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CITY OF CUPERTINO
PERMIT
BUTLDIN - DIVISION
BUIL-DING ADDRESS:
PERMIT NO.
6660 JOHN DR
LINDY R00F ING CO INC
09050011
OWNER'S NAME:
PERMIT ISSUE DATE
V(1TTI\T(' DT 73E�T D TTTTI VTT
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p CONTROL NO.
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(408)285-9990
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTORS DECLARATION
Job Description
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business and �Pro`fessions Code, and my license is
in full force and cNet. rj ct1
RE—RF RAV EXSTNG CMPRF INSTL LOW—E RDINT
!�
License Class Lic' a
Date Contractor
UNDRLMN P&
ARCHITECT'S DECLARATION
30# FLT UNDRLMNT CLS A 2 2 S Q 4 0 YR CMP
I understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the
following mason. (Section 703 L5, Business and Professions Code: Any city or county
which requires a permit to construct, alter, improve, demolish, or repair any structure
! prior to its issuance, also requires the applicant for such permit to file a signed statement
9
Sq. Ft. Floor Area Valuation
that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
$9000
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
APN Number Occupancy Type
not more than five hundred dollars (5500).
36923009 .00
❑ 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
Required Inspections
and Professions Code: The Contractor's License Law does not apply to an owner of
property who builds or improves thereon, and who does such work himself or through his
own employees, provided that such improvements are not intended or offered for sale. If,
however, the building or improvement is sold within one year of completion, the owner -
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044. Business and Professions Code:) The Contractor's u.
cense Taw does not apply to an owner of property who builds or improves thereon, and,
who contracts for such projects with a contractors) licensed pursuant to the Contractor's
License Law.
❑ I am exempt under Sec B & P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
'
i/hsve and will maintain a Certificate of Consent to self -insure Cor Worker's compim-
,sra 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 required by Section
3700 of the Labor Code, for the performance of the work for which this permit is issued.
My Workers _Compensation isipmance igarrier and Policy number am:
Cartier. AIVL Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section creed not be completed if the permit is for one hundred dollars ($100)
or less.)
I cenify that in the performance of the work for which this permit is issued, 1 shall not
employ anyperson an_ry�`ncr spra{a b9coBy=bject to the Workcrs' Compcnaton
iiro!:�in
Laws of Cali(o ate aj.(�-�-3=J --
Applicant
NOTICE TO AP ANT: If, after making this Certificate of Exemption, you should
become subject to the Worker's Compensation provisions of the Labor Code, you must
7 forthwith comply with such provision or this permit shall be deemed revoked.
j
CONSTRUCTION LENDING AGENCY
07
I hereby affirm that there is a convection lending agency for the performance of
> the work for which this permit is issued (Sec. 3097, Civ. C.)
~ Lendcr's Name
L.cndees Address
DI certify that 1 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 convection, and hereby authorim 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
yl liabilities, judgments, costs and expenses which may in any way accrue against said City
in consequence of the granting of this permit
APPLICANT UNDERSTANDS AND WILL COMPLY WI A L NON -POINT
Issued b): Date hJ
SOURCE REGULATIONS.
-
Re -roofs —
Signa of Applicant/Contractor Date
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety
Code, Section 25532(a)?
All roofs shall be inspected prior to any roofing material being installed.
❑ Yes o
If a roof s installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant use equipment or devices which
nit hazardous air contaminants as do cd by the Bay Area Air Quality Management
all new materials for inspection.
District?
[3 Yes
1 have read the hazardtws materials requirements under Chapter 6.95 of the Califor-
-� ` ` J �� 5 f,1 0
1
nia Health & Safety Cade, Sections 25505, 25533 and 25534.1 understand that if the building
docs not currently have a tenant, that it is my responsibility to notify the u ant of the
Date
reqs' ts which must be met prior to issuance of a Certificate of Oce
SI E of Appl decent
All roof coverings to be Class in" or better
Owner or rized agent are
9
'061o:5 00//
CITY; OF CUPERTINO
RE ROOF .
PERMIT° -APPLICATION
APN #
Date:
Building Address: n�
o -TOh17
Owner's Name:
Phone #:
A-
qo 7-,�2 S-3 - 6 It
Contractor: U
Phone #:
lnC� f�60��
Fax#:.
Cupertino Bu ' ess License ttJ
Contractor License #:
�8l
Type of Roof Covering:
Existing: Proposed:
❑ Built -Up Ropf 0 . Built -Up roof
Asphalt ShinOgso Asphalt Shingles
C3 Wood Shakes " Wood Shakes
❑ Wood Shingles O Wood Shingles
I , n ntl,
V V 4AbA `IJ lJVVIl' /
XT.,..,1, of nviohinn rnvarinbc
❑ Provide I.C.B.O. Report #
l� To be Removed
�-
❑ Provide Mf&. Installation Specs.
Job Description: re to 0( v��� � FIIs r"X� L- Gu •-r� Y C� o , �� ,STrt (PI
- �- (uY t T 4t- �� Govt �r%c'iinvl7L ��-,�Ll�.
- c r}
U ✓i
-3,)
Li
Residential
Commercial
Fire Zone: Yes ❑
No
Confirmed with Planning Dept. if
there are any restrictions: U
Valuation:
U(h
1
I Have Read, Understand and Will Comply with Cupertino's Tear -Off Policy:
Si atre
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CITY OF
"IJPEkJINO
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
Commissio a Fee
B
ALL PERMIT TYPES
1BSEISMICO
Seismic Commercial
B
2 2
1REROOFRES
Re -roof Residential
B
1SFDWLR00F
1BCBSC
Cal Bldg Standards
Commissioni Fee
B
ALL PERMIT TYPES
1BSEISMICRE
Seismic Residential
B
1REROOFMRES
Re -roof Multi -Family
B
1MFDWLROOF
1BCBSC
Cal Bldg Standards
Commission Fee
B
ALL PERMIT TYPES
1BSEISMICRE
Seismic Residential
B
1 BUSLIC
Business Li ,-ense
B
Cornniunity Development Department
Building Division
City ,A C ups rt:n
Fax 406) 777-3;
Building Department
Subject: Ke -roofing policy for the ('ity of Cupertino
Prior to permit issuance, you must agri,e to compty with 19C)7 UHC Standards
'lllLl 111anlllactUrel'S SpeC111catloll5 JIl r('-rUUllllg.
?. New roof coverings shall not be applie_I without first obtaining all inspection
and written approval from the buildin,, inspector. A final inspection and
approval shall be obtained from the building inspector when the re -roofing
is completed.
�. All roofs shall be inspected prior to an., roofing installation.
4. To receive a final sign off from the Cite, the follolving steps clic
required.-
-1)
equired:1) Pre -inspection and/or tear off appr-)val.
2) In -progress inspection approval.
3) Final inspection approval.
.1) Spark arrester installation.
D. If plywood is installed, a plywood nail inspection is required.
e. 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.
NOTE: If you call for a plywood nail-nspcction and the J01) is not r��a�i�,
you will be charged a re -inspection feE of 517e.18. The re -inspection fee must
be paid before another inspection can be scheduled.
IMPORTANT:
1. Flat roofs must have a minimum of per foot slope and dcmunstratc
that there is no poncdilg.
2. An I.C.B.O. report is required to be on the job site at the time on inspection.
1 understand and will comply with the above stated policy on re -roofing.
Homeowner's Name: �� U C/ ---------
Job Site Address:
Roofing Companv Name: �I-P1 �� J'�f,-- C_ —
:applicant's Signature. 1^ . L ---Date: �U� Z
Greg Casteel
Building Official
Revised 11/2/04