01040064 CITY OFNCUPERTINO CONTRACTOR INFORMATION:
PERMIT
BUILDING A DURESS: PERMIT NO.
x0200 LUCILLE AV # 113"120 ROYAL ROOFING 01.040064
OWNER'S NAMIT. APPLICATION SUB DATE
STONESON DEVELOPMENT CORP THE 1345 VANDER WAY 04/13/2001.
PHONE: SANITARY NO. CUMUROLNo,
(408)279-2332
B GOARCHITECIIENGINIiER: • BUILDING PERM1'1'INFO
BLDG ELECT PLUMB MECH
LICENSEDCONTRACTOR'S DECLARATION Job Description
14 1 hereby o ffnnn Incl I an,licensed under rrnvinim,a of Chapter 9 a'„ntmeneing
��Fw with Section 70mn ot Mockialf Sol the l luxinev.vnnd l'mlcn,us Cuda and on,hoose
_oda
is in °C11 e° ' Lie.#7�935� REMOVE SHAKES INSTALL 1/2" CDX
nore_� of Co
LL o so ARCIIITECU's DECLARAr1ON & 30 YR. CERTA I NTEED SHINGLE.
5 I understand any plan:shall be used as public mord,
<s
Llen,nW Vmlessionul
m chat I OWNER-BUILDER.he CoAI ntractor
w=y F hereby a(Bnn thus 1 am exempt Irnm,he Cu,ion,C License Law for the
C 3 following mrsmt,(Slain,703 15.]1 lc,,trod pe.denml.Cudc:Any n,or county
x o
which rcgaims a p<•n„a u,eo„ewa,a1mr,hoprove.dmnobsn,m repair am swnarc
w3ca
" prior to its issuance,alw,equire%the applicant Pro such pemun m
,ifile a signed clmvenl
c. than hclxlicxnsedp:usuanuorhe pnomoloof the Comuccur'x Licence Law(Chapter v Sq. Ft. Floor Area Valuation
comtncncing tuith Section 700(f)01Division Sof the m,iml,u I Prot c,sinns Code)
or that he is exempt rharcfmn,and the basis fm the alleged exemption.Any violatn
io
' of Section 7031.5 by any applicant for a proton subjects the applicant to a civil Penalty
(if not one mnnlive lmadredmawre(S51kn. APN Number Occupad42 0
C 1,. none,of the pmpcny.or my cordo,oc,with wage,astheirsole, repenmrion,
w111 do the work,and the orneauc'm our nitrated or offered lin rule(See.7114,
names,and Pmfesshms Codc:The Contractor..License Law doer not apply to an 316020914ggD vd Inspections
owner of Pmpory Why builds or improves rhereom,and who duces such work hinewlf
(itthroughfor
his own I rotor, Il provided that such.....c vament,I n i at intended or ,par A
otfemd for solo.IL however,rhe building o,impic improvements
msnts within one year or
completion.the owner-builder a;n have the burden of proving that he did no,build or 1305 — FRAME
improve for pnrpooe ol'sAel. /
C[.:is ow net of the n 307 — INSULATION
pmlr y,m„esteress and tnmcting with Bee:)TheCracmnr'o 601 — ROOF TEAR OFF Q✓
Llcconermct,he pmJcc,(See.Ito;i ownBuser of and property
wlit)b Qafea The improves
tthereon,
e ro n,
-and who
Law docs bel r such
tom,owner th aouncre tubo naiads ,itnpmv ant to
the
and rat rs,Lie%lar sen prnjeers wird a eommanmis)Lie<mw•d pursuant Io me 602 — ROOF PI_YlJ00D NAIL
Cosh, ox's License Stu.
❑laic exempt ardor Sri. ,R.@YClin chis rcurvn 603 — ROOF BATTENS
o.oc, Date 604 — ROOF IN—PROGRESS
W'ORKER'S COMPENSATION DECLARATION
1 hereby aIY,m under penmly of pc Jury one u1'Ne loUnwing dedamtions'.
❑ 1 have and will maintain a Certificate of Consent to wif-intim fir Worker's
Contpenearinn, as pmvidcd for by Salo 1700 or the ].all Code. ILr the -
perfmmance of IM work for which this pem,it is issued.
0have and will nntinluin Wnrkcr's Cmtnpcngtlinn Insurance,n,u....and by Section
]IX)of the Labor Code,for the performance mf the work for which this permit is
ouM,My Worker's Compensation�11nwfmu
, c carrier and Policy number am:
Carriee�MtCi.C4�VVC ll cy No-
CERTIFICATION OF EXEMM ION FROM WORKERS' ,
COMPENSATION INSURANCE
(This section need on be completed if the .an is for one hundred dollars
Ig I ME or Its.) -
1 eerily that in rhe parllnne nce of the work fill which this permit is issued,I
shall not employ any penin in any manner or as a,become suhjuct a,the Workers
Cmu,v,rserion Lows Lit Cahfnniu.Dam
Applicant
NOVICE To APPLICANT:If,lift.,making,his Certificate of Eacmpdon,you should
become,mover Ira the WorkeLr Cnmpemsatlon provisions otlhe Lobb,Code,you tnum
Q fodhwnh enmplr with such prOVor)s or rain lwnnh dmn he deemed mooted.
Z
CONSTRUCTION is a FON L.tion NG iogageAGENCY
a 7 I hereby mhnn this Iliac is n e...Il(Sri. Icnding agency for the peronnunoe
Lender',
work for.4ich this ry•nni,is issuN(Sec,3897.Cil C.)
5 Q Isndcr's Name
l libeler's AJJrca
U C) I terrify that F have mond this application and Lime that the above information is
4. F. correct.I agree,o comply with all city and enemy ondinames and sort,laws mcoding
Q U It,building nms,merion,and hoachy:wthori're rtproenrmives of,his city locmcnipon
rhe abovemcm,oued pmucry fir imperial,l mpow,
F per, (We)ugme insme.indemnify and keep harmless the City of Cupeninr against
V] Itnul'aics,jndgn ou",eno.and o,,pemes which may to ity way accrue against said
U Z Cu'r in consequence of rhegrarlin,of this permit.
APPLICAM'UNDIiRSTANDS AND WILL COMPLY WITH ALLPON;FOINT Issued by: Date YJ�V
SOAR REGUTATIO S. �� -I y'
Si umill'ApplicadUOcmotor , !' / Done Re-roofs
IIAZ, lit A AI'S DISCLOSURE'
Will lhu""I"am on- o mg nanl arta.o,handle haranlous m,:ticrinl Type of Ro
as defined by the Cnpedino Municipal Code.Chapter 0.12 and the Health and Sa(dy
Cole.Section255331x)^ 71 No
All root's shall be inspected prior to any roofing material being installed.
Will the applicant or future handing olcupmn use equipment or devices which If a roof is installed without first obtaining an inspection, 1 agree to remove
cava baearduus air contaminants as ddinN by the Ray Arca Air Quality Management
Die,rien all new materials for inspection. Applicant understands and will comply with
OYc. 0 N all non-point source regulations.
I have mail the hmurdon,ms,,6u1.r.....m vat.under Chapter 6.95 of the
Coldomia Ilcallin&Safe,y('ale.Sections 355115.25533 and 25531 1 undenwnd that
iflhe Wilding does not cumandyhave a tenant.that i,is my respmnibility m notify theOJ
orntpam of the rcq,dnmome whirl,mus,be met prior to issoancc of n Nnifinne of
O"atntt`y' Siiigfature of Applicant /"� Date
y/— All r ermgs to be Class •B'•or better
ow ,r I:lohodred open Liam
OFFICE