06020044 CPPY OF CUPERTINO �' >Te a+¢,awKs o' 4a• >1 �- - +T+7g'�'s%
BUILDING DIVISION PERMIT = CONTRACTOR�YNFORMA.TION
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BUIMINGADDRESS: LINDY ROOFING CO INC PERA1RN0'06020044
7OLT,TNQFR Rn
5R'S NAME:3 B
'NEPERMrf LgUEDATE
KAREN A LEASURE 5554 HARVARD DR 02/08/2006
PHONE: SANTIARY NO. CONTROL NO.
(408) 286-9990
ARCHITEC tENGINEER: BUILDING PERMRINFO
BLDG ELECT PLUMB MECH
0 0 0 0
300 LICENSED CONTRACTORS DECLARATION lob Description
i I busby&MM than I am I'm under p.WCh",a of Ch",9 fcmomcrming P
n< Lith Sc&nJU110)ar dNeBy���,a,nd PmfraWm nc�wscu
B�_: � 2( w REROOF-INSTALL 6 SQUARES/3 PLYMODIFIED W/TIE
D . comm« h + ocrn� INTO (E) COMPOSITION ROOF� � �®
3 < CNIIFL DEC,, A : l -r�
(U 1u &my Pkat MVI h used u public rcccrtls
a O UJ licevcd PIM al v .
J OWNER-BUILDER DECLARATION r� (] �1� rl(lo^
coyny I bc¢by.from Thu I am acmpl from Ih Cantmcrl Liccnso law for Ih I- 0 G. L(J b
`G 0 following won.(SCnYm 7031.5.Buumla and Pla(a+ium Code:My shy or.1y
5$� which otvirm I pomou to corwmcl.Wer,Import,&mdlah.m opts'
any monurt t'%Q M n,. -
_ZI, Prior N its IEWrCe.IIW IegWrtJ NC 1ppli[LLL for l hp it to Ele l signori LlLL'mCm yy A�u•
< dwheuliwrtsoJ matanttothpoW..fOCCtnu .',fiwrtscfaw(Chapkr9 Sq.Ft. Floor Area FF., Iyyy{ {��j gg I p�1nYI\yY'aFlu'at 4000
go (caomcming with See&n 7(00)d Dvsion 3 of the Bush¢sand Pmfmiam Code)or - U U `v9�
R- that h is acme tbcmtmm and dt basis for th a1MgW erempbm MY VW&tam of 111111 VVVI
Section](131.5 by an/applicant for l pump sobjrcu Ne aPplfcuu m a Civil psahy d ATN Number Occupancy Type
twl mmetlan Bsc hulled&IWI(5500)' 35923031 . 00
0 L as,owocr of th propmty.or MY=00yv,Lihh Wates as Iheh sole Campennaun.
win&NeWk.aras Nc manure U nm N¢n4d oraRortd for ak(Scc'NM.Boar. R aired Inspections
and Pmf=O"Code m
Th ContorS Hume law En onm
Eon apply W owner of eq P
properly wW bdldsmun ran lherem and who dons¢h Work hlmPRorWmugh his
own emplcYea•fmm d Oat mch impmrcnrau ate nmtntendeW mafferN fade If.
hawescr,da boj:OM a impmsemem it sold within now year of=Pledm the awnm-
bunds wiB bne th btRdor of paving NSI h aid nm mild a bnpmsc fm Pupo¢d _
❑I.as.d Ih Properly.Iso adutlstlY canuctiog with licraxd wa.W
caaRmcl Ih pmjm!(Sc.706x.Bwmms Ind Prnkss"a Code:)Tho Co orae s U-
Lice
wase law ams ud apply u an owar d popCnYwW btdMs ar impow-s Wertar�uW. .
Lilco.Law.
lanaacu Iso Word pmfcw with•contnnw(s)Ilwrt¢d purawm b Ih Convacmla
ol
❑ .scop under See .Bh PC fm thL rolon
Due
WORKERS COMPPNSATTDN DECLARATION
1 bereby affirm under penalty of per}cy one d the following dclarrimu:
a.c lrM will mnnaina ConiMu d C.to adr-1 rtfm Wwkdl Contpn- �
tkn,n pmvMW fm by S..son 3700 of&labor Code.for th pWmmarca of th
wart for which that permit is iumd.
0 1 have and will malnuln wml¢r',Canpenutlan Invu .n ro#.d by SCalan
3700 of the labor Codc,for Ibc po farman¢of Ih work for which NII yammil h IssucQ
My Wmkee, om rantion lownna aeric and Polcy mvnbcr arc
( '
Cartier. % > Policy No.:IS S I ,,, ,,/USO'
CERTIFICATE OF EXEM PITON FROM WORKERS'
COMPENSATION INSURANCE
(This action noN not be®tpk"Ugh Nsrok U imam huntreddonaa(SIM)
or kn.)
1 euafv Om in du pufurrn.of th work for which NII pumit is lsso q I"I om
uaplq any Arson in any manrcr m as n bec.subjea to th Wwkcrs'Compeavllon
Laws of"ifmva Disc
Applicam
NOTICE TO APPLICANT:If,afWr making Nb Ccnillcam Of Eaempion.Yw shuts
bccorne mbjw m tht Wor "Conpmadon povisimu d th Labor Cade.you mtw
0 Q ronbwilk Limply with soch F(nd3iom Co Nu Pmmil shall h dtrumd mwkcl
Z" CONSTRUCTION LENDING AGENCY
E
N IltmbY.Basso stat lhrtllacoruutNonluWWt.patty rmdtlrrrurman¢uf
> th wan for which this permit U Ivud(Sc.3097.Ci,C.)
ILd A Iandces Nares
DZ Lando.Aldous
U0 I anify that I barn rid this apphcuion arW lou That th sbotc Information Is
IL E cvrtctt 1 ago¢m tmoplY wilt all oily aAi connly oldllurnes a1M sok laws rclulnY to
C) Willing coossmcllon,and hncby mtharim rtp otlllrcs d this city to cmcr upon arc
W ahmx mcmimrtd lvo,cny fm lmpNos Purpmcv
(WC)agroo W nae,it C l rdfy a&kCCP h tCss NC City d Cuperorn aptnl
y Ilabillt ,jud:mwu.eosu%ox1cx enselwhieh may U soy +y aaox sgainsl Wd City
U In wme9ttrte of the granting of this permit
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NO -POINT Issued by: Date
SpuR�REGULATIONS.
h� _ . (O Re-roofs
Sign ApplipnNCantiactmNk
HAZARDOUS MATERIALS Df5 URE Type of Roof
Will the applicant m fmmt Wilding aavwt Imam or bandit hrmdom muclSal
as d oC,i by th Cupnlm MuniCipH Codc.CNptr 9.11,and the HeBN and Safny
.seo&n 2031(07 All roofs shall be inspected prior to any roofing material being installed.
0 Yu
Won tIt Wow (atm dine aavpant egmpmml m dtvl�watt If a roof is installed without first obtaining an inspection,I agree to remove
cmh barudntss it I u dcfircd by do Bay Ara Air Qt ty Mmatmm all new materials for inspection.
DWritt?
Ihaseread& matrialsnpnr cruunder CbPwr 6.95 duh Carom
Na lblm&Safa1Cudc,Swu.2005.25533 ant]n531.Iwhrcvd dmifth buiWm:
dm nm r°arc a tmane that it u ro"on oronwit, mafy of Qle
b mµab m par =a CatiOnmfi�r^ Si aur fApplicant Date
V�+ G D.
All roof coverings to be Class "B"or better
'red atwl Dau
t
CITY OF CUPERTINO
L0 1 of 1 PERMIT RECEIPT OPERATOR: suem
COPY # 2
Sec: Twp: Rng: Sub: Elk: Lot:
APN . . . . . . . . : 35923031.00
DATE ISSUED. . . . . . . : 02/08/2006
RECEIPT #. . . . . . . . . : 33140
REFERENCE ID # . . . : 06020044
SITE ADDRESS . . . . . : 7533 BOLLINGER RD
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : KAREN A LEASURE
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . .. : CUPERTINO CA, CA 95014-4332
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 3, 000.00 83 .16 0.00 83.16 0.00
BSEISMICRE VALUATION 3, 000.00 0.50 0.00 0.50 0.00 '
TOTAL PERMIT 83 .66 0.00 83.66 0.00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 83 .66 1546
TOTAL RECEIPT 83 .66
•
i
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CRY OF Fax(408)777-3333
JPEkTINO
Building Department
JOB ADDRESS: _ PERMIT #
OWNER'S NAME: ez PHONE # cZ (o a
GENERAL CONTRACTOR FAX #
I am not using any subcontractors: t2r-- •� —��
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
.e2
Owner/Contractor Signature Date
CITY OF CUPERTINO
qMR, REROOF
opo aoGgy
CUPEkT.INO PERMIT APPLICATION FORM
APN#
Date3-5-qa3J3
Building Address: 33 &AbkRCS
Owner's Name: Phone#
:
lk o erj h �Lt5iJr 5-6
q- l
Contractor: LI - 1 l co License s8
Contact: Cupertino Business License #:
e„ o t�-a-8tn- 1 go
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood ShinglesCF�"P ��• L3Wood Shingles y
2C Other(Specify) X Other(Specify) 3 PL, MODrFi
Number of existing coverings ❑ Provide I.C.B.O. Report#
X To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read, Understand and Will ComplZ With Cu rtino's Tear Off Policy:
Job Description: C4-n t,A4—C!F
L V► � w fie. lvi-� tvKis-1�2 Co, �St+ia� fT�c
Residen bal q' Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning D�t. if
there are an restrictions:
Cost of Project: Type of Constriction: Occu ancy group:
�i
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