99090134 3 s- 7 J
.APPLICATION FOR CITY OF CUPERTINO
REROOF PERMIT INSPECTION DIVISION PERMIT EXPIRATION
(4DB)T77-322B PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
1W DAYS FROM LIST CALLED INSPECTION.
BUILDING ADDRESS UQ`S" t�C ��rlf
22 � ( J (OCIt LI1�� e.'lCT RESIDENTIAL COMMERCIAL OTHER
OWNER'S1- - HAZARDOUS FIRE AREA
NAME Ra�o�2T r. YES ❑ M yes-1 understand that a Class A
R A y 1H. essemlbly is required.
NO ❑ Initial I.C.B.O.11
ADDRESS 5p/A - EXISTING ROOF COVERING
PHONE �{O Q cL-.5 2. NUMBER OF EXISTING COVERINGS /
CONTRACTOR'S -
�p��4 LSSh►yGC, NV r, TO BE REMOVED__L__TO BE RETAINED
NAME
ADDRESS t n TYPE OF RDOFOQOVERM
crrvaziP 22CiZ LI/JC�C�u ft L/e So-nlJos
ING
PHONE UO y 6g. BUILT-UP ROOF '^ /�
NUMBER
LICENSE S S 9 �'-3 6 ASPHALT SHINGLES v/ ,
LICENSED CONTRACTORS DECLARATION
I hereby affirm that I am Ilconsed under provisions of Chapter 9(commending with Secf on WOOD SHAKES r'
1000)of Division 3 of the Business and Professions Code,and my license b In lull force an/q�, IIJI
efts C3G 4 3 rX" WOOD SHINGLES
License Close uc.Numbor 3 lin\ ❑ �I
Data gl2 /z9 R Corinna or OTHER(SPECIFY) 119 I
OWNFA BUILDER DECLA '1� SEP �' g U P
I hereby aftlrm that I am exempt from the Conirodiors License w FL
res UU fZ(Sec.1031.5,Business anti Professions Code: Arty city ar ty whuires a permll to
construct,after,Improve,demolish,or repair any structure,prior to Its Issuance,aLw requires the BUILT-UP RQOF
th
applicant for such permit to file a signed statement at he Is licensed pursuant to the provisions I p
of the Contractors License Law(Chapter 9(commencing with Section 1000)of Division 3 of the Y
Business and Professions Cade)or that he Is exempt therefrom and the bests icr the alleged ASPHALT SHINGLES ❑ / ' - ,n 1 /, /
exemption.Any violation of Sectall tion 1031.5 by any applicant for a permit subjects the applicant to V Y
a penalty of not mora than five hundred dollars(9500).):
El 1,ae owner of the property,or my employees with wages a91 sole compensation.will do WOOD SHAKES � � ) A��
the work,and the stib
uoure net Intended or offered for sale Sec.1044,Business and Profea. {7
store Cade:The Contractors License Lew does not apply to an owner of property who bullies orWOOD SHINGLES
Improves thereon,and who ideas such work hlmsed employees,
or through his own provided!that ElJ
such Improvements are not intendetl or offered for sale.If,however,the building a improvement
is sold within one year of completion,the owner-bullder will have the burden of firming Mat he did , OTHER(SPECIFY]
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.1044,Business and Professions Code:The Conbadore ucenna Law dI not PROVIDE I.C.B.O.REPORT NO.
appy to an owner of property who police o Improves thereon,and who contracts for such projects
with a contractor(s)licensed pursuant to tie Contractors License law. PROVIDE M FGR.INSTALLATION SPECS.
❑I am exempt under Sec. ,B&P.C.for this reason
OwnerDate
WORKER'S COMPENSATION DECLARATION APPLICATION DATE VALUATION PERMIT FEE
I hereby affirm under penalty of perjury one of the following decierattem
❑1 have and will maintain a Certificate of Cowent to solkinsure for Workers Compensation, Building
as provided for by Section 3100 of the Labor Code,for the pad«mance W the wort for which his ��' ^ ^O
mft is imuetl. LV Seismic
eve and will maintain Workers Compensation Insurance,as required by Section 3100 of
Code,for the performance of the work for which this permit Is issued. y W ars
01forn Insure carrier an J Policy numbs are: '�-�/ � Total.
xcarO//✓- 5k 1C S �1c licy No. PERMIT AUTHORIZATION DATE
r •Vic L ,CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE N.CC M1 ^ I / hQ
(This section need not be completed If the permit is for Dnaes.)hundred sellers(5100)or le / L Vl 11
I partly that in the performance of the work for which this permit is Issued.I shell ret employ
any person in any manner so as to become subject to the Workers'Cempensaucrn Laws of call- All roofs shall be inspected prior to any roofing material being
fornia. installed. If a roof is installed without first obtaining an
Data Applicant inspection,I agree to remove all new materials for inspection.
NOTICE TO APPLICANT: 11,after mri this Certificate of Exemption,you should become Applicant understands and will comply with all non Dint
subject to the Workers'Ce penmtbn proMikens of the Lebon Code,you must IoritrMth comply AAP P Y P
with such previsions or thio permit shall be deemed revoked. source regulations.
I c6nlly,that I have rapid this application and state that the above Informatlon Is correct.I agree
to campy with all cry and county ordinances and state laws relating to bullisng constmction,entl All C Verings to &077
hereby authorize repreeentui of this city to enter upon tine nstl e atepokmentlaproperty for In-
spai purposes. - /
(We)agree to save,Indermlfy and keep harmless the C y o1 Cuperi against Ilabllli es, 40& _ oZ
Judgments costs aro ove expenses which may In any way acagainst sapi Cly In cansequerra
199
of the granting of thle permit. /SI ATU E OF. PPL CANT DA
PRE-INSPECTION: PLYWOOD: IN-PROGRESS:
INSP. DATE INSP. DA INSP.-DATE
TEAR OFF INSPECTION: BATTENS: . FINAL:
INSP. DATE INSP. DATE INSP.-DATE
NOTE: OSHA APPROVED-ACCESS TO ROOF SHALL BE PROVIDED FOR INSPECTION
OFFICE-�COPY
INVOICE INVOICE, INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO
• BUILDING PERMIT INVOICE OPERATOR: yvonnek
Sec: Tp: Rng: Sub: Blk: Lot:35709045.00
INVOICE DATE. . . . . . : 09/21/1999
REFERENCE ID # . . . : 99090134
SITE ADDRESS . . . . . : 22113 STOCKLMEIR CT
SUBDIVISION . . . . . . .
CITY .... . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER .. . . . . . . . . . .: PRALL ROBERT H JR
ADDRESS . . . . . . . . .. : 22113 STOCKLMEIR CT
CITY/STATE/ZIP . ..: CUPERTINO CA, CA 95014-2727
CONTRACTOR . . . .... : DADDARIO, STEVE LIC N 20739
COMPANY . . . . ...... : RENAISSANCE ROOFING CO INC
ADDRESS . . . ....... : 2292 LINCOLN AVE
CITY/STATE/ZIP ... : SAN JOSE, CA 95125
TELEPHONE ........ : (408)448-0697
NOTE: THE FEES LISTED ARE ONLY THOSE DILE BEFORE PERMIT PRINTING
FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DDE
_______________ ___ _________ ____________ ______-___-
BPERMFEE P 177.00 0.00 177.00
BSEISMICRE P 1.20 0.00 1.20
____ ____________ ___________
• 178.20 0.00 178.20
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
........ �-�......................... ........ ............................
305 FRAME 307 INSULATION
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
603 ROOF BATTENS 604 ROOF IN-PROGRESS
•
CITY OF CUPERTINO
• 1 of 1 BUILDING PERMIT RECEIPT OPERATOR: yvonnek
COPY # 1
Sec: Tp: Rng: Sub: Elk: Lot:35709045.00
DATE ISSUED. . . . . . . : 09/21/1999
RECEIPT q. . . . . . . . . : 10120
REFERENCE ID # . . . : 99090134
1
SITE ADDRESS . . . . . : 22113 STOCKLMEIR CT
SUBDIVISION . . . . . . .
CITY ...... . . . . . . . : CUPERTINO '
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : PRALL ROBERT H JR
ADDRESS . . . . . . . . . . : 22113 STGCKLMEIR CT
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-2727
RECEIVED FROM .... : TIM _
CONTRACTOR ..... .. : DADDARIO, STEVE LIC 4 20739
COMPANY . . . . . ..... : RENAISSANCE ROOFING CO INC
ADDRESS . . . ..... . . : 2292 LINCOLN AVE
CITY/STATE/ZIP . .. : SAN JOSE, CA 95125
TELEPHONE ....... . : 14081448-0697
FEE IO UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
__________ _____________ __________ __________ __________ __________ __________
BPERMFEE VALUATION 12,000.00 177.00 0.00 177.00 0.00
BSEISMICRE VALUATION 12,000.00 1.20 0.00 1.20 0.00
______ __________
PERMIT 178.20 0.00 178.20 0.00
METHOD OF PAYMENT AMOUNT NUMBER
_________________ ____________ ----------------__
CHECK 178.20 16134
'aa
TOTAL RECEIPT 178.20
VOICE ID DESCRIPTION VOICE IO DESCRIPTION
........ ............................ ............................
305 FRAME 307 INSULATION
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
603 ROOF BATTENS 604 ROOF IN-PROGRESS
•