03090066 ' CITY OF CUPER'I'INO
BUILDING DIVISION PERMIT CONTRACTORANPORMATION ':
BGB.DwGADDRFss: LINDY ROOFING CO- INC PERMIT"°03090066
0199 DR.
OWNER'S NAME: 5554 HARVARD DR PERMIT ISSUE DATE
YTTAN
NE: - SANITARY NO. CONTROLNO.
(408) 269-2025
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
+00 LICENSED CONTRACTOR'S DECLARATION
ee U❑ 1 hereby affirm that I em licensed under Provisions of C ours. 9(commencing .IObgCL$CI'Iption
fZW with fI[(.Section adefOfDivision3mfJcRualnmsand ProfcssinmCMe.and mylianuis ALED
<< in full forte ad effect. REROOF
6
)A? Licca 1 ��
Lis.
`p Dalc Cum ECL — SEP 1 8 20�
££ ARCIiI'ILCI-S DECLARA ION t
f C I oularmi nd my plansshall W meJ as puhlie records ,
)yO
co,�„ LiccnuJ Professional -
�q OWNER-BUILDER mDECLARATION 6UILDING
2 a£ 1 hereby affirm the 1 ore exempt from the Contractor's e:Any
Law for Nc ,
m� fallowing reason.(Senium](ALS, .Business and improve,
dcrioli Code:Any tiny or county
which its issa a pemsR re times the ohne improve,demolish, file
repair my tammem
;z` that
the its issuance,pursaegathe provisions
for SucbpermiOa Nc at LaMamtemcm
asa (commescingwJPrirsuaul(KadidDiaiomnfthc cBusiniandPrmLaw(Chaper9 Sq. Ft. Floor Area Valuation
21- (cat he is(commencingwith
ore in to and th basis for of nhc alleged
exemption,
on,An ions CMc)of
Net he is cacmPn tMefrom and the baso for On al Icgcd cacmption.Any violation of 36928014 . 00
Section 703LS by any applicant for a permit subjects the applicant to a civil penalty of APN Number . 00C° Type
non mora than five hundred deltas(5500. --- - - - ----- - Occupancy --- - -
❑1,u owner of the property,or my employees with wages as their sole compensation,
will do the work,and the tructure is not imendmd or Offered far Sale(See7044,Business 3 Ub — Required Inspections
and Pmfec om�Code:The C.m.11.M1 License Law docs not apply u m owner of 3 0 7 - I NS ULAT 1-ON P
progeny who builds or improves Recent,and who doessach work himself or through his
own employes.provided Oat men improvements are not intended or offered mrsale.If, 601 - ROOF TEAR OFF
however,the building or improvement is sold within one year of completion,the owner
builder will Inv.the burden of proving than he did non Wild or improve for purpose of 602 - ROOF PLYWOOD NAIL
sade 01. 603 - ROOF BATTENS
❑Lae Owner of Rhe Sec.property, Business s and contracting wird licensed contractors m
camw Law
does jenpplyoinownofproprty who Wilds
i Thoves derom,Li 604 - ROOF IN-PROGRESS
come hes docs not apply m ts owner of progeny who Wilda or improves Centra,and
who concocts for each projects wird a canwnar(q licensed pursuant Rothe Convenor's
are Law.
E)
❑lam esempl under gee. '- ,B&PC for this reason
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby Strom under Penalty of pe jury one of the following declarations:
I have and will mainuin a Cenifieme of COnsenuo self-insure for Worker's Cam pen-
1371M
on,as provided for by Section 37M of the Labor Code,for the performance of the
k for which this pe mb is issued.
1 have and will maintain Worker's Compnuadon Insurance,ns required by Section
of the Labor Code.far the Performance of the work for which Nie permit is issued.
Worker's CqnPgRcanimn mrancexcerrerand Policy number are /rtier�:/lC��Ls(L. Policy No.: _
CERTIFICA n.O E MON FROM WORK
COMPENSATION INSURANCE
(This section need non Ivcompleted If rhe fermis is foronc hundmd dallars(51110)
Or It
1 cenify that in Ne Ferranti of the work for which Nis permit is issued.I Shall not
employ any person in any manner SO IS in Wcomc Subject to the Workers Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:IL after making this Ceniacaue of Exemption,you should
become subject to the Worker's Compensation provisions of the ISWr CMS,you most
� ,Z forthwith comply with such provisions or this peomiuhalt W dimmed ranked.
Z O CONSTRUCTION LENDING AGENCY
I hereby affirm that there its construction lending agency Ior the Performance of
]Sti the work fur which this permit 0 Issued(Sec.3097,Civ.CJ
.y o Undoes Name
Z)z Lender's Address mas
J 0 1 terrify that 1 have rod this application and sou that the above information is
,L F correct.I agree to comply with all city and county ordinances and sum laws relating to
J C.3 building crnswction,and hereby amM1orim mprmentatives of this city to enter upon Nm
above mentioned r mpeny for inspection purposes.
el
(We)agree m Save,indemnify and keep harmless the City of Cupcdino against
�f,O luddinies.judgments,eosu and capertu which may in any way ace.m against said City
in consequence of the grouting of this permit. /r 1
J APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGUL (j(VS.
Z
9—�-C7t Re-roofs
Signatumof ApplicanUContra bb Data
HAZAR GUS MA RIALS DISCLOSURE Type of Roof
Will the applicant or future building Occupant store or handle hamNous material r
IS de0ncd by the Criterion Municipal Calc,Chapter 9.13.and the Health and Safety
cndm. Yss3zla)]
Eet, gH Nu
All roofs shall be inspected prior to any roofing material being installed.
❑Ycc
Will the applicant or future Wilding Occupant use equipment a,demes which If a roof is installed without first obtaining an inspection,I agree to remove
it hasardous air contaminants as defined by nW Bay Area Air Quality Management all new materials for inspection.
trin9
❑Yes No
I have mal the haraNRxs materials mVuiremenuunder Chirac,6.95rfdm Cnlifor C
nim Health&Sammy Cade,Sava.35505,25533 mW 25534.1undcouni tha iftr Wilding
does non currently haat a conn.Net it is my mapo.ihiliny m amity Rlte Occupant of the -/ i1y
requiremcnuwhich must W men priorw assortments Certificate of Occupancy. Signature of AppL&an1 Date
Owner or authorived agent Date All roof coverings to be Class "B" or better
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
• Telephone: (408) 777-3228
CITY OF Fax: (408) 777-3333
CUPEkTINO
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.
Homeowner's Name:
Job Site Address: 9ZQ 1..92 s-a�llctV Ll
Roofing Company Name: gka
t
A 27
plicanYs Signature: Date: Q�
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN#
Building Address:
Owner's Name: r Phone#: 409
Y V
Contractor: n ` Phone yp17License#: /
Contact: G Phone 4h Cupertino Business License#:
go,_ G
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.B.O.Report#
❑ To be Removed ❑ Provide Mfgr.Installation Specs.
�. I Have Read, Understand and Will Comnly With Cu ertino's Tear Off Policy: ❑
Job Description: � X(S � e f S - ZHz rr O$J5 q` 5 O
ResidentialJZ Commer ❑
Fire Zone: Yes ❑ No ❑ Confirmed Planning t. if
there ar r trictions:
Cost Qfftoie ll Type of Const cti n: Occu cy up: r
I
Qty. if
A li a e Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
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