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07090204�Op iIUU <a LL ,N: Tae )aC W V .oma 3pC ^u csc eF'a 1. . wE N 1 U CITY OF CUPERTIJNO PERMIT 77 77 C0NTIECTC'iR INRAITT�N� BUILDING DIVISION BU9WMESPAIRW00DS CT LINDY ROOFING CO INC PERMIT NO. 07090204 OWNER'S NAME: PERMIT ISSUE DATE SUSAN VERGHO 5554 HARVARD DR 09/28/2007 INE: SANITARY NO. CONTROL NO. (408)28-)-9990 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7(th() of Division 3 of the Business and Professions Code, and my license is RMV EX S t ['NG WOOD SHAKE, I N S TLNG 1/2" 0SB, 30# FELT in full -_nsLic.# �1 & 34 SQ. OF NEW LIFETIME COMP. �L_ Cont1S DEC LAR TION 1 understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the following reason. (Section 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure Sq. Ft. Floor Area Valuation prior w its issuance, also requires the applicant for such permit to file a signed statement License Law 9 that he is licensed pursuant to the provisions of the Contractor's (Chapter $20000 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 5913 11 Number Occupancy Type not more than five hundred dollars (5500). ❑ I, as owner of the property, or my employees with wages as their sole compensation, Required Inspections q will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law docs not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, die owner - builder will have the burden of proving that he did not build or improve for purpose of sale.). 0 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:) The Contractor's Li- cense Law does not apply to an owner of property who builds or improves thereon, and. who contracts for such projects with a cantractor(s) licensed pursuant to the Contractoes License Law. 0 1 am exempt under Sec. B & P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: 0 I have and will maintain a Certificate of Consent to self -insure for Workces Compen- sation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 0 I have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My Workers Compensation Insuawe carrif and Policy number Cartier. ;E;T�_� I-V Policy No.: � 1 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is formic hundred dollars ($100) or less.) I certify that in the performance of the work for which this permit is issued. I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be decreed revoked. CONSTRUCTION LENDING AGENCY -n. I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097. Civ. C.) ~ Lender's Name Lender's Address 7 1 certify that I have read this application and state that the above information is -� correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against n liabilities, judgments, costs and expenses which may in any way accrue against said City in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH AL NON -P NT Issued by: Date :4 - —• 6. URCE REGULATIONS. b —�'l r lk--- Re -roofs , ------ Type of Roof tg rc fApplicant/Conlraetor v Dam MATERIALS DISCLOSURE dl the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipa odc, Chapter 9.12, and the Health and Safety Code, Section 25532(a>? All roofs shall be inspected prior to any roofing material being installed. ❑ Yes o If a roof is installed without first obtaining an inspection,agree to remove Will the applic or future building occupant use equipment or devices which emit hazardous air contaminants as efined by the Bay Area Air Quality Management .1 all new materials for inspection. District? Q Yes o I have read the haze ous materials requirements under Chapter 6.95 of the Califor- if the building �( nia Health & Safety Code, Sections 25505, 25533 and 25534.1 understand that does not currently have a tenant, that its my responsibility to natiry the cupant of the Date requirements which must be met prior to issuance of a of Oc l�el�-7 Sign erre of Applicant All roof coverings to be Class 'B or better - Own o thorired agent Dare CUPEkTINO (0-709 0a0 L+ CITY OF CUPERTINO REROOF PERMIT APPLICATION FORM APN .# � G Date: Building Address: Pcv_r-Lk),podS C7 - Owner's Name: Phone #. �SvS re- A o P -a a Contractor: i �-� nc�l hone.#: License #: Roo�i✓i F& "c2l Cont4ct: hone #: Cupertino Business License #: BSEISMICOM Seismic Commercial BUILDING Type of Roof Covering: Existing: Proposed: ❑ Built -Up Roof ❑ Built -Up roof ❑ Asphalt Shingles .—'Asphalt Shingles `R_ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other (Specify) ❑ Other (Specify) Number of existing coverings O 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: • "r, Job Description:mo L" e yL, S •-, ' W o a[G2 �� ice, %( Residential'X Commercial Fire Zone: , Yes ❑ No Confirmed with Planning D�t. if there are anrestrictions: Cost of oject: D Type of Cons ;tion: Occupancy group: Ovo e✓— rooT Sin Qty. if Applicable Fee ID Fee Descri tion Fee Grou BPERMFEE Bld Permit Fees BUILDING BENERGY Energy BUILDING BSEISN UCRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING BPLANCHK :Plan Check Fee BUILDING BUSLIC :3usiness License BUILDING 2 ITEMS OF 2 CITY OF CUPERTINO PERMIZ RECEIPT Sec: Twp: Rng: Sub: Blk.: Lot: APN 35513115.00 DATE ISSUED.......: 09/28/2007 RECEIPT #.......... BSC00002807 REFERENCE ID # ...: 07C90204 SITE ADDRESS .....: 20577 FAIRWOODS CT SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ...... OPERATOR: patg COPY # : 1 OWNER SUSAN VERGHO ADDRESS ..........: 20577 FAIRWOODS CT CITY/STATE/ZIP ...: CUPERTINO CA, 95014-4200 RECEIVED FROM ....: LINDY ROOFING CO CONTRACTOR .......: RUMFORD, LINDY LIC # 3921 COMPANY LINDY ROOFING CO INC ADDRESS ..........: 55-`,4 HARVARD DR CITY/STATE/ZIP ...: SAN JOSE, CA 95118 TELEPHONE (408)286-9990 FEE ID UNIT QUANTITY IMOUNT PD -TO -DT THIS REC ---------- NEW BAL ---------- ----------------------- BPERMFEE VALUATION ---------- 20,000.00 ----------- 277.56 ---------- 0.00 277.56 0.00 BSEISMICRE VALUATION 20,000.00 2.00 0.00 2.00 ---------- 0.00 ---------- TOTAL PERMIT ----------- 279.56 ---------- 0.00 279.56 0.00 METHOD OF PAYMENT ----------------- CHECK TOTAL RECEIPT AMOUNT --------------- 279.56 --------------- 279.56 REFERENCE NUMBER -------------------- #2924 Community Development Department Building Division City of Cupertino 10300 "Torre Avenue CITY OF Telephone: (408) 777-3228 CO P E IST I N O Fax: (408) 777-3333 Building; Department Subject: Re -roofing policy for tr.e City of Cupertino Prior to permit issuance, you must agree to comply with 1997 UBC Standards and manufacturers specifications on re -roofing. New roof coverings shall not be apflied 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. All roofs shall be inspected prior to any roofing installation. 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 mail inspection is required. 6. Any roofing which is applied withcut first obtaining an inspection, will require the removal of all new naterial down to the sheathing, so a proper City inspection can be F erformed. 7. NOTE: If you call for a plywood nz<il inspection andthe 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 :an 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 1.C.B.O. report is required to be :)n the job site at the time on inspection. I understand and will comply with the ab )ve stated policy on re -roofing. Homeowner's Name: 1J(,LSa4i b h Job Site Address: U �� t r-t,�,t U o "� S C7- 17 Roofing Company Name: L Applicant's Signature. ! V 1�W C, -,ate: W12-7/07 Greg Casteel Building Official Rerised 11/2/09 Prinfo i on Recycled Piper Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 CITY OF Fax (408) 777-3333 (."UPEkTINO Building Department JOB ADDRESS:_ PERMIT # OWNER'S NAME: C e Ve O PHONE # GENERAL CONTRACTOR FAX # D I am not using any subcontractors: ��`--' 9/,2,7/ Signature Date and rmmrilata t1lP fnllowincr information: Owner/Contractor Signature Date 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