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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. 11 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)