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04040109 (2) CITY OF CUPEIMNO a " "j - .: BUILDING DIVISION PERMIT 4g�'-'�a0Y�\f�T,,TRACTOR1ttg/L'©RMAT�QI,�.a a BUILDINGADDRESS: LINDY ROOFING CO INC PERMIT N004 04 0 10 9 37S MYRTLEWQ01) DR OWNER'S NAME: PERMIT ISSUE DATE AMTPMOP SABADO 5554 HARVARD JNE: SANITARY NO. CONTROL NO. (408) 269-2025 ARCH=CT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 v0, LICENSED CONTRACTOR'S DECLARATION wF I hereby affirm that 1 am b sister under previsions of Chapter 9(commencing I DED i r`$ with Section?000)of Division 3 ofthe Business and Proressionx Code,and my license is no, ire mu rnrLe and �9u ��k�.zl b l 1. REROOF a/nI� t D v2? Lie Class LIC.N NOV Datc_ .`., ,Curt 2YO4 eqq 7W R LA 4fY O 9 tl d U 1 undcr6tanJ my p a l C .c 05 public cords BUILDING T O y Licensed Pmresslnnal OWNER-BUILDER DECLARATION a0 1 naso affirm on 1 ore exempt from the Conbomm's License Law for the p o following meas a (Section]rDLA Business and Professions Code:Any city or roomy K witch requires a permit in inn,,the ahec improve,h permit t or repair any structure _za promonscense opmant 1.t he the applicant for Contractors censele Low statement that he g (cumtetingwith dpSectio7")ofDivision3ocna Of heeBasinisancenutoonsCode)or(Chapter 9 Sq.Ft.Floor Area Valuation y�m (cat he is treating it doereions and df Division r the Business and Professon.Any vi lino Lir aQ that he is exempt therefrom and Ne basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally of 361r N-Mf iber00 Occupancy Type Out more than five hundred dollars($500). P Y YP ❑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 and Profession Code:The Con exclore License Law docs not apply to an owner of _ Required Inspections property who builds or improves Ihemon,and who does such work himself or through his awn employees.provided that such improvements he 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 Wild or improve for purpose of salt.). ❑1,as owner of ON prupstrty,am exclusively contracting with licensed contractors N Construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li- cense Law docs not apply to an owner of property who builds or improves thereon,and who contracts for such projects with a contractors)licensed pursuanno the Contractor's License low. D l am exam pt under Sec. ,B&P C for this mason Owner Date WORKER'S COMPENSATION DECLARATION I hereby off mr under penalty of perjury one of the following declarations: - I have and will maintain a Cenificao of Consent to self-insure for Worker's Compen- sation,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 myuired by Section of the Labor Code,for the performance of Ne work for which this permi,is issued. My Wor erY Compensation Insurance to rierand Policy numpher arc: carrier: {twapsrlicy No.: L ( 0(1 t CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE - (This section need not he completed lithe permit is income hundred dollars($100) or lase) 1 cenify that in the performance of the work for which this permit is issued.I shall not employ any person in any manner so as hs become subject to the Workcrs Compensation Laws of California.Dow Applicant NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must - - .J,Z forthwith comply with such provisions or this Permit hall he deemed revoked. zO CONSTRUCTION LENDING AGENCY [-+ I hereby affirm Nat there is a construction lending agency l or the performance of aim the workUndoes for which this permit is issued(Sec.]fN],Civ.C.) Q Leader's Name Add �z Lender's Address U 0 1 certify that 1 have read this application and state that the above information is d, Loren.1 agree to comply with all City and County ordinances and state laws relating to O V building construction,and hereby authorim representatives Of this city to enter upon the above- e)i etl property for inspection purposes. '(W '(Wo)agree to save,indemnify and keep hay in an the City accrue Cupertino against n'UrN in equnce of the coarsing of thisexpenses which may inanyway accmc egaina said City („),'� A APPLICANT of UNDERSTANDS of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGUL NS. /� _:e -_!+- � ' _ It,�e� Re-roofs __ak� Signature o n p c BAZARDOUS MATERIALS DISCLOSURE Data Type of Roof Will the applicant Lir future building occupant sore or handle hasarduus material u defined by the Caperton Municipal Code.Chapter 9.12.and the Health and Safety "Mik.da,Section 25532001 All roofs shall be inspected prior to an roofing material beim ❑Yea p.lm P P Y g g installed. Will the alicant Id fuwrc building uttupant vu cyuipmcnl or devices which If a roof is installed without first obtaining an inspection,I agree to remove til hacardnus a"P�PCOr ntaminants as defined by the Bay Area Air Quality Management all new materials for inspection. coicRDyesI have mad the bri.ah usmmerials myvirememaunderCh ipa r6.95 ofthe Calif., ria Health&SafetCode,Sections 25X15.25533 and25534.1 ndersund NotHthe buildingIJuts nm curenpyha atenant,that itis respunsibil y m nmily tM cecupanr of Ne t 4reyuiremLrtswhiat met r nLLnra ehra .rxraySignature ofApp 'cant Date owrerorauOci 'Date All roof coverings to be Class "B" or better Community Development 10300 Torre Avenue I }";1 Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax 11(408)777-3333 UPEkTINO Buildin De artment JOB ADDRESS:3 75 yyr t la.�P�t .� Qit, .cam PERMIT 4 o 4 6 / o OWNER'S NAME: S PHONE # 25 2--446 93 x GENERAL CONTRACTOR: FAX/ # )C I am not using any subcontractors: 4.o,4 Si nat re Date Pleasecheckapplicable subcontractors and complete the following ' ormation: SUBCONTRACTOR BUSINESS"NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile / Owner/Contrac r Signature Date 10/28/03 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 V4" 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: Zzu*� Job Site Address: G 3 7 's yin ' `*t cr"4 kl2 p- Roofing Company Name: w cQ*-p ry �►e A plicanYs Signature: �C-=�� Date: S�a qGreg eel Building Official Revised 1/30/03 Printed on Recycled Paper CITY OF CUPERTINO REROOF I OF S CUPEkTINO PERMIT APPLICATION FORM APN# Date: 3 L� 2 - a o_3 Vll5/Oy Building Address: �� t� 6 3 Z 5 �:�%u-��. IJn.- Owner' Na Phone #: a,G 0. cP�o � S z — V 6 83 Contractor:- Phone#: License#: Z86 -4996 z / ,s-r/ 6 Contact: Phone#: s Cupertino Business License#: Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof Asphalt Shingles X 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 Policy: Job Description- 7-10 escription•T o �& . Qaf .r Residential X Commercial ❑ Fire Zone: Yes ❑ ' No ❑ Confirmed with Planning Dept. if there are an restrictions: LJ Cost of Project: Type of Construction: Occupancy group: 87os vb Qty. if A licable Fee ID Fee Description Fee Group BPERMFEE Bld Permit Fees BUILDING BENERGY Ener BUILDING BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING