06090224 (2) CITY OF CUPERTINOATnx4BUILDINC'DIVISION PERMIT _190 T �Q N,
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BUILDING ADDRESS: LINDY ROOFING CO INC """'N006090224
22120 STEVENS CREEK BLVD
OW NEWS NAME: PERMIT ISSUE DATE
OCITY OF CUPERTINO 5554 HARVARD DR 09/25/2006
NE: SANITARY NO. CONTROL NO.
(408) 286-9990
ARCHRECT/ENGINEER: BUILDING PERMMNFO
BLDG ELECT PLUMBO
�00 LICENSED CONTRACTOR'S DECLARATION Job Description
ZU I hereby affirm that I am licensed under provisionsof Chap.9(...in$
.zj with Sectlan]IXIU)afDivinon]ofthe Bnsitmm and Professinm Lode.aMmylucnseb REROOF- STOCKLMEIR HOUSE . TEAR OFF EXISTING,
E m full forte sad eRen.`' •���jj G
j�2Lice Clm I.u.g 2("' �l
Dem contactor 3 31 �� INSTALL 15 32 PLYWOOD, 30LB FELT & 2 LAYERS, 40y�
'Q� ARCHRELTSOECLARAI LANDMARK CERTAINTEED. CLASS A
< 1 undersand my plans Nell be used as public meards
)j U
c ts�
Licensed Professional
Oat I am UILOER DECLARATION
I hereby.(Tiro on I am exempt from the Convacmrs Ucense Law for the
pO which
mason.Permit
]1171.5,Business and Professions Cods:Any chy stcounty
m t2 which requires a permit to ennetdeL alms pophow,Such
demolish,or mash any muctare
',jgpdmmsIlermdPMMOLCOido tW applicant for uohpomittoa=Lawdataumcm
< that he is llceveJ purmanttothc provisions of that Contmetork lJceve law(Chapter Sq.Ft.Floor Area Valuation
11 O (commencing with Sermon 7000)of Division 3 of the Business and Prormaions Cade)or $30000
9- that he is exempt therefrom and the bub for the alleged exemption.Any violation of
Sectim 7031.5 by any applicant for a permit subject,the applicant to a Civil penalty of APN Number Occupancy Type
not mom then five hundred dollars(S500).
0 L u owner of s m property,or my employees with wages As their sale campenmdon,
will da du work.and du structure is wantended ar.fremd for sale(Sec.70M,Business Required Inspections
and Professions Cade:The Convector's License Lew doss at apply to an mean, ns of q P
Property who builds orimproms tWroon,and who doessuch walk himaelfor Waugh his
awn employees,provided Nat such Improvements m not Intended or offered formle.If.
however,Ne building or Improvement Is mid within aro year ofcompladon,the owner
Wilder win have dm intonate of proving Nat be did tut build or improve for purpose of
sale.).
0 1.as awmr of the property,am excluively Cro uaning with Ilcemed conuuton At .
construct the project(Sec.70x4.Business and Professions Code:)The Conuacmfa U.
cave law doss not apply m an owner of property who Wilda or improves themon,and.
who comment for such projects with a conuacmns)licensed pursuant to the Contrecmrl
Lice.U-
0 lmoexempturnmSee .Bh PCrorthiamasan
Owner Dau
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penally of perjury on of du following dedaradmu:
I bave and will maintain a eattilinteof Covent to self-insure for WartefaCompen-
ad..As provided her by Section 3700 of the tabor Code,far dm perrormane of ma
Atoll,for which this Permit is issued.
0 1 have and will maintain Worker's Compression Insurance,as required by Section
3700 of On,Labor Code.for the performance of the work for which this permit b WOOL
My workef pensdon Laurance carries and Policyn�u(ot ram:
`
Cartier. ia7"'e fv.r d Policy No.:,L.g)`a T A,�Cb10
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE '
(This acetic need netbccompthu i lithe permit Is far.Imedreddellm(S100)
or less.)
1«nay that in tW performanee of the work for which this permit is issued,l shat]net
employ any person in any manner an As to become subject to the Work eCompewtion
Laws ofCalifomia.Dam
Applicant
NOTICE TO APPLICANT:If,after making this Ccniflcau of EsemMlon.You should
became mbjem to the Worker's Compensation provisions of the Ia Wr Cede,you most
.J O foMwith comply with such ptivifiav m Nis permit shall be dod m
mevolud.
„Z,r► CONSTRUCTION LENDING AGENCY
[-w I hembysflon the Jure laacoimmctlnn lendingagency far dm,m,fmrmauf
ai7 Ne work for which this Permit Is issued(See.3097,Clv,C.)
14 .
Lendces Nameow a
'
i7. z Leaders Address
U Q I certify that I have read ibis application and suss that the above informetiun is
W Comet.1 agree to comply with all city and county ordinances and sure laws miming to
C) building Convection,and hereby atelmdsempresentvOves of Nis city to enter Conn the
(sI above-mentioned property for inspection purposes.
CL (We)agree to save.indemnify and keep harmless the City of Cupertino against
ver In liabilities,judgments.casts and expenses which may in any way accrue against mid City
V Z in consequence of the gmnvng of this permit.
APPLICANT DERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
B� ^L•�-� Re-roofs l�
Signuuse ofof Applican✓CaARDau
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WIII the applicant no Muni Municipal
Co e.Coapt stem wand the
hanNoanmaurbl
u defined by du Cupertino Municipal Code.Chapter 9.12.and the HeaIN anti Safety
Code.Semon 355334)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes Nu
Will that applicant err f/atom Wilding aeetpant Am equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hvAt& All commi u as defend by the Bay Ares Air Quality Management all new materials for inspection.
District?❑Yes No
I have mal LN mauriau mquimmewundcr CNpc,6.95ofNeCalile,-
niaHcalthBSafctyCodc,SsGov35505,35533and35534.1ebennadthatirdw building
docs Inst currently have a unset,that It b my responsitelity to notify the occupant of W
requite rota oat met priorm issuance otaccrtirmam or Occupancy. Signature Of AppllCaflt Date
�� 1`� q All roof coverings to be Class"B"or better
Owner err mthorissd gens Dau'
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
• Telephone: (408)777-3228
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 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 and the 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 comply with the above stated policy on re-roofing.
Homeowner's Name: C l Tif C cu Pe'`rr n o
c�
Job Site Address: J 120 S-(:2 L)2 n S C t ee K $1 V
Roofing Company Name: G lyt Roof t,L
Applicant's Signature: -F^^,/V U�y (�-�/y Date: 0?-Z5 G 6
• Greg Casteel
Building Official
Revised 11/2/04
CITY OF CUPERTINO
• REROOF
CUPERTINO PERMIT APPLICATION FORM
APN# 35-7— bQ � Date:
3 — !1 �"O
Address• 1 b
Building C�
1�.0' �i1et e e f; I U d
Owner's Name: Phone#:CIT- V rlino
p&' 777 - 3272—
Contractor:
- 32? 2--Contractor:L_ t
koafl t Co License#:t \
Contact: Cupertino B sin`e�ss License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
Asphalt Shingles X Asphalt 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 Policy:
Job Description:
Residentiai�_A Commercial ❑
Fire Zone: Yes ❑ No Confirmed with Planning Dept. if
there are any restrictions: U
Cost of Project oO� Type of Construction: Occupancy group:
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
•