06060182 (2) CITY OF CUPERTINO 777
•BUILDING DIVISION PERMIT CONTRACTOR INFORMATION -"-
BUILDDIOADDRESS: LINDY ROOFING CO INC PERMIT No.06060182
11743 TRINITY SPRING C
OWNER'S NAME: PERMIT ISSUE DATE
MS LI 5554 HARVARD DR 06 /20 /2006
)NE: SANITARY NO. CONTROL NO.
(408) 286-9990
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
r�rOp LICENSED CONTRACTOR'S DECLARATION lob Description
C I lereby affirm that 1 am limned under provisimu of Chapmr 9(commencing
^<to with Section 7000)or0ivision 3 ofthe,Business and P,Ofessk and my Beene is
o` inrallromeaMerr REMOVE EXISTING 1 LAYER SHAKE ROOF. INSTALL 30L
sem FELT. NO PLYWOOD AND 20 SQUARES OF NEW 50YR COM
;F,c Da¢ COntrxwr
A HITECTS DECLARATION
$a
m< 1 underhand my plans shall he used a public recorN
tto
yu
s o Licensed Professional
OWNER-BUILDER DECLARATION
I I hereby aRnn Nat I nm exempt from useConvxmfs License Law for Ne
00 following mason.(Section 7(131.3,Business an Prefeum a Calc:Any city or county
K m which rmums,a pencil to construct,alter,improve,demolish,or.,an hay swcmm
u-m prior it its issuance,alae mit ira the applicant for such Permit m Bk a signed succo m
-�i that heti limnsed purwam to Nc provisions of me Commethliecuc Law(C'haper9 Sq.Ft. Floor Area ValuaF$6000
EEC (commencing with section 7000)of Division 3 of be,Business and Profusions Coek)ter
that he u exempt therefrom and the buts for the alleged cwmption.Any violation of
Section 7031.5 by airy applicant fora permit subjects du applicant ro a civil penalty,ofppN Number Occupancy Type
not orae than five hundred dollars(M). 3 6 6 5 3
036 . 00
❑1,u owner of Ne progeny,rm my empbyw with wages r Nie(hale 041,Business cation,
will dofmama and Ne swmumunue,Likeeedo affered Law
Out apply 7D s4,Bminw Required Inspections
Nd erofetaou Code The esthermfs and
law dw Out apply N an roow.h is SII q P
Owne ywho
es,promimprovesch imroveme t dceasuou unwork himelfor through his
Own employees, NetsmhimProsemmsaseneyearoedmpleded for aic If.
owner- 9 } 11
however,the building of improvementuhaltwithin aneyev or improv to.the owner- �` ,I 11"a
builds ham have the buNen of proving that k did trot build car improve rue purpose of
sak). y
9
❑1, mom mom or Ne progeny,em exclusively contracting with licensed mn0ammrs to JUN
C2 UU
consct N 014
e project(Sec.7 .Business and Profetim oCade:)The Conmcures Li C 4 t�tl
cense law does not apply to an owner of propcny who Wilds or improves hereon.and
Lwho immm Lacs for such projects wihamnlncwKs)liaised pursuant w
antNe Conuacsoh' /twt�rJ rh� aa.,,, ,p
01Law.
on l....... tkl9}$'y'u}/(I trtt�f/N7 I4f{Iy7r`l/It/hj 1`11111IIIYlII /�
I am der sec ,B&P C for Nis reason [Cf\lr•�`+^7s'!
Owner Dau
WORKER'S COMPENSATION DECLARATION
1 bemby Nm Mer penalty O(penury mu of Ne following dakratiwu:
1haveand will mA Un ina CeNr.amof Conventwself-insumforWorke&Compcn-
wtion,as Provided for by Section 3700 of the labor Code,for den Performance of the
work for which his permit is issmd.
❑1 have and will maintain WmkeYs Compensation Insurance,as un uired by section
3700 of Oe labor Code.for he performance of he wort for which NU Permit is issued.
My Worker's Cgmpe an I9sylanmcanter surd p th,
EXEMPTION
Grrier. Policy 7�'�
CERTIFICATE OF EXEMPTION FRORO M WORKERS'
COMPENSATION INSURANCE ,
(Thu section recd not W completed Rde permit u fore.hunduddoBan($I00)
or less)
I certify het in he performatte of he wart for which this Permit is Osumi,I shall not
employ any Person in any manner an as w become wbjeci to Ne Work a'Compeaation
Laws of Uifmmia.Dau
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption.you should
become subject m he Workr's Compensation provisions or dte labor Cat,you most
.J O forthwith comply with such provisions or this permit shall W deemed revOlim.
ZN CONSTRUCTION LENDING AGENCY
�-+ I herchy affirm hat Nert is.mmusuctinn ectim,agaey for the se,fartnwauf
C' he work nor which this permit u issued(See.3097,Civ.C.)
1 Q !antler's Name
D Z Lender's Address
U C) I eestify hat 1 hast read this application sued some ha he above information is
W f-'
comm.I agree w comply with all city and county ordinances and sum laws relating to
0 building couwction,and hereby auhmrim repreenuniver Of out city to enter upon Ne
r 4k1 alwve-mentioned property for inspection purpoes
(We)agmc in as..indemnify and kap harmless he City of Cupertino times,
rq limiliva,judgmcnu.costs arms expcnes which may In any myattmc agalna saidCity
U Z in couo,cura a of the granting of Nu permiL / -Z 'gg
PLICANT,UNDERSTANDS AND WILL COMPLY WITH ALLN-P .Issued by: Date L
\URCE RE�TIONS.
��Z Re-roofs C,
Sngnaz O ApplscwUConnacror Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Ne applicant or form Wilding acupintnore or handle haasemis material
a dcrimd by he Cupertin7f.1.1
ipal Codc.Chapmr 9.13,and he Health and Safety
cat.SO'ansss3z(a)? All roofs shall be inspected prior to any roofing material being installed.
Yon
If a roof is installed without first obtainingan inspection,I agree to remove
Will Nc epplinnt building acupanl um cyvipmcm car devices which P g
emit hvardnas air marmmfmnls u rncd by Ne Bay Area Air Quality Management all new materials for inspection.
DisuictT P
❑Ya o
Ihave SaciyCha4Ntions Mriedo 5.2553 kmcmundc ndroedthaith,WiCalifor-
nia Health de safetyeode,Sectors 35SUs.3s5J3 and 33.1.1. undesy Nuif Ne building
does rly hose,tenwL No it u my rapomihility N ufy acvp science
rt rremcnasneh uiLr+uLmetpriorwiss_ uakofaCeniru, Signature of Applicant Date
Owner car cad asent Date All roof coverings to be Class "B"or better
CITY OF CUPERTINO
•m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 36653036 . 00
DATE ISSUED. . . . . . . : 06/20/2006
RECEIPT # . . . . . . . . . : 34949
REFERENCE ID # . . . : 06060182
SITE ADDRESS . . . . . : 11743 TRINITY SPRING CT
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : MS LI
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
RECEIVED FROM . . . . : LINDY ROOFING
CONTRACTOR . . . . . . . : RUMFORD, LINDY LIC # 3921
COMPANY . . . . . . . . . . : LINDY ROOFING CO INC
ADDRESS . . . . . . . . . . : 5554 HARVARD DR
CITY/STATE/ZIP . . . : SAN JOSE, CA 95118
TELEPHONE . . . . . . . . : (408) 286-9990
�EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 6, 000 . 00 126 . 36 0 . 00 126 . 36 0 . 00
BSEISMICRE VALUATION 6 , 000 . 00 0 . 60 0 . 00 0 . 60 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 126 . 96 0 . 00 . 126 . 96 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ---- -- - ----- ------------------
CHECK 126 . 96 1846
TOTAL RECEIPT 126 . 96
•
a. Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408) 777-3333
�UPEkTINO
Building Department
JOB ADPERMIT #
�f3 j 2�1,4n S ��tN S Ct ,,az
OWNER'S NAME: 1- 1 PHONE #
GENERAL CONTRACTOR lnie AX # J '
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the followinginformation:
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
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 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: " ; , Lt
Job Site Address: I 117 LI 3 �r r� A' i Sot-
Roofing Company Name: L1 rJU P rn(\4n64 Co
Applicant's Signature::
' Greg Casteel l
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF
.CUPERTiNO PERMIT APPLICATION FORM
APIV 1 n Date: a
W 0
Building Address:
171 Tr,✓) 1 ' S cam.
Owner's Name: Ph
t`1 S , l_', B Q 4S
Contractor: C CoPho OS �� License :
Contact: Q Phone-#: Cupertino Business License #:
Type of Roof Covering:
Existing: Proposed:,
❑ Built-Up Roof C3 Built-Up roof
❑ Asphalt Shingles Ar—' Asphalt Shingles
,"!Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
I Number of existing coverings ❑ Provide I.C.B.O. Report#
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Com 1 With Cu ertino's Tear Off Policy: ❑
JobDescri tion.Yc-- .60,—) x,s /�..� ayQ� 3hu� roo Irn
o l wad 4fi li�S o� nQ rU U e Co 3
Residential Commercia ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project: Type of Co struction: Occupancy group:
Qty. if
Applicable Fee IDFee 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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