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CITY OF CUPERTINO
BUILDINGDIVISION PERMIT
OI!Rt�CTORi,1V'kC1.ItMATsIIfI�;
BUILDINGADDRESS:
PERMIT NO.
23500 CRISTO REY DR
LINDY ROOFING CO INC'
OWNER'S NAME:
PERMIT ISSUE DATE
OM
A A O. CONTROL NO.
Ann
(408)286-9990
ARCHIIECffENGINEER:
BUILDING PERMIT INFO
-�
BLDG ELECT PLUMB - MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
P
1 hereby affirm WI I Am liaved under provisions of Chapter 9 (mmmenring
iw Section 7") of Division 3 of we Business and ProfessionsCCode/, a�nd my license u
k full forte and 2 S W
RE—RF INSTLL 40YR ARCH DIMNSL COMP SHNGLS CLS A
_ O
License a.. Lk.N
OS Q '
Q
y
Dam Co.. /aa
A HRECI S DECLARATION
1 andwaml my plans shall be used As Public mord
Licensed Professional
OWNER -BUILDER DECLARATION
I he.by aHimr Nal 1 am cacmpl from the CoalnctoYs Ll... Law far the
following mason. (Section 70I.S. Business and professions Code: Any Cily m Manly
,
which "tams a permit m commec4 aline improve, demolish. or repair any shuctuto
prior no its k amea. Also mQala{ Inn applicant fmsuch perrnllm film a signed Abnormal
Contractor's Lienee Law 9
Sq. Ft. Floor Area
Valuation
that he is licensed pumanl to dm provisions of the (Chapter
(commencing wish Sectio 700W) NDivision 7 of to Business and professions Cod,) or
$11000
Nat he is aampl sherefram and the bast$ fm she alleged exemption. Any violation of
APN Number
Occupancy Type
seeden 70313 by erry appllant fm a permit subjccls to applicant to a civil penalty a
not ream wan five bandmd dollars 4500).
34252100 . 01
❑ I. as owner of dm pmpvry,mmY �plrtYry wish wga athe'v sok Mmpewdon,
Required Inspections
will wart, andth c edaran,
ale(Sec. TOW, BrearO
dArte
onsisme.I i owner
as coon: The Contmtors
and ProfThe apply lf
who law dao
M r r is
property wM buildarimproves lhrsrnn,aM whodassah work himself err Wvu{h hu
eny w
own employers. provided shatach impmwmMs art not intended maRemd (resale B.
-
howevv. g ha imPmvemant ksola the swan-
did as year of mp
-
a ove for
wiB Nw dm buAan of poving Nat Ire tlitl not mild m improve far purpme a(
id havem
saw.).
saw.).
❑ 1, As owner M dm pa -Pitt• w aelusiwly eontrcting with Ilaaid rnnsclma to
aawcl she p.jeet (Sec. TOW. Busfnea and Professions Cade:) The Contractor's Li -
Mae Law oma not apply m an owner of Property who builds or imPmw Ineran, and.
who contracts far inch Mj ms witha,iona cer(s) Imems d pursuant m the Comrantors
License law.
E]I w exempt under Set .B A P C fmshis wan
Oswsr Dam
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penally of perjury arc of the fallowing osclaations:
I haw and will maintain a Certificate of Covent to mIf-insure fm Wmk<fsCamper-
salian, As provided fm by Section 3700 of the Labor Code, fa the pe formanM of wn
work for which this Permit is issued.
❑ 1 have and will maintain W alcor, Compensation I., as requited by Section
7700 M the Lab.Code• fm the perfmmataz of we work fmwhich this permit is iamd.
'
My Wafter" Compensation In a ca ' and Policy nu
L�0
Polity
NFlAN WORKERS'
CERTIFlG OF FROM
COMPENSATION
COMPENSATION MSURANCE
(fnt$ mien nerd set be completed Bible permit is faoa handed dolWs ($100)
at lest)
I certify oat k the pmfe erame of we work for which this I rmall u'..,w. I shall not
employ any person in any mannerso a m became subject m to Workers' Compcaadon
Lava of California Data
Applicant
NOTICE TO APPLICANT: IL after making wk Certifies. of Exemption, you should
become subject to we Workers Compensation provisions of thn Labor Code, you mus
' forthwith comply with such pmvism. or this pcTit shall be deemed mwkc0.
CONSTRUCDONLENDING AGENCY
iherebyslimsthat were ksued(Sa0on agerq far the pafarmana of
.Ch,
' work for which tht$ permit t$ issued (Ser. 709'1. Civ. CJ
'
Lenders Name
Le
,
Undoes Add.
1 anify shat I have read this application and sum win we Above kfonnatiuo is
s corms 1 agree W amply with all City and county on inaav and sum laws relating to
'
building consvation• and hcreby aworise mpmxnuliwa of wt$ city to enure upon the
shove-mendoned property for inspection puryums.
(We) agree to ave. indemnify and kap harmless dm City of Cupertino against
Iiabilitia•Judgra.max.us and expo•... which may In any way.m. agai.Assid City
in consequerce of the granting of this permit
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NP01NNN[jj
Issued by: Date !�
S REGULATIONS. F�J
` r
Re -roofs
Type of Roof
SigmstarderAppimaittComascuar Data
HAZARDOUS MATERIALS DISCLOSURE
Will am appllcantm future bu0wng accupam sem a lunak hiandoes material
As defied by dm Cupertino Mania Cade. CLepmr 9.13, and the Halt end Safety
Code. Geon 25533(a)7
All roofs shall be inspected prior to any roofing material being installed.
Yes e
If a roof is installed without first obtaining an inspection, I agree to remove
Will the appb i or ratio. ho Id 6 occupant sec c9uipmcnl or &A. which
nil naardnno air cMu 0 m u rad by she Bay A.a Air Quality Management
all new materials for inspection.
et7
❑YaNu
I have road the bnndna mamriaH.quimmenuun4r Ch.pmr 6.95 of we Ulifm-
out Hcalm At Safety Coda. Sccliav 25505,25533 mW 35534.1 uMcntaM this if the building
^
IED 2 / Q
does not correctly have • mini wt$ it is my.aponsibilily to maty dm a Pa^t of to
mqui'c uuwhich.mR melpiarwt$um ofaCertifwamofa
i atu of Applicant Date
All roof coverings to be Class'' or better
.
Owmrm arced agent am
0 2 ITEMS OF 2
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ......... 34252100.01
DATE ISSUED.......: 10/27/2008
RECEIPT #.........: BS000006466
REFERENCE ID # 08100167
SITE ADDRESS .....: 23500 CRISTO REY DR
SUBDIVISION .......
CITY ......... :... : CUPERTINO
IMPACT AREA .......
OPERATOR: patg
COPY # : 1
OWNER ............: MID PENINSULA REGIONAL OPEN SP
ADDRESS ..........: 23500 CRISTO REY DR
CITY/STATE/ZIP ...: CUPERTINO, CA 95014
RECEIVED FROM ....: LINDY ROOFING CO, I
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
•
FEE ID UNIT
QUANTITY
AMOUNT
PD -TO -DT
THIS REC
NEW BAL
---------- -------------
1BSEISMICR VALUATION
----------
11,000.00
----------
1.10
----------
0.00
---------
1.10
---
0.00
1REROOFRES SQ FEET
44.00
572.00
0.00
572.00
0.00
TOTAL PERMIT
----------
573.10
----------
0.00
----------
573.10
----------
0.00
METHOD OF PAYMENT
-----------------
CHECK
TOTAL RECEIPT :
AMOUNT
---------------
573.10
---------------
573.10
VOICE ID DESCRIPTION
-------- ----------------------------
601 ROOF TEAR OFF
604 ROOF IN -PROGRESS
•
REFERENCE NUMBER
----------
#3779
VOICE ID DESCRIPTION
---------------- ---
602 ROOF PLYWOOD NAIL
605 FINAL REROOF
Community Development Department
•"'. Building Division
City of Cupertino
1o_t00(-108) A�-3226
I'cicphunr: (-108) 777-.3225
Fax: (406) 777-3?33
Building Department
Subject: Re -roofing policy for the City of Cupertino
I Prior to permit issuance, you must agree to comply with 1997 UBC Standards
❑nli
111a11U fe CCU r (21 S spec if icat'lo ns Un rC-Ioofi I IY.
2. t!ew root coverings shall not be applied without first obtaining all inspection
and written approval from the building inspector. A filial 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.
_) Pinal inspection approval.
a) Spark an'ester installation.
3. 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 Cit}' inspection can be performed.
7, NO'l : If You call for a plywoocl nail inspection and the job is not read;',
YOU will be charged a re -inspection fee of $176.18. The re -inspection fee must
be paid before another inspection can be scheduled
1:N4PORTANf:
1. Flat roofs nutst have a minimum of % " per foot slope aria denumstrate
that there is no ponding.
2. An I.C.B.O. report is required to be on thejob site at the time on inspection.
I understand and will comply with the above stated policy on re -roofing.
H�ne: �%(D Peolnsu)o� )eeglodtca —0'0eJ 'fQc Dr57-rlcC '
jib Site Address:
).-,25-00 Crrs-Tz )eev Or.
Roof ingCornpanyNamc: Ll%1G=Ptx)-)�.,�q
Applicant's Signature: � ' Dato: 10 —,;; 171'J O
Greg Casteel
Building Official
Revised 1'1/2/04
CITY,;OR;QUPERTINO:.
-;....RQOF:
-- CUPEkTiNO PERMIT APPLICATION
3Ll,�?5 ,2 io 0 . of
4/oo/�-9v7
N #
Date: ate:iG Ly- o�
Building Address:C ZI S7-0
o
CU P-e� rip
((
Owner's Name: 1-4(0 jaSScj/c�,_ pglvh Phone#:�SD-��f���ZU�
-7S-Do S7- Tgs&P1q 7}ve,
&Y -h
Contractor.
Phone #: y
�/.
G C i
Fax.#:. ?o if 020 (o
Cupertino Business License #:
Contractor License #:
/S
Type of Roof Covering:
Existing:
roposed:,,;:..
P .
❑ Built -Up Ropf
Asphalt Shinol s
❑ Built -Up roof
Asphalt Shingles
❑ Wood Shakes
O Wood Shakes
Q Wood Shingles
❑ Wood Shingles
❑ Other(Specify)
❑ . Olher(Specify)
1 Number of existing coverings
❑.': Piovide I.C.B.O. Report #
❑ To be Removed
❑, Provide Mf& Installation.Specs.
Job Description: �li fq Llb yr, i9rc�,
oil? 213 wt osl�OOSi o.� raty S
C_( ,A-,
Residential
C ercial
Fire Zone: Yes ❑ No [�
Confirmed with Planning Dept. if
there are any restrictions: ❑
Valuation:
// D eo
I Have Read, Understand and.Will Comply,with;Gupe;tino's Tear -Off Poli ,cy: