05110120 (2) CITY OF CUPERTINO +.^<e�'''' "%' "'' '
BUILDING DIVISION PERMIT CONTRAC,"T,ORxINFORMATION +'
BURRING ADDRESS: LINDY ROOFING CO INC PERMITNO.05110120
20881 PEPPER TRP.P. IN
OWNER'S NAME: PERMIT ISSUE DATE
JEAN CHANDLER 5554 HAR
NE:
SANITARY NO. CONTROL NO.
(408) 286-9990
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
�Go LICENSED CONTRACTORS DECLARATION Ob Description
fZ C 1 Mxby Affect,that 1 am licensed under pmvisionm of Chapter 9(commencing //,,�t If
<U with section 7")ofDivison 3 ofthe Busneu and ProbesnovC;and my license is �{/�ry .A
in full forte and erccc 4'T' /
nes Lice .0. Uc.e 21 �f3 REROOF--T O SHAK STALLg�COMP.
F, Dam Contractor /� ([`''w
e AR RECT'S DECLARA ON
t o l understand my plans shall he used u public rtonrd C O r
l e. (a
s
Wt; Licensed Protean...I
`03 OWNER-BUILDER DECLARATION
i1 thereby affirm that 1 am exempt from the Contractor's License Law for the
d O following reason.(Section 70J 1.5,Business and Proftumms Cade:Any city or,d.n,,
29 which naf ires a permit to eonwtcL eche+.imp ow,demeliab,a repair any smsnure $9000
°i y prior us its issuance.ales requires the applicant forsueh Penn,to file a signed sidemen,
< wt he u licensed pursuant to to Provisione ofthe Contractor's lactose Law(Chapter Sq.Ft.Floor Area U(/ US. V Valuation
AFa (commencing with Section 70DO)of Division 3 ofthe Business and Profession Code)or I7
e tt;$ that he u exempt therefrom and the besis for the alleged exemption.Any violation of
Section 7031.3 by any,appliam for a permit subjects the applicant to a civil penalty of
mat mart than five hundred dollars(S300). P Occupancy Type
Q I,as owner of Ne Propmy,omy eroploym with wagau Heir xle campennton,
will do the work.and Nestmcmm is notkmended wagered formle(Sec.7066,Business Required Inspections
and Profestio"Cade:The Cm oseme,License Law dao cot apply to an owner of 9 P
property whob iIds orimpoms thereon,anewbolocosuch weak himselforthrough his
own employee,provided that such improvements are not intended wagered Iursale.If.
bowdmo.the building or improvement is sold within one year efmmpkuaq the awner-
Wilder will have the burden of proving that he did not Wild or boyrow for purpose of
sale.).
Q 1.as owner of the pmpeny,am exclttsiwly contracting with licensed contractors;to
constmet the Project(Sec.7014,Business,and Professions Code)The Commodes Li.
cense Law truss not apply to an owner of proerty'who Wilda or improves thereon,and.
who contracts for such Projects with a consacter(s)licensed pursuant m the Commuter's
License Law.
Q lam exempt under sec ,B A P C Ivo this mason
1371W.f
mer Date
WORKERS COMPENSATION DECLARATION
1 hereby alfires under penalty of perjury nue of the following declarations:
I haw and will maintain a Cuts!roof Consent m self-imaefmWorker'sCompen-
on.u Provided for by Section 3700 of Ne Labor Code.for the performance of the
rk for which this permit las untied.
1 haw and will maintain Worker's Compensation Instrantt,as required by Section
the Labor Code,far Ne performance ofNe work for which this Permit is lewd.
Worker's Cam1motion Inmhnna aria and Policy number am:
rtier. I. --as Policy No, I Ss I cro)0317
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
mmum maced do,W completed Uthe permit Is foam humbecloollus(SIOD)
ser lass)
I certify that in the per(ormanee of the wort for which this permit is issued,I"I not
employ any persen in any mamnerm As to become mbjcct to the Worken'Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,After making this Cenifha¢of Exemption,you should
become subject to the Worker Compemadan provisions of the Labor Code you most
.J z foMwith comply with such provisions or this permit shall be deemed revoked.
[-+rO CONSTRUCTION LENDING AGENCY
I hereby aRren that Nen is a consuueunn landing agency,for thepedi mance of
!Yi > 1M work for whim this Permit u Lssned(sec.3097,Civ,Q
WM tender's Name
= z L<ndh es Address
U C) 1 ceNfy,Nat I have rad We Application W mate this the aWvc ihdo..do.u
U, t" corm,.1 agree to comply with all city and county ordinances tad atm laws relating m
O[, Wilding construction.and Wrebyauthorim representafi=f this city m corer upon Nc
4 above-mi.judg d property for inspectione ipurposes
(we)agree 1.saw,indemnify and keep harmless the City of Cupertino against
fA liabilitiesjne ofhegranting es penseswhich may in anyway accmu against still City
Oz in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NO .P01NT Issued by:
tt �2
IA
DateS uIQN . lRe-roofs
Signuuseo Aper am
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will the appliant-1futwe Wilding occupant Imre w handle noardous mamrial
asj
u de0udtio by the Cuptatna Muni Code.Chapter 9.12.and the Hcaith and Wely
ale.S0 y.o 23332(a)? All roofs shall be inspected prior to any roofing material being installed.
Yrs No
If a roof is installed without first obtainingan inspection,I agree to remove
Will tc aPPlian r future bis' ng by the tax equipment ser devices which P
mit h..Mo.air contaminants fined by the Bry Arta Air Quality Management all new materials for inspection.
D IWIL'
QYm No
have Nehv aur mamriaurtquiromew underChapmr6.93ofNe Calif.,. 'l. .
ria HalN85almfmyCnde,Sadw 25305,233]3 uu123331.1 undersurhE Out if the Wilding
Joos wremly have a tmtanl Nu It u my responsibility m mury tc occupan of do
myu mems chmupbgmctpnarmusuan� ceaf 'afO,nmancy, �� g ueofApplicant Date
Owner or sd.,cm. 1, Dtal. All roof coverings to be Class"B"or better
Community Development
flumtis 10300 Torre Avenue
e Cupertino CA 95014
Telephone(408) 777-3228
CITY 0, Fax(408) 777-3333
UPEkTINO
Building De artment
JOB ADD' ESS: PERMIT #
u1 2 0
OWNER'S NAME: O n• o L4=wPHONE # — 0-7
GENERAL CONTRACTOR: r nr D rcj [ FAX #
I am not using any subcontractors:
-
Signature Date
Please check applicable subcontractors and complete the following information:
60 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
Owner/Contractor Signature Date
Community Development Department
Building Division
' City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408) 777-3228
Fax (408) 777-3333
U P E T I N O
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.
7. NOTE: If you call for a plywood nail inspection andthe job is not ready,
you will be charged a re-inspection fee of$176.18. The re-inspection fee must
be paid before another inspection can be scheduled.
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 compllyCl
comply with the above stated policy on re-roofing.
Homeowners Name: �J• an "1Gcr�Gl t'ey—
Job Site Address: o?(.)a 8 (
Roofing Company Name: L t h
Applicant's Signature: Date: j 22`Qfj
• Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINO _ J
410 I
REROOF
CUPERTINO . PERMIT APPLICATION FORM
APN # L D l / Date:
Building Address: t;2 O 8 Lard
.e 2ti
Owner's Namo
e #:
can CAAAc eer a33- 67a9
Contract o : Phone #: icense #:
�ih Rooms - Co . 8-aBG�� �ISB/,6
Contact: Phone#: Cupertino Business License #:
Type of Roof Covering:
Existing: Proposed:
o Built-Up Roof O Built-Up roof
Cl Asphali Shingles Asphalt Shingles
r.Wood Shakes Li Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings oZ. ❑ Provide I.C.B.O. Report#
X To be Removed ❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: N__
Job Description: r0fv Ov2- e5-A5; :Zr _ [n l 2 ` GQK PICT
0- 1 uare o-F a, r/rtCnS��l4 e Ge �iai /'oo( '
Residential`Z_ Commercial ❑
Fire Zone: Yes ❑ No E5 Confirmed with Planning Det. if
there are anrestrictions: LI
Cost of Project: Type of Constructs Occupancy group:
aft) re-r ex-i- h a 122g,
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
# 3 � �� /