06070026 CITY OF CUPERTINO �s,�� Rr p�k=I � k�♦"�" rte ,
BUI,DINU DIVISION PERMIT ly �t' ^''�hu,��ORY'g 5 p
EUI LONG ADDRESS: ' LIND ROOFING CO INC PER-111,0060700261101 HOLLYHEAD
LA
OWNER'S NAME: PERMTTISSUEDATE
SUNDAR GANESH 5554 HARVARD .DR
NE: SANITARY NO. CONTROL NO.
(408) 286-9990
ARCHITECT/ENGINEER: BUILDING PERMM INFO
-BLDG ELECT PLUMB MECH
0 0 0 0
loo LICENSED CONTRACTOR'S DECLARATION Ib Description
1 hereby affirm that 1 am licensed under provision of Chapor 9(commencing OBSCTI p
with Section 700f.fDiHrlon 3 of the Business and Proksmons Codc,md my lkease is
in(utlfmroeandefe9_ 21! REMOVING 2 LAYERS COMP OVER TAR & GRAVEL INSTAL
Date clw COOLIO. 30# FELT AND 21 SQUARES OF NEW LIFETIME COMP
3 � CHIT TS DECLARA ordT_—� - - V1 C'US'S' A
f�U 'd
my Plans Wbe il he used u public records
a
10 Licensed Professional
OWNER-BUILDER DECLARATION
iI hereby affirm that I am exempt from the Commetor's Licensu Law for Co
jai fallowing mann.(Section 71131.3,Business and Professions Code:My city or county
$ which requires a permit les cm orua,cion.Improve,demo]M.or n:pait any nmetute
x> prier m in issuance.alas requires the applicant for auctioned,ro file a signed moment
�Q that he is licensed pursumlto the provisions of the Comrwmr's Liccn�Law(Chapter 9 =Number
Valuation
33 (commencing with Section 7000)of Division 3oftheBusiness and PiardemosCode)or $8000
..
that he B tempt therefrom and the basis for the alleged exemption Any violation of
Secam 7031.3 by any applicant for a permit subjects the applikant tm a civil penalty of Occupancy Type
mut marc Nan five hundred dolWa(f300). /
0 1.as owner of the property,er my employees with wages as thehsule compensation, 36226
wiudolhewark.mddnwnaambnotmnndedmonlied(orsale(sa.70ta.Buaiieu Required Inspections
and Prefexlons Codc:The Commis res License Lew does act apply m an owner of q p
property who builds err improves Ncrmn,and who does soh work himself m through his
own cmploy cd,provided that such improvements tie ratimende l moRered formle.if.
however.the building w Improwmant issuld wWin ane into of mmpleuan,tic owner-
ho lder will have the burden of proving Naf he did nm build m improve for puryose of
0 1,as agar of the Property,am ertlmiwly conducting with licensed contracsers to
construct the project(See.701x,Sddnum,and Profeuians Code:)The Con rademr's Li- v(")
wLaw cues oat apply to
m Wqwnnvv of property y who builds Improves Cmre
om . d,
who
V/
ace far such proje ba
lthanmcwKs)Ilcemmwm
ed pursuant Comment's
Lkeam L (�
1 A.
0 lam exempt undo See .B b.PC for this mason
Owns Data
WO KER'S COMPENSATION DECLARATION
1 hereby ammt under penslty of perjury one of the following declaretians:
I have and will maintain a Certificate of Cansentau self-alum for Workc/sCumper-
saaon,as Provided for by Section 37M of Ne Labor Code,for the performance of the
work for which this permit is issued.
0 1 Mw and will maintain Worker's Compensation Insurance,as required by Section
3700 of Ne labor Cade.for the performance of she work fm which this permit or iaswd
My Wmim's Communal.,hamrerom carries and Policy o/umbm awe:
Gorier. 57476 r uNd Polley No.:f EL�
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
Cibb auction need not he complcu:d Irma permit is froom hundred dollar(SIM)
or less)
I anify that In the performmce or the work for which this permit h,Wood.I shall not
employ any penin In my mannerm m to became subject m the Worked Compensation
Laws of CaBflo l am
Applicant \ -�
NOTICE TO AP :IL net making NLL CeniOeso of Labor Cos you should
become object y the Waher's Compensation provisions of do Labor Code,you must
0 0 faMwiN comply with such provbians m this permit shall he domed mated.
tiCONSTRUCTION LENDING AGENCY
(—, IherebY affirm that them iso construction lending.rorY for the performance of
fYv> the work for which this permit Is lured(Sec.W.Civ,C.)
143 Q Lmdoes Name
0.
0 z Lcmices Address
U O I unify that 1 have read this applicatien and made that the.bow Wdrmatiun U ,
[1.H torten,I agree in comply with all city and county ordinances and sate laws relating to
OU building Cominution,and hereby authamre reprexnm utivof this City to enter upnn the
LU shove-.edum,cd property for inspection puriwses.
LL (We)agree to saw,indemnify and kap handles,the City of Cupd,l against
Lq tiebilides,Judgmemt toss and expenses which may in my way act oaNnst mid City
U Z In consequence of the gaming of this permit.
.. APPLICANT UNDERSTANDS AND WILL COMPLY WITH
� �A�NON-PO—
I
Issued by
: Date
S RC EGULATIO% sti �� _7/0Y Re-roofs
Slg une ppEcmt1Cantranmr Da
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will the applicant or future building m=pantsmre W harMk haardous material
as defined by the Cupenim Mun ipal Codd.Chapter 9.12,and the Health and Safety
Cade.Section M324)? All roofs shall be inspected prior to any roofing material being installed.
C]Y. No
Will the applic'anf forum building aceupsnt use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hammous aircrosminsns m deMcd by t Bay Area Air Quality Management all-new materials for inspection.
Disttla7 /
CYm CMO �0 /
Ihow&Safet Nehmen tons,25labmqulreme 55534.1rChepord.93 o(theWildin• rte_ -] /2
do Heslth&Safety Cade,Scramshath]is25533
myruu12133lityto nuMNulfde Wilding
I `'
does not eumently how a snenL Cat II u my mponsihility m nod Y the occupant of Ne
requiromcnts which must be met prior m issuance of a Ccmificam Occup y SI eof Applicant Date
ow er ram smd.g m, All roof coverings to be Class"B"or better
CITY OF CUPERTINO
em 1 of 2 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36226012 . 00
DATE ISSUED. . . . . . . : 07/07/2006
RECEIPT # . . . . . . . . . 35140
REFERENCE ID # . . . : 06070026
SITE ADDRESS . . . . . : 1101 HOLLYHEAD LA
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : SUNDAR GANESH
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 8 , 000 . 00 147 . 96 0 . 00 147 . 96 0 . 00
BSEISMICRE VALUATION 8 , 000 . 00 0 . 80 0 . 00 0 . 80 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 148 . 76 0 . 00 148 . 76 0 . 00
•
Community Development
10300 Torre Avenue
f 7yy, Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408) 777-3333
jPEI�TINO
Building De artment
JOB ADDRESS: PERMIT #
.b a gevho L.9
OWNER'S NAE: qA-0- 0 PHONE #
M -
GENERAL CONTRACTOR: LI N , p FAX #
I am not using any subcontractors: L2�) -'\-
ignature Date
Please check applicable subcontractors and complete the following ' ormation:
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
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
lit Telephone: (408)777-3228
C�����'` ,O Fax: (408) 777-3333
N Building Department
artment
Subject: Re-roofing policy for the City of Cupertino
1. Prior to permit issuance,you must agree to comply with 1997 UBC Standards
and manufacturers specifications on re-roofing.
2. New roof coverings shall not be applied 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. '
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.
3) Final inspection approval.
a) Spark arrester installation.
' 5. 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 City inspection can be performed.
7. NOTE: If you call for a plywood nail inspection and,the 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 can be scheduled.
IMPORTANT:
1. Flat roofs must have a minimum of r/4 " per foot slope and demonstrate
that there is no ponding.
2. An I.C.B.O. report is required to be on the job site at the time on inspection.
I understand and will comply with the above stated policy on re-roofing.
Homeowners Name: S V'n,&,.alI r Ga-n e s1h�
Job Site Address: I I d( Y-1 b l l" h eae L r-09_
Roofing Company Nam IVNAA &00tlnq CO _
Applicant's Signature: Date:
' Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINO
"- REROOF
CUPERTINO PERMIT APPLICATION FORM
APIC# Date:
31D2. - -OVa- 7
Building Address: 10 l A U I I east n e.
Owner's Name: P ne#:
Contractor: - Plpne#: License #:
i�d Roo v8� a8 O 1 S
Contact: Ph a#: Cupertino Business License#:
UB� a-S�e -�R4 c�
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
324- Asphalt Shingles E e Asphalt Shingles
❑ . Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
1a Other(Specify) T 4 G- ❑ Other(Specify)
Number of existing coverings 6; ❑ Provide I.C.B.O.Report#
Cx To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read, Understand and Wi 1 Comply With Cu ertino's Tear Off Policy:
Job Description:re—rout�5 ayrr C-Or P (!er qG 'ns 30
�t.Q vary a Lr �ime C6 s_ a�
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: U
Cost of Prcjec • & Te of Cons�uction: S Occupancy group:
�eco r n
Qty. if
Applicable Fee ID' Fee Description Fee Group
BPERMFEE ldg Permit Fees BUILDING
BENERGY Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
•