09090167I CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 11648 BIRCH SPRING CT I CONTRACTOR: LINDY ROOFING CO INC I PERMIT NO: 09090167
OWNER'S NAME: MARY LIN
476 W TAYLOR ST
DATE ISSUED: 09/22/2009
;R'S PHONE: 4087778877 SAN JOSE, CA 95110 PHONE NO: (408)286-9990
❑ LICENSED CONTRACTOR'S DECLARATION
License Class C 3 I .p Licc.. # 2 1 J— a (r
Contractor L1h%r') j4 Ieoor,.vJ Date_! /Z Z C
el
11
1 hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business & Professions
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self -insure for Worker's
Compensation, 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 provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION
I certify that 1 have read this application and state that the above information is
correct. 1 agree to comply with all city and county ordinances and state laws relating
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Signature \�� Date �Z
G OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
I, 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 sale (Sec.7044,
Business & Professions Code)
1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
declarations:
I have and will maintain a Certificate of Consent to self -insure for Worker's
Compensation, 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 provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
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 Worker's
Compensation laws of California. If, after making this certificate of exemption, I
become subject to the Worker's Compensation provisions of the Labor Code, I mu
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
correct. I agree to comply with all city and county ordinances and state laws relating
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
it -iffy and keep harmless the City of Cupertino against liabilities, judgments,
c :md expenses which may accrue against said City in consequence of the
grar:ting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Signature
Date
BUILDING PERMIT INFO: BLDG F ELECT f— PLUMB
MECH f— RESIDENTIAL f— COMMERCIAL F
JOB DESCRIPTION: RE -ROOF REMOVING EXISTING SHAKE ROOF,
INSTALLING
30# FELT & LIFE TIME DIMENSIONAL COMP ROOF BY
GAF/ELK GRAND CANYON COLOR STONEWOOD CLASS A 26 SQ
Sq. Ft Floor Area: I Valuation: $10000
APN Number: 36654072.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued bye
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
Signature pf Ap lic Date:
'2
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District 1 will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
authorized agent: q 07
2
e.�^ Date:
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
ITY OF
CUPEf�TINO
CITY OF CUPERTINO
REROOF
PERMIT APPLICATION
Oq 09 ol (,-7
APN#�
Date -
Building Address: C
Owner's Name: JG�c.r_ L.,�
Phone #: Offdq %%- FX72
HOA: Yes No ❑ If yes, provide letter from HOA
Contractor: . �
Phone #: ;2 g-�
Fax #:
Cupertino Business License #: a /
Contractor Len e #.
Type of Roof 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: t -e e? C4 4e-
0 � -E ,D;rh��s�U��--� Gov, .
J c) *� .
K - Gv- CZN 611 1) - C6 c?� Sy.
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:
r)
I Have Read, Understand and Will Comply with Cupertino's Tear -Off Policy:
Signature
Revised 02/05/09
al --.
CITY OF
JPEkT]NO
CITY OF CUPERTINO
REROOF
FEE SCHEDULE
Number of
Squares
Fee ID
Fee Description
Fee
Group
Permit Type
1REROOFCOM
Re -roof Commercial
B
1COMMLROOF
1BCBSC
Cal Bldg Standards
Commission Fee
B
ALL PERMIT TYPES
1BSEISMICO
Seismic Commercial
B
r
1RER00FRES
Re -roof Residential
B
1SFDWLR00F
1BCBSC
Cal Bldg Standards
Commission Fee
B
ALL PERMIT TYPES
1BSEISMICRE
Seismic Residential
B
1 REROOFMRES
Re -roof Multi -Family
B
1MFDWLROOF
1BCBSC
Cal Bldg Standards
Commission Fee
B
ALL PERMIT TYPES
1BSEISMICRE
Seismic Residential
B
1BUSLIC
Business License
B
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 36654072.00
DATE ISSUED.......: 09/22/2009
RECEIPT #.........: BS000008738
REFERENCE ID # ... 09090167
SITE ADDRESS .....: 11648 BIRCH SPRING CT
SUBDIVISION ......
CITY CUPERTINO
IMPACT AREA ......
OPERATOR: patg
COPY # : 1
OWNER MARY LIN
ADDRESS ..........: 11648 BIRCH SPRING CT
CITY/STATE/ZIP ...: CUPERTINO CA, 95014-5138
RECEIVED FROM ....: LINDY ROOFING CO IN
CONTRACTOR .......: RUMFORD, LINDY LIC # 3921
COMPANY ..........: LINDY ROOFING CO INC
ADDRESS ..........: 476 W TAYLOR ST
CITY/STATE/ZIP ...: SAN JOSE, CA 95110
TELEPHONE ........: (408)286-9990
FEE ID UNIT
QUANTITY
AMOUNT
PD -TO -DT
THIS REC
NEW BAL
-----------------------
1BCBSC VALUATION
----------
10,000.00
----------
1.00
----------
0.00
----------
1.00
----------
0.00
1BSEISMICR VALUATION
10,000.00
1.00
0.00
1.00
0.00
1REROOFRES SQ FEET
26.00
338.00
0.00
338.00
0.00
----------
TOTAL PERMIT
----------
340.00
----------
0.00
----------
340.00
0.00
METHOD OF PAYMENT
-----------------
CHECK
TOTAL RECEIPT :
AMOUNT
---------------
340.00
---------------
340.00
VOICE ID DESCRIPTION
-------- ----------------------------
601 ROOF TEAR OFF
REFERENCE NUMBER
--------------------
#4177
VOICE ID DESCRIPTION
-------- ----------------------------
602 ROOF PLYWOOD NAIL
604 ROOF IN -PROGRESS 605 FINAL REROOF
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408) 777-3228
Fax: (408) 777-3333
Building Department
Subject: Re -roofing policy for the City of Cupertino
1. Prior to permit issuance, you must agree to comply with 2007 IBC Standards
and manufacturers specifications on re -roofing. All roofs are Class "A" per Cupertino
municipal code 16.04.080.
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 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.
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Homeowner's Name: M 4rLi_ 1-4 i1
Job Site Address: Z5 t 1
Roofing Company N
Applicant's Signature:
Greg Casteel
Building Official
Roo _T,-7 j
Revised 07/30/08
Date: ? -e)