07030121 CITY OF CUPERTINO
BUILDING DIVISION -PERMITS
PERMIT NO.
BUILDING ADDRESS: LINDY ROOFING CO INC 07030121
22145 ORCHARD CT
— PERMIT ISSUE DATE
I.iWNER'S NAME:
RAY SCHEUERLEIN 5554 HARVARD
SANITARY NO. CONTROL NO.
jNE:
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: REMOVE EXISTING LAYER OF BLDG ELECT PLUMB MECH
0 L O
LICENSED CONTRACTOR'S DECLARATION r O Description
OOZp
UF I hereby affirm that I am licensed under provisions of Chapter 9(commencing
y w with Section 7000)of Division 3 of the Business and Professions Codc,and my license is
t<a- in full force and eff L -
;n? License Class Lic.#
o Date Contractor
E m ARCHITECT'S DEC A
a
I understand my plans shall he used as public records
)aU
u.I-Licensed Professional
o a OWNER-BUILDER DECLARATION
j<f 1 hereby affirm that I am exempt from the Contractor's License Law for the
p O. following mason.(Section 7031.5,Business and professions Code:Any city or county
e which requires a permit to construct.alter,improve,demolish,or repair any structure
u' }
Prior,:
rior m its issuance.also requires the applicant for such permit to rile a signed statement .Ft.Floor Area Valuation
_ that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 q
t— (commencing with Scction 7000)of Division 3 of Lhe Business and Professions Codc)or
i that he is exempt therefrom and the basis for the alleged exemption.Any violation of OCCu anC Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number P Y YP
not more than five hundred dollars(5500).
❑1,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 Conuactoes License Law docs 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.).
❑I•as owner of the property,am exclusively contracting with licensed contractors to
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 contractor(s)licensed pursuant to the Contractor's
License Taw.
❑1 am exempt under Sec. B&P C for this reason
vnu
Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑I haoe and will maintain a Certificate of Consent to self-insure for Workees 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 required by Section
3700 of the Labor Code.for the performance of the work for which this permit is issued.
My Wor�co nsati//on�insur_a/nce carrier and Policy number are: q (�
Carrier C A,X90 Policy `�O
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is foronc hundred dollars($100)
or less.)
I certify that in the performance of the work for which this permit is issued.I shalt not
employ any person in any manner so as to become subject to the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,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 shall be deemed revoked.
Z� CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for the performance of
the work for which this permit is issued(Sec.3097,Civ.C.)
W Q Lender's Name
C1� Lenders Address
U 0 I certify that I have mad this application and state that the above information is
correct.I agree to comply with all city and county ordinances and state laws mlating to
w E" building construction,and hereby authorize representatives of this city to enter upon the
U ahove-mentioned property for inspection purposes.
a (We)agree to save,indemnify and keep harmless the City of Cupertino against
Hliabilities,judgments,toss and expenses which may in any way accrue against said City
U,Z in consequence of the granting of this permit. Date
r- APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
SOURC EGULATI NS.
Re-roof:,
Signature of Applic atractor Dae T of Roof
ARDOUS A LS DISCLOSURE Type
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Muni' al Code.Chapter 9.12,and the Health and Safety
Code,Section 25532(a)? (^�(� All roof 3 shall be inspected prior to any roofing material being installed.
(:]Yes �7ryv
v If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use equipment or dgvices which
emit hazardous air contaYrdous
cfncd by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes 1 have read the harials requiremct s under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 25505.25533 and 25534.1 understand that if the building P
docs not currently have a tenant,that it is my responsibility to notify dtc occupant of the Date
rcgUireme w or to issuance of a Ccrtificatc of Occupancy. S lg to'e of Applicant
All roof coverings to be Class"B"or better
Owner a thorizcd agent Dale
CITY OF CUPERTINO
2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: bethe
COPY # 1
Sec: Twp: Rng: Sub: B1];: Lot:
APN 32617041. 00
DATE ISSUED. . . . . . . : 03,'16/2007
RECEIPT #. . . . . . . . . : BS000000702
REFERENCE ID # . . . : 07030121
SITE ADDRESS 22345 ORCHARD CT
SUBDIVISION . . . . . .
CITY CUF ERTINO
IMPACT AREA . . . . . . :
OWNER RAN SCHEUERLEIN
ADDRESS . . . . . . . . . .
CITY/STATE/ZIP
RECEIVED FROM . . . . : RECEIPT INTERFACE
CONTRACTOR . . . . . . . : RUMFORD, LINDY LIC # 3921
COMPANY . . . . . . . . . . : LINDY ROOFING CO INC
ADDRESS . . . . . . . . . . : 5554 HARVARD DR
CITY/STATE/ZIP . . . : SAN JOSE, CA 95118
TELEPHONE . . . . . . . . : (406)286-9990
FEE ID UNIT QUANTITY AvIOUNT PD-TO-DT THIS REC NEW BAL
-------- -- -------- ______
---------- ----------
BPERMFEE VALUATION 13, 000. 00 201.96 0.00 201. 96 0. 00
BSEISMICRE VALUATION 13, 000. 00 1.30 0. 00 1.30 0. 00
-- -------- ----------
---------- ----------
TOTAL PERMIT 203 .26 0. 00 203 .26 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
------ --------------- --------------------
CHECK 203 .26 2727
---------------
TOTAL RECEIPT 203 .26
CITY OF CUPERTINO
RE ROOF
CUPEI,TINO PERMIT APPLICATION FORM
APN# Date: S
Building Address: d'a 1 C(5 OrcAc u<-4.
Owner's Name: Phone#•
Contractor: U Phone#: License#:
f(/�Clcl P0Contact: Phone#: C, r Cupertino usiness License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
*V� 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 Comply With Cis ertino's Tear Off Policy: 1
Job escription: re: �.,c C :•�) ,� 5 f�:;� ! _ J
Residential Commercial ❑
Fire Zone: Yes ❑ No �5— Confirmed with Planning Dept. if
there are any restrictions. LJ
Cost of Project: Type of Constntction: Occupancy group:
Qty. if
Applicable 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
Community Development Department
Building Division
i City of Cupertino
i 10300 Torre Avenue
"Telephone: (408) 777-3228
CITY OF Fax: (408) 777-3333
CUPEI�TINO
Building; Department
Subject: Re-roofing policy for tha City of Cupertino
1. Prior to permit issuance, you must E gree to comply with 1997 UBC Standards
and manufacturers specifications or re-roofing.
2. New roof coverings shall not be applied without first obtaining all inspection
and written approval from the builcling 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 withcut first obtaining an inspection,
will require the removal of all new naterial 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 at ove stated policy on re-roofing.
Homeowner's Name: L �� Ce
Job Site Address:
Roofing Company Name: l�t+'` �'`�U�
Applicant's Signature.
�U� t"r-Date: S 71
Greg Casteel
Building Official
Revised 11/2/04
Prir,red on Recycled Pgper
Community Development
10300 Torre Avenue
Cupertino CA 95014
,. Telephone(408)777-3228
Fax(408)777-3333
CITY OF
"UPEkTINO
Buildi:n Dea ':'
JOB ADDRESS: PERMIT #
OWNER'S NAME: PHONE # qO 9 - �?&` 7
GENERAL CONTRACT R: i w' 2v FAX # qLq-2
I am not using any subcontractors: 44120
Si;nature Date
Please check applicable subcontractors and complete the followinginformation:
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
er/Contractor Signature Date