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06100211 CITY OF CUPERTINO BUILDING DIVISION PERMIT M. A. .x�N� BUILDING ADDRESS: LINDY ROOFING CO INC PERMITNO-06100211 21900 WOODBURY DR PERMIT LSSUE DATE OWNER'S NAME: RENEE WILSON 5554 HARVARD DR 10/30/2006 SANITARY NO. CONTROL NO. NE: (408) 286-9990 ABUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH p 0O LICENSED CONTRACTOR'S DECLARATION Job Description V(= 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing Z with Section 7000)of Division 3 of the Business and Professions d my license is !=a. in full force and cfl, t. lJ� REROOF- REMOVING WOOD ROOF INSTALLING 30# FELT z License Class L� AND WEATHERWATCH UNDERLAMENTS, 1/2" OSB, F ; Datc r Contractor HITECPSDF-CLARA 24 SQUARES, 40 YEAR CLASS A i a< I understand y plans shall he used as public records :2. U.F' Licensed Professional y OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the 00 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 Z y priorto its issuance,also requires the applicant for such permit to file a signed statement Valuation =c that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area t— (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $10000 ., 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 APN Number Occupancy Type not more than five hundred dollars($500). ❑L as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for salt(Sec.7044,Business Required Inspections and Professions Code:The Contractor's License Law docs not apply to an owner of q p 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,the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑1,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 contractors)licensed pursuant to the Contractor's License Law. ❑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: �j I have and will maintain a Certificate of Consent to self-insure for Worker's Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑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 Compgen�sa^tion Ins ca and Policy num r arc l_`. bQe Cartier. S�r t a�i Policy No.: IL(,{L�}/_ CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one 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 Qforthwith comply with such provisions or this permit shall be deemed revoked. Z 2 CONSTRUCTION LENDING AGENCY 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.) QLender's Name a Lender's Address U 0 1 certify that I have read this application and state that the above information is LL►-t correct.I agree to comply with all city and county ordinances and state laws relating to Q U building construction,and hereby authorize representatives or this city to enter upon the W above-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against to liabilities,judgments,costs and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit. Date ►-� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-PO NT Issued by: 17-- REGULATIONS. �- ." _mak " l d A) n Re-roofs sindure of plicant/Contractor Datc HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant store or handle hazardous material as defined by the CupertXNo 1 Code,Chapter 9.12,and the Health and Safety Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. E]Yes Will the applican 'ding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove :mit hazardous air contami;tSfincd by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building �^ docs 1 have a tenant,that it is my responsibility to notify the occupant of the re trcmcnts whit list Ix met prior to issuance era Ccnirtcatc of ices Signa Of Applicant Date All roof coverings to be Class"B"or better Ownc r auth 'e agent are Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 47UPEkTINO Building Department JOB ADDRESS: •�l rf�� .JL��Ou PERMIT OWNER'S NAME: C—S� PHONE #(Iyo ) GENERAL CONTRACTOR: 1,1�du iRc> FAX # I am not using any subcontractors: -Vk _ Signature Date Please check applicable subcontractors and complete the following information: 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 CITY OF CUPERTINO .m 1 of 1 PERMIT RECEIPT OPERATOR: amyw COPY # 2 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 32619066 . 00 DATE ISSUED. . . . . . . : 10/30/2006 RECEIPT # . . . . . . . . . : 36610 REFERENCE ID # . . . : 06100211 SITE ADDRESS . . . . . : 21900 WOODBURY DR SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : RENEE WILSON 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 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL - - - - --- - - - -- - --- - ------ ------ ---- - --------- ---------- ---------- -------- -- BPERMFEE VALUATION 10 , 000 . 00 169 . 56 0 . 00 169 . 56 0 . 00 BSEISMICRE VALUATION 10 , 000 . 00 1 . 00 0 . 00 1 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 170 . 56 0 . 00 170 . 56 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER - - - -- - - - --- - - ---- - - - - ------ - - - ----- - ---- - ------ CHECK 170 . 56 2094 TOTAL RECEIPT 170 . 56 CITY OF CUPERTINO ' W1000 I REROOF CUPEkTINO PERMIT APPLICATION FORM APIC# 32(_0'101 — C)�D Date: Building Address: C� 0(5 1,L)`) v^ Owner's Name: Re /I-e-e.� 1AJ Sot-) Phone#: Contractor. nn Phone# OF License #: Cont4ct: - h ne#: Cupertino Business License #: Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles — Asphalt Shingles ca-''%'5od 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: El Job Description: J,e rv�vo U,►mac _>c:; ro o- l h:, In Residential Commercial ❑ Fire Zone: Yes ❑ No Confirmed nfirmed with Planning Dt. if ere are any restrictions. Cost of Project: Type of Construction: Occupancy grou 0 04:, U Si 0e 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