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09030045 CITY OF CUPERTINO 7777-777777 BUILDING DIVIMN PERIVIIT BulfT>(D c�qq� PERMIT NO. � /U PALO VISTA RD LINDY ROOFING CO INC 09030045 "NERS NAME: PERMIT ISSUE DATE LAKSHMI SUB 476 W TAYLOR ST 03/11/2009 PHONE: SANITARY NO. CONTROL NO. ARCHITECTIENGINEER: BUILDING PERMIT INFO REMOVE EXISTING COMP INSTALL BLDG ELECT' PLUMB 0 Z LICENSED CONTRACTOR'S DECLARATION Jph Description U I hereby affirm that I am licensed under provisions of Chapter 9(commencing '^'^^^' ''^'^"^ �'^ z with Section 70(10)of Division 3 of the Business and Professions Code.and my license is =H in full force and eff 3 tit 2.(� Z License C�I�ss;; Lle• n F p Date d ContractorOli `g!. ARCHITECTS DECLARATION t I understand my plans shall be used as public records �yU 4 Wo y Licensed Professional y 3 OWNER-BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for Ole a0 following reason.(Section 7031.5,Business and Professions Code:Any city or county V6 which requires a permit to construct,alter,improve.demolish,or repair any structure prior to its issuance,also requires the applicant for such permit to Glc a signed statement cthat he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation (commencing with Section 7000)of Division 3 of the Business and Professions Code)or y 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(5500). ❑I•as owner of the property,or my employees with wages as their sok compensation, will do the work•and the structure is not intended or offered for sale(Sec.7044.Business Required Inspections and Professions Code:The Contractor'se License Law does 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.). ❑I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044.Business and Professions Code:)The Centrsctoes In- cense law does not apply to an owner of property who builds or improves thereon,and who contracts for such projects with a contractor(s)licensed pursuant to the Contractors License Law. ❑1 am exempt under Sec. B&P C for this recon ,1W Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑I have and will maintain a Certificate of Consent to self-insure for Workers Compen- sation,as.provided for by Section 3700 of the Labor Code.for due performance of the work 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 Worker's Compensation I ca er and Policy number are: Carrier. <-T�P � Policy No.: )12"W CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for otic 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'Compcnsaton Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Workers Compensation provisions of the Labor Code,you must Oforthwith comply with such provisions or this permit shall be deemed revoked. Z 0' CONSTRUCTION LENDING AGENCY P4 1 hereby affirm that there is a construction lending agency for the performance of Ix> the work for which this permit is issued(Sec.3097,Civ.C.) W A Lender's Name az Lenders Address V O 1 certify that I have toad this application and state that the above information is LL 0-" correct I agree to comply with all city and county ordinances and state laws relating to 0 V building construction,and hereby authorize representatives of this city to enter upon the W above-mentioned property for inspection purposes a (We)agree to save,indemnify and keep harmless the City of Cupertino against r y to liabilities,judgments,toss and expenses which may in any way accrue against said City V Z in consequence of the granting of this Permit Date r APPLICANT UNDERSTANDS AND WILL COMPLY WITH LL NON POINT Issued by: 2r.> SOURCE REGULATIONS. Re-roofs Si of Appliamr-onumclor Date HAZARDOUS MATERIALS DISCLOSURE Type of Loof Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Mumeip I Code.Chapter 9.12,and the Health and Safety 'ide,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. C3 Yes o If a roof:s installed without first obtaining an inspection,I agree to remove Will the applicanvefuturcbuilding occupant use equipment or devices which :mit hazardous air comaminan defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑Ya ❑No I have mad the hazardous materials requirements under Chapter 6.95 of the Cali(o g ria Health&Safer Code,Sections 25505,25533 and 25534.1 understand That if the building ` d urtenty have a tenant.that it is my responsibility to notify the occupant of the uiremen hich must be met prior k issuance of a Certificate of Occupancy. S lgn of Applicant Date Owner w 'zed agent Date All roof coverings to be Class'J ''or better N Community Development S�ab� 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 XPEI�TINO Building Department JOB ADDRESS: f1�LU v�� r PERMIT # 1� 10'- 06 L(S� OWNER'S NAME: A-1<SILM 7 ScLSPHONE # . 6F- - GENERAL CONTRACTOR " o o FAX # I am not using any subcontracto7��.gnature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSI14ESS 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 at�_- RE'ROOF CUPEkTINO PERMIT APPLICATION 0gb3bbeV5 APN # Date: Building Address: l0 Z70 Pko Vls7il A'd Owner's Name: LA K S 4 44 , Sv g r Phone #:!_ HOA: Yes El No If es provide IE tter from HOA j 7 q`g / Contractor: Phone #:f o J _�9yc) L�fvd ,�o�' � . l Fax #: Ljak� 2�-(i —`l 417 V Cupertino Business License #: Contractor License #: S Op Type of [hoof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof Asphalt Shingles ❑ Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other (Specify) ❑ Other (Specify) Number of existing coverings _ ❑ Provide I.C.C.E.S. Report# ❑ To be Removed ❑ Provide Mfgr. Installation Specs. Job Description: U N r) 00,1tj ^n 1N T AWO �� L� F-TI rm E C o - Residential Commercial ❑ Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if Green Building Checklist & attach it to the application or if there are any restrictions: ❑ applicable, include in plan set & the sheet index. Valuation: �j (/ 0�aP _ I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy: Si re Revised 02/05/09 CITY OF' CUPERTINO R]KROOF CUPEkTINO FEE S CHEDULE Number of Fee ID Fee Description Fee Permit Type Squares Group 1 REROOFCOM Re-roof Commercial B 1COMMLROOF 1BCBSC Cal Bldg; Standards B ALL PERMIT TYPES Commi,,sion Fee 1BSEISMICO Seismic Commercial B � 1REROOFRES Re-roof Residential B 1SFDWLROOF 1BCBSC Cal Bldg; Standards B ALL PERMIT TYPES Commission Fee / 1BSEISMICRE Seismic Residential B l REROOFMRES Re-roof Multi-Family B 1MFDWLR00F 1BCBSC Cal Bldl; Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICRE Seismic Residential B 1 BUSLIC Business; License B Cunununity Development Department Building Division City c�i Cupp-rt�;;,� I cicphurnc (1;06) Fay (-108 ,-�;; Building Department Subject: Ike-roofing policy for the City of Cupertino Prior topt�rmit issuance, you must agree to comply with 1997 UBC Stan" Lird5 anal lnal1l11ictul'el's sp��111CatrUlls l�Il :i'-rU�%1ll1��. ?. New root coverings shall not be appl ed without first obtaining till inspection and written approval from the buildi Zg inspector. A final inspection and approval shall be obtained from the L uilding inspector when the re-roofing is completed. �. All roofs shall be inspected prior to a-1y rooting installation. -l. To receive �� final sign off from the Ci��, the following steps lffc required: I) Pre-inspection and/or tear off apF roval. .) In inspection approval. Final inspection approval. a) Spark arrester installation. �. It plywood is installed, a plywood nail inspection is required. o. 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 pe formed. i\'OTE: If you call for a plywood nail inspection and the job is not D2ady, you will be charged a re-inspection fie of $17b.18. The re-inspection tee must be paid before another inspection con be scheduled. IMPORTANT: 1. Flat roofs must have a minimum of '�- per tout sl.>pe arld de1111011strat'_. that there is no ponding. �. An I.C.B.O. report is required to be o.i thejob site at the time on inspection. I understand and will comply with the abo-e stated policy on re-roofing. l-lomeo�\'rler's Nan1e: �G� Sl�r►, t � b ------ ------ ---- Job Site Address: bad �C V154-r'_ RA Rooting Company Name: .applicant's Signatur Greg Casteel BuildiIg Ofticial RevISed 11/2/04