04080194 (2) CITY OF CUPERTINO �„
BUILDING DIVISION PERMIT ` C4QNTRACT�OR INFORMATIO0
BUILDTNGADORESS: LINDY ROOFING CO INC PERMIT NO 04080194
RATNRQW DR
OWNER'S NAME: PERMIT ISSUE DATE
ONE: SANITARY N0. CONTROL NO.
ARCHITECTfENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Y00 LICENSED CONTRACTOR'S DECLARATION O
ui I Wreby affirm that I am liauW under provisions of CNpmr 9(commencing Job Deserip n
a< with Section 7M lief DM,km the Bud.end Proposal..Cade,and my[fee.in
< in full(come Ind off r'
5�4 License lace Lk.N `� REROOF W/LIFETIME COMP. SEP N 2OOT
nDam Conuanar '
ARCHITECI'SDECLARA ION
5 I Professional my plana ehdl be uudupublic menrtle BUILDING;8
Licensed Pmfcuional
OWNER-BUILDER DECLARATION
q I hereby.('Sinn IWI I i. exempt from Nr Contractors :Any c Law for @c
D o whicfolloh re massa. �rit t 703S.Business and w. uium Cade:Any city as county
$ which its Wu•permit re rnnswcL titer,impmsu demch olish,ri repair any nmctuto `
Fit^ pdarmsl6nsed pursuant
the OnePard applicants thefor Connector's
UccmLo rile a awdsummcm
< Nahmist'pt, hinSeetion70 mpmviA,han3OftheBummr'Wttnmlaw(Chapter Coda)
Sq. Ft. Floor Area Valuation
$ that he I, Whia Scotian]and did,basis f r the
the eg Business pt Profusion.My
Code)or
.. Nm he ie 31.5 b therclrom end the bunt for Ne Illegctl a phial,1.Any it peraton of
iSectionm,.. than by any red 4.11 fnr a perm)eubjeeu the Ipplicw m a civil penalty of 3 8XIS 2IibBef 0 0 Occupancy Type
not mom Nen Bve hundred dollen(SSfA). P Y YP
0 1,a"M of dm pmKny,m my employees with wages u theb sale compcnsadon,
will do that wart,and Ute stoumuto is otimended oraRered Tousle(Sec.7044,Business
and Profesdons Code:Th.Cantratoh Liana law does not apply to an owner of Required Inspections
property who builds arimproveathereon,and who doessuchwork himselfarlhrough his
Own employees,provided dialauch impmsemenle an,not intended oroRered for ale.If,
however,the building or hernow mcnt is cold within an year of oompledon,the owner.
Wilder will bave the burden of proving Ws he did at build or improse for portents of
sale.)
0 1,as Owner of the property,em exclusively connecting with licensed contractors to
construct Ne project sec'
tra
7044,Business and Professions Cade:)The ConctoLi
r's .
cense law dao not apply to an Owner of property who Wilde or improves thereon,and,
who cone(s for such projects with a cauemor(s)licensed pursuant in the Contractor's
License Law.
0 1 am exempt underSec. .B&P C for this reason
Owner Data
73010WORKERS COMPENSATION DECLARATION
1 hereby eRrm under pcndty of perjury ore of the following deelamdoa:
1 hale and will maintain a CcrdOoate of Consent to self insure rte Worker's Compete
0
art,a provided for by Section 3]00 of Use labor Code.for the performance of the
fk for which this permit is issued.
I have and will maimdn Worker's Compensation Insurance,a required by Section
of the labor Code.for the performance of dm work for which this permit is issued.
y Warkefs Compound Ina este d PPolliiccy dtnkr ase:rrier. / Hrem cy Na.i 7Y V�
eERTIFICATEOF EXEMPTION FROM WOR ERS'
COMPENSATION INSURANCE
(This it.need nut becampletcd if the permit Isidro.hundred dollars(5100)
err lest)
1 ardfy that in the performance of the work for which this permit Is issued,l shall nut
employ any person in any manner mato become subject in the Workers'Campenadon
Laws of California,Date
Applkat
NOTICE TO APPLICANT:If, for making this Cenificam of Exemption.you shauW
become subject to the Worker's Compensation provisions of the labor Cade,you mum
.JO forthwith comply with such provisions or this permit shall be deemed mvokcd.
y y CONSTRUCTION LENDING AGENCY
[-� I hereby afftrm that them is a costrocdnn lending agency orho performance of
Cif the mark for which this permit is used(Sat.3097.Civ.C.) '
all Name
= z lender's Add.
U Q I sentry that 1 have read this application end stem that the mon information a
lT. Fconed 1 agree to comply with all city and county ordinances and sum laws totaling to
QUbuilding construction.and hereby audtodre topreandatim of this city to enter upnn dm
r at mon-mentioned property for inspection purposes
(We)agree to ase,indemnify ad keep harmless the City of Cupertino against
w f/1 Iiabilides,judgments,costs and expenses which may in any way accrue agamen aid City
in conseq
U^ APPL CANTO UNDEor the RSTANDS Aranting oftND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS, 9 �
Re-roofs
HAZARDOUS
signatue rof ApplinRData
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WIII the applicant or future building e,Chapt.core or hand's h Health
a material
u do,See by the Cupertino Municipal Code.Chapter 9.12,and the Heslth ad safety -
°"`'CY.2.Ss32(a)] y All roofs shall be inspected prior to any roofing material being installed.
7 If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant tore,equipment or devices which g
Id.
mit haardous air cdruminanu a defined by the Bay Arca Air Quaity Management all new materials for inspection. -
istrict]
0Ya Afo
I ham mad the WeaNuusmacrials requirements under Chapter6.95 of ee Califon.
ce Health k Safety Code,Sections 25505,25533 x.125534.I understand lhaifthe Wilding
net mmently have a temnl,that it is my responsihility to mury the m:cupat of dm i.. Baas. t,quimmenu which an s,W I pdo o issuance ' cf Occupancy. Signature of p icant Date
wner or.mharivc All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
szom
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
�UPEkTINO
Building Department
JOB ADDRESS: , PERMTT # G�
1 `
OWNER'S NAME:
7�tPHONE #
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors:
Sign a 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
]Septic
ng
tion
caping
g
ry
ental Sheet Metal
ng/ Wallpaper
g
ring
ing
g
Tank
Sheet Metal
Sheet Rock
Tile
z4<_4
pt-i/
Odvn"er//ontractor Signature Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
U P E IST I N O 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 with, firstobtaining 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: A a ,�-2
Job Site Address: /
Roofing Company Name: /_ /Y7SJZ O L'
A plicant's Signature: Date:, /
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Pepe
CITY OF CUPERTINO 0
REROOF I l
CUPERTINO PERMIT APPLICATION FORM
APN# 3 / / �-Z o n� Date:
b(� �Oy
Building Address: ,
Owner's Name: Phone#:
Contractor: hone#: 5/ License#:
Contact: Phone#: Cupertino Business License#:
,LZzye v o
Type of Roof Covering:
Existing: Proposed:
❑ . Built-Up Roof ❑ Built-Up roof
Asphalt Shingles );r Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings / ❑ Provide I.C.B.O. Report#
X To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read, Understand and Will Comply With Cu rt' o's Tear Off Polic
Job Description: gjy� Bl.2� / a° '�� //J0,4e7&, V— .2—y
i
Residential Coffmercial ❑
Fire Zone: Yes 0 No ❑ Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project: Type of Construction: Occupancy group:
QtY i
Apdicaft 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
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