03050124 (2) t CITY OF CUPERTINOe',
BUILDING DIVISION PERMIT �.C®NTRAC�TQR°INFORMATION ;
BUILDING ADDRESS: PERMIT NO.
LINDY ROOFING CO INC 03050124
NA PEtMIT ISSUE DATE
5554 HARVARD DR 05/27/2003,
SANITARY N0, CONTROL NO.
(408) 269-2025
ARCHITECT(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
+0o
LICENSED CONTRACTOR'S DECLARATION Job Descri tion
I hereby affirm Net I Am licensed under provision of Chapter 9(commencing P
i with Section]Ofq)of Divinm Sof dm Bu W profession Code,and my license is B�W I�
in fullforcesd if ��Bvb.s��G®
iMj. LlcenseCis Lk.N y�5 G REROOF
a Date Contgqcllgqr rn5 �7 '']]
A C ITEC, DECLARA 'N / JUN ? J 200,1
vtanx my Me IN As puhli nr
y
5 Licensed Professional
y O ER-BUILDER DECLARATION BUILDING
1 hereby affmthe n that 1 am exempt from Convaetoh License law roe the
.00 following reason.(Section 70313,Business and Prefcaalon Code:Any city Of County
5$E which requires•Permit an cunsvuct.alter,improve.demolad.an repair may structure ,
Prior to its issuance,also requires the applicant forsuchpetmit to rile a signed statement
< that as Is licensed Pa...,tothe provrslonofthe Conurtwr',U.nmLaw(Chapter 9 Sq.Ft. Floor Area Valuation
Y�O (commencing with Section 7000)of Division 3 of the Business and Profession CaM)at 10000
e w$ Net At is exempt therefrom and the basis for the ellcgW exemption.Any vlobtlon of
Section 7031.5 by any applicant fm a permit subjects the applinnt ro A civil penalty of �tos( P y Type
not more Nen Bve hundred doll..($500). 3 AP.L le50 O CCU araC e
❑1,At owner of the pmpmy,Co my employees wit wages As their seta compen.ton,
will do the wink,and themrucmt is net immmded ar offered f.nde(Sm.7044.Business 305 - FRAME Required Inspections
and Pmf.W on Code:The Conmctora Limns n e Saw donot apply to an owner of 9 P
property whobulldsmimprows Hereon.and whod.essnh work himself.,through his 307 - INSULATION
own employees,provided that such improvements art nmintended arOffareA foreale.If. 6O1 — ROOF TEAR OFF
however,the Wilding or improvement Is sold within am year of completion.lie ownrn
builder will have Use Which of proving Ban he did not Wild m Improve far Purpose of 602 - ROOF PLYWOOD NAIL
cale.).
1.as Owner of the property,am exclusively contracting with licensed contractors to 603 - ROOF BATTENS
construct the project(Sec.7044,Business and profession Cade:)The Contractors Lr' 604 — ROOF IN—PROGRESS
cense law does not apply an an ownar of property who Wilds or impmves themon,ad,
who contractsfor such projects with a contractor(s)licensed puma t to the Contractors
License Law.
CI I Am exempt antler See. .B d:P C for this morm
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby a(fum under pcnity of perjury ore of the following decla.don:
I hove and will maintain a CeNfinm of Consent to self-insure foo Worker's Comper-
.iton,As provided for by Section 3700 of the labor Code.for the perfom.nm of Ne
work for which this permit is heated.
❑I have and will maintain Workers Compensation Insurance,as acquired by Section
3700 of the laver Code,for ite performance of the w rk far which this permit la Issued.
My Workers Compensa�on lnsug9pe egRLLr6r�' 43XIdher use:
@^IR �✓r/i-! O'&•s'S�Po(ICY Nom N��aO o
CERTIFICATE OF EKEMMON FROM WORKERS'
COMPENSATION INSURANCE
(Thu section aced rot W completed if the match isforonchundied dollars(SIM)
m Ina)
1 cattily that In the palmmsne of Ne work for which this permit is added 1 shtll am
employ any porion in any manner an As m become subject m the Workers'Compewton
I.A.of Celifomia Data
Applicant
NOTICE TO APPLICANT`.If,after making this Ccrafcam of Exemption,you should
become subject m the Worker's Compensation provisions of the Lehm Code,you mum
.,Q forthwith Comply with such prnvislons At this permithill W damned revoked.
zCONSTRUCTION LENDING AGENCY
y
�-m I hemhy afRm that dart its C..tion kndinpgeny for the performanm of
!Yi> IW work for which this permit is issued(Sec.3097,Civ.C.)
UA Landers Name
=Z Leader't Address
V(2 I certify that 1 have rad this application and sate Out the aWve Infomatiun is
1L t correct I Agree to comply with all city and county ONindmes and state laws relating w
0[V' building conswcdon,and hereby authorise represanmives of 06;city to enter upon 0u
W above-mentioned property for insi mTlon purposes.
(We)agree to move,indemnify and lamp harmless rte City of Cupertino Against
n,m Taj] IlabllWu.judgments,costs and expenses which may In my way accrue against did City
() in APPLICCUN UNDERSTof the grarting ofANDS ANTEND WILL Splvl&Y WITH ALL NON-POINT Issued by: Date
SOURCE ` TION
L_X — Re-roofs
Si um of Appliar/ omaelm Date
H ABOGUS MATERIALS DISCLOSURE Type of Roof .
Will oro appiream An lot=Wilding acupml mom or handle hamadous material
As a'ned by the Cupertino Municipal Code.Chapter 9.11.and the Harm and Safety
Cade.Section 255320)7 All roofs shall be inspected prior to any roofing material being installed.
O Yes u
won the applicant or rot building o upant use equipment or deal es which If a roof is installed without first obtaining an inspection,I agree to remove
nth hmaNnua airC....manu d de0ncd by the Bay Area Air Quality Management all new materials for inspection.
DimricR
Ya u
I have read f hang
maleralsom aimmentsunderChaptcr 6.95of dm Carter"
nu Health h SafetyCade,Sections M505.25533 and 25534.1 uWentsnd ft lfthe Wilding a
does not currently have mnum. hurry 'lity A,miry ate om'upant of theix
rt rtmen which be 'ormiss 'Bum ofOc ry. Slgnat eofApp [ D to
l
Owner meat,..,. / Dote All roof coverings to be Class nBn or better
Building Division '
to 10300 Toren Avenue
i Cupertino,CA 95014-3255
Telephone: (408)777-3228
CUPE�TINO F= (408)777-3333
Building Department
Subject: Reroofing policy for the City of Cupertino.
1. Prior to permit issuance,you must agree to comply with 1997 UBC Standards
and manufactures specifications on reroofing.
I New roof coverings shall not be applied without first obtaining all inspection
end written approval from the building inspector.A final inspection and
approval shall be obtained from the building inspector when the reroofing 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) Preinspection and/or tear off approval.
2) In progress inspection approvaL
3) Proal 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 that the
_ 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 of inspection
We understand the above policy on reroofing and will comply with this policy.
Homeowners Name: h !%i A
Address: W—/Z eel,' z4�.I
Reroofing Company Name:P,rA , ',
Applicants Signature Date t=d,
Joe Antonucci
(Chief Building Official)
6/25/01
t
CITY OF CUPERTINO
I REROOF Z
CUPERTINO PERMIT APPLICATION FORM
APN# Date:
Building Address: t
Owner's Name: Phone#:
Contractor: Phone#: License#:
Li
Contact: / / Phone#: Cupertino Business License#:
L int�l a9-
Type of Roo Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt ShinglesAsphalt Shingles
Wood 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 Off Polic : ❑
Job Description: �?w�ovv44 9 �t 4wr 4c Ds� i30,> yG S`G„/7C 9t�i lr
ase
Resident al " Commercial ❑
Fire Zone: es-❑::�N� Confirmed with Pla 'ng Dept. if
there are anyrictio s: LJ
Costo roject: Type of nst do Occupancy ro
O -
Qty. i
A c b 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