03010192 (2) ' CITY OF CUPEW11NO
BUILDING DIVISION PERMIT CONTRACTOR I JNFOR""'! TION
BUB.DINGADDRISS: LINDY ROOFING CO INC PERMIT NO.
g 10144 RIEDEL PL 03010192
OWNI:R'S NAMIi: 5554 HARVARD DR APPLICATION SUB DATH
II`) GUTMANN MANFRED AND ROCHELLE 01/292003
IONS: 408) 269-2025 SANITARY NO. CONTROL NO.
ARCI IITECIDENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
w00 LICENSED CONTRACTOR'S DECLARATION Job Description
U I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing P
with Section 70000 of Division 3 of the Boinens and Profession,Code,and my license is
Gia. inminomc and efe REROOF
oyzoq: Lieena-aaa �_ L.." Kdot7 ' REMOVE SHAKES, INSTALL OSBD 5�0k YR COMP. SHINGL
F� Dare_ Contractor
ARCIIITECI'S DECLARAT10 �' f1��®
1 undersand my plana shall M cad es Ischii,records 6
xpu
uta a. LiUmcd Professional
FaOj OWNER-BUILDER DECLARATION FEB0 6 2003
ney<2 I hereby affirm that I on,exempt from the Contractor's License Law for the
m a 00 following rearm.(Section 71131.5.Business and Profeasimu Code:Any city or county
a which requires a permit m construct,alter,improve,demolish,or repair any slrucmm
F-Ze
Prior it)its issuance,also requires the applicant for such permiuo file a signed smtemenl
£xx that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq. Fl. Floor Area aluation
yF$ (commencing with Section 7100)of Division 3oftheBusiness and Professions Code)(it $10575
03.. that he is exempt therefrom and Be basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally of APN Number Occupancy Type
not...than five handled do]]..(M). 31621054 . 00 P Y YP
❑I,as owner of the property,or my employees with wages a their vile compensation,
will do the work,and the structure is not intended proffered for sale(Sec.7041,Business
and Professions Code:The Contractor's License Law does not apply in an owner of 305 - FRAME Required Inspections
property who builds or improves thereon,and who doessuch work himself or Brough his
own employees,provided that such imprawmcnsv ere not intended moRered for mile.Ir. 307 — INSULATION
however.Be building or impromment is sold within one year of complinda,the owner.
builder will have the burden of proving that he did not build or improve for purlwse of 6 01 - ROOF TEAR OFF
sale). 602 - ROOF PLYWOOD NAIL
01,as owner of Be property,am exclusively contracting with licensed contractors m 603 - ROOF BATTENS
cons met the project(Sec.704,Le:),Business and Professions CodThe Contractor's Li
cense law does not apply m an owner ofproperty who builds or improves thereon.and 604 - ROOF IN-PROGRESS
who contracts for such projects with a conlrachoodd licensed foliated 10 the Contractor.
License Law.
❑ 1 am exempt under See. ,B k P C for this reason
Owner Dow
WORKER'S COMPENSATION DECLARATION
1 hereby aRlm under penalty of perjury ane of the following declarations:
L I have and will maintain a Certificate of Consent to al 4insue for Worker's Compere
aetion,a Provided for by Scninn 3700 of the Labor CnJe,for the pctnrmancc of the
work for which this Permit is issued.
1 have and will maintain Workers Compensation Insurance,as required by Section
3100.1'Be labor Code,for.the Kine mance of Be work for which this Permit is amod.
My Worker's Cam nsatinn lnsuonce carrier and Policy number an:
IFICAT O EXEMPTION P.IiFRO!;lA41WORKERS'
COMPENSATION INSURANCE
(This acton need nal Iecpmpleted 11'the permit is for one hundred dollars(5101)
or Im,,)
I cenify that in the Performance of the work Or which this Permit is issued,1 shall not
employ any person in any manner xn as to become subject n the Workers'Compensation -
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Cenificam of Exemption,you should
become subject it the Worker's Compensation provisions of the tabu Code,you must
O O forthwith comply with such provisions or this permit shall M deemed revoked.
'Z' CONSTRUCTION LENDING AGENCY
[-� 4 I hereby affirm Bat there is a construction]ending agency for the performance of
> the work for which this permit is issued(Sec.3097.Civ,C.)
Q Leader's Namc
=z Lar,Zs Address
U O 1 Unify that 1 ban read this application and slow that Be above information is
L4 P Correct,I agree to comply with all city and county ordinances and sate laws relining to
0U building construction,and hereby authorize representatives of this city to enter upon the
r above-mentioned pmperly for inspection purposes.
0. (We)agree to save,indemnify and keep harmless Be City of Cupertino against
r h liabilities,judgmenu,cami and expenses which may in any way same against mid City
in
of the granting of
U t—t
APPLICANT cUNDERSTANDSIAND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS,
Re-roofs
Signmureof ApPlicato, Dare
HAZARDOUS MATERIALSdinocDstore or
Type of Roof
Will Bc applicant m future building iec Capt stem or handl,hazardousmaterialSafer l
as defined by Be Cupertino Municipal Code.Chapter 9.12,and the Ilcalth and Safely
Gsde.se,tex zss3z(a)7 All roofs shall be inspected prior to an roofing material being❑Yesya P P Y g g installed.
Will the applicant of future buildi ng occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
mit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
Distriect (/
Cl Yes
1 have mad the hazardous materials mquiendenks under Chapter 6.95 of the Cali for- A
niallealthSSafety Code,Sections 25505,25533 and 25536.l understand dw iftle building
does not currently have a mount.Nat it is my responsial' w notify rim welq am of Be
acquiremcnas hichmust at prig oiwuanw of of Occupancy. SlgnaturCof llcape" Date
Owner Oram cmc tag / am All roof coverings to be Class °B° Or better
Building Division
10300 Tone Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
Fax: (408)777-3333
CUPERTINO
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.
2. .New roof coverings shall not be applied without first obtaining all inspection
Wand 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) Pinal 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 n;ru'mum of Y"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: R(Y��.o 11-P 42 7 �� ,d i t j-)
Address: ///tl� 2i �e
Reroofing Company Name:
Applicants Signature: Date:
Joe Antonucci
(Chief Building Official)
6/25/01