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03100190 (2) p Vi CITY OF CUYER'1'INO t� � �'� z:wilk� �•m''� ,rr fa BUILDING DIVISION PT RMIT CONTRACTOR INFORMATION �;- BUILDINGAODRFSS: LINDY ROOFING CO INC PERMIT NO.03100190 11521 SUNRISE SPRING CT OWNER'S NAME: 5554 HARVARD DR FERNUTIS5UEDATE ZHIMIA LINS 10/27/2003 IF"E: (408) 269-2025 SANITARY NO. CONTROL NO, ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 I0 o LICENSED CONTRACTOR'S DECLARATIONtonsorhap Job Description 1 Wrchy efOrm that 1 em licensed untie revisions of Chbpmr 9(commencing P £¢ wins onion mda)of Division 3ollhe Busir uiu dProfcns Codc,and mylicense is +�<„ Tomo nderre _ REROOF-REMOVE EXISTING/INSTALL ;�? Lice CI o Den — C.ntraen! 50 YR COMPOSITION SHINGLES vt-p� ntr 1 undors1 my plans shall used u public merit /O / E `3 �p5 Licensed Pmfcuional .] OWNER-BUILDER DECLARATION �/ C<I I hereby aso .Loan that 1 ori exempt from the Contractor's License Lew for the O p o following mason.(Sermon IIon LA Business and are,Professions Calc:Any city or county 5$ which nyuires a Permit m ennswp,alta,improve,h parmit t teterepair anygned atmmum Priors its iuuance,also suant to Waisions Of for such Permitnrilese signedstatement s^^s� that he(commencing wit pursuant to the of Division of the eBusi ossa License Lew(Chodmr9 Sq. F[. Floor Area Valuattpg 507 rjF (commencing exempthanner an and of D rusionr the the exemption. Any vi Code)or $ Nei he u exempt mcorfmm and be buts for Ne allcgw emmpuon.Any violation of Section 7031.5 by any applicant for a permit subjects Ne applicant n a civil penalty of 3 15itfMA"ge—rO0 Occupancy nmtmmmthnfwchundorddolon($500). P Y Type ❑I,as owner of the pmpcny,or my employees with wages u Heir solo compensation, Will do the work.and the swamrt is not intended or offered for sale(Sec.7041,Business and Professions Code:The Contractor',License Law docs not apply to an owner of Required Inspections pm,ny who builds or improves marten,and who doeaeuch work honest far through his own employes,provided that such improvements are not intended or offered for sale.If, . however me building or improvement is sold within one year of completion,One owner- bullder will have me burden of proving that he did not Wild or improve los purpose of sale.). I,as owner of the property,em exclusively contracting with licensed comracuma to consumer the project(Sec.7044,Business and Professions Code:)The Connector's Li. . can=law dose not apply in in owner of property who Wilt or improves memun,and - who terminate for such projects with a coomctm(p licensed pursuant o be Contractor's License Law. ❑lasomemptundersec. ,B&PClormbmuon Owner Data WORKER'S COMPENSATION DECLARATION 1 hereby am.under peach,of p do,ore of me following declarations: I have and will initiation a Certificate of Consent to sel6insum for Workers Compcn- union,u provided for by Section 7700 of he Lam Labor Code.for e perfurmancthe s of work for which this permit is issued. ❑1 be"and will maintain Workers Compensation Insurance,u required by Section 7700 of the Labor Code,for the performnce of me wprJ/for which this Permit is Issued. My//W�orkers Cn nse0on nsurG�o, earricnnd number art: CaQra / /R Policy No.:9/0/%] aJY' CERTIFI ATE OFEXEMFTION FROM WORKERS' COMPENSATION INSURANCE Thnscction need not becomplemd If the permit is for one hundred dollen nI00) less.) I certify that in the performance of me work hot which this Permit u issued,I shell not . employ any person in any consumer so as in become subject o the Workeri Compensation Laws of Celifomie.Due Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker's ComPcuation provisions of the labor Code.you must D z forthwith comply with such prnvisiou or this Permit shall W deemed Invoked. ti O CONSTRUCTION LENDING AGENCY I hereby affirm mat mere is a convection lending agency for the performunc of 3i out.,it for which this permit Is imucd(Sec.3097.Civ,C.) L A Lender's Name Z, z Lender's Add.. C) 1 certify that 1 have read this application and some that the above information is F connect.I agree IDI comply with All city and county announce,and sok law$relating to DU building construction,and hereby mthadse representatives of this city to cnmrupnn to alive-mentioned property for inspection purposes. (We)agora On save,indemnify and keep hAfmleu the City of Cupertino against s N Iimilidu,judgments,costs and expenses which may in any way same against mid City ,S l J',[ in consequence of the granting of this permit. C G ." APPLICANT UNDERSTANDS AND W L COMPLY WITH A NONPOINT Issued by: Date SOURCE ItF,(iy}LATI 5 �s .sac/ C/� NON-iOI uurc of Applin tome, Dam Re-TOOLS AZARD US MATERIALS DISCLOSURE Type of Roof Will the applicant.,future building occupantetore or handle haurdous material u defined by the Cupertino Municipal Code,Chapter 9.11,end mm H..10 and Safety we.Section 25532(a)? - - All roofs shall be inspected prior to any roofing material beim installed. ❑Yes g Will the aplifemn or r um bddddddupppiilding mention,use equipment Of devices which If a roof is installed without first obtaining an inspection,I agree to remove it havnrdous air concemineEncd by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes o Ihe.fitful meht,Secuu ialsmquirtmcnountkr ChnPmrdS.fthe Califon Signature 'i4�rs�� Die Hcalth&Safcty Coth.aami.ne 15Xmisocs5.1and pia molu Chipwr mhmirme Wilding does not cu rally hew s anent,mat it u my N rlity n notify the OccUPanl Of the �7 mquinot Wich ntpri.rni a cemirrca OCE.pxry. SignatureofA cant V Date �� All roof coverings to be Class B" Or better or tuthon'ror en�Dan t 9 Community Development Department Building Division City of Cupertino 10300 Torre Avenue Telephone: (408)777-3228 CITY OF Fax: (408) 777-3333 UPEkTINO Building Department 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. IMPORTANT: 1. Flat roofs must have a minimum of 1/4" 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. � t Homeowner's Name: �j i-'1 L iia Job Site Address: ZA-'2 / Ste/ .t/Z�c�fi ice✓ (a ' Roofing Company Name: A plicant's Signature: Date:�fz3 Greg eel Building Official Revised 1/30/03 Printed on Recycled Paper CITY OF CUPERTINO REROOF CUPEkTINO PERMIT.APPLICATION FORM APN# i t Date: _0 Building Address: Owner's Name: / Phone#: y Contractor: G , Phone#: License#: Contact: Phone#: Z /QE_ Cupertino Business License#: Type ofRoofCovering: 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.B.O.Report# ❑ To be Removed ❑ Provide Mfgr. Installation Specs. • I Have Read, Understand and Will Comply With Cu ertino's Tear Off Polic : ❑ Job Description: �g {!✓�. G .+ s ti� &-,67 t �� Residential Commercial Fire Zone: Yes ❑ No ❑ Confirmed with nning D t. f there are an estrictions: Cost of Protect- Type of Constructio Occupan ou AQt t A lic bl Fee ID Fee Description Fee Group BPERMFEE Bldg Permit Fees BUILDING ENERGY Energy BUILDING BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING Z3 � �