
p o following Mason. ano 7031.5,Business and Professions Code:Any lilyerr county
m which requires a permit to construct,alter,improve,demolish,or repair any structure810000
Sri
poor o its issuance.also requires the applicant for such permit file a signed statement
F¢za that he is licensed purmanuo the provisions of the Comment's License Law(Chapter 9 Sq.Ft.Floor Area Valuation -
u+t-m (commencing with Section 70(k))of Division 3 of the Business and Professions Coda)tar
so, drat he Is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects Ne applicant to a civil penally of er00 Occupancy Type
not mom than Five hundred dollar.($50)).
P Y YP
1,m owner or the properly,or my employees with wages m their sole compensation,
will do Ne work,and the swcture is not intended or offered for sale(Sec.7094,Business
and Professions Code:The Contracmes License Law docs 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 oroRered foraale.If,
however,the building or improvement is sold within one your of completion,the owner
builder will have Ne burden of proving Nal he did net build or minnow for purpose of
sale.).
❑1,as owner of the propeny,am exclusively contracting with licensed convectors to
consumer the project(Sec.7044.Business and Professions Code:)The Contractors Li. _
came law docs not apply to an owner of property who builds or improves themon,and
who contracts for such projects with a eonoccumb)licensed pursuant to Ne Commences
License Law.
❑I am exempt under Sec. B&P C for this mason
wner Date
WORKER'S COMPENSATION DECLARATION
I hereby afOmm under penalty of perjury one of the following dedarnimee
1 have and will maintain a Corsican of Consent to self--insum for Worker's Cumpcn-
sett..,as provided for by Section 37W of the labor Code,for Ire perfrmmon of the
work for which this permit is issued.
❑I have and will maintain Worker's Compensation Insurance,as acquired by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Compensation Insurance Cartier and Policy number arm':�](�
Ca 'er. N+T �[ ooyf�Y No.:
CERTIFICATE OFE MPRON FROM WORKERS'
COMPENS TION INSURANCE
(This section need not M completed if the permit is Toren hundred dollars(SIMM
err local
1 certify that in the performance of the work for which this Permit is issued.l shall not
employ any person in any manner so as m become subject o the Workers''Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If,after making this Ci nilicam of Exemption,you should
Seemed subject to the Worker's Compensation provisions of the Labor Code,you must
�z forthwith comply with such provisions or this permit shall he deemed revoked
ti O CONSTRUCTION LENDING AGENCY
I hereby affirm Nat dere is a convection lending agency for the performance of
x ti
But work for which this permit is issued(Sec.3(197,Civ.C.)
Q Lcndcr's Name
z Lenders Addreas
L)Q 1 certify(hat 1 have read this application and state that the above information is
tI. H comUL.l agree to comply with all city and county ordinances and state laws relating to
V building construction,and hereby authorim representatives or this city to enter upon the
Trot shove-mentioned property for inspection purposes.
y (We)agree to a...indemnify and keep harmless the City or Cupertino against _
N liabilities,judgments.costs and expenses which may in any way accrue against said City
Upin
ea ac UNDERSTANDS nemogufLAND WILL COMPLY WITH ALL ON-P INT Issued by:qjta� Date G I
5 ERF.GULA,
IONS. Ivy t �� T
k"�-� V Re-roofs
re of ApplicanVContractor Data
HAllARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building Occupant store or handle haverdous material
as do d y ilia Cupertino unmipal,Code,Chapter 9.12,and the Health and Safety
dc, c tC525532(a)? No All roofs shall be inspected prior to any roofing material being installed.
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
it M.,m us air contaminVials
efined by the Bay Arca Air Quality Management all new materials for inspection.
isuict?
❑Yes
Ihave&S,f,t thehavaN5533.dMS34.1cr Chapter d6. Li of the Goldin
ria Hcolter Safety Codes,Secdons2atit is yrsnd25534.Ino nourydthmlonpant Wlog
Jnes not curtcntly have a tenant(hat it is ire respor a C,uni eve,Or dhc recupent of the
Met whichmusthmetpoorlesissuanttofaCcniOcamof upon 1 attar Of Applicant Date
% vg�— tl ( All roof coverings to be Class "B"or better
0 br auth.ri'rcd agent etc
4w I �
` Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
afflt 4
CITY OF Telephone: (408)777-3228
Fax: (408) 777-3333
U P E_—I No
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 iuspectioii 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. 5'T-1,t, Lk)/1J U F(_
Homeowner's Name: /1 D91 f��
Job Site Address: 200q,(
Roofing Company Name: L l Nb y
A plicanYs Signature: (�V / �"` Date: ) � �1 D
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO o 3 / /
REROOF /
CUPERTINO PERMIT APPLICATION FORM
APN# 36
219-7 o �� Date:
BuildinAddress: C ��
00
Owner's Na e: Phone#:
&i44 n1 ST /V (A)i� Ec—
ContracL p tj f f�k // Phone#:2�_CJ9a/� License
Contact: C O Phone#: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles Asphalt Shingles
XWood 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 ertino's Tear OOffPolic
lou DescriPlC YYIo l/]F '�' dl S TIQ LC l Urctd Com -----
K 5
Residential PIr Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Plan ' g t. if
there are anres ions:
Cost of Project: /0 000 Ag Type of Construction: ccupancy gr
Qty. ifil-
Appliabje Fee ID Fee Description Fee Group
If BPERMFEE Bldg Permit Fees BUILDING
!ENERGY —Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
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