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99080210CITY OF CUPERTINO I. 1 of 1 BUILDING PERMIT RECEIPT OPERATOR: karenb COPY q 1 Sec: T.P: Rng: Sub: B1k: Loe:32643019.00 DATE ISSUED......,.: 08/30/1999 RECEIPT N.........: 9927 REFERENCE ID q ...: 99080210 SITE ADDRESS .....: 21366 AMULET DR SUBDIVISION ....... CITY ........... ..: CUPERTINO IMPACT AREA ....... OWNER ............: YU KOO AND LEE-CHUN ADDRESS ..........: CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-1301 RECEIVED FROM ....: TIM CONTRACTOR .......: COSMOS, RICHARD LIC 4 18844 COMPANY ..........: COSMOS ROOFING ADDRESS ..........: 450 SAN ANTONIO RD CITY/STATE/ZIP ...: PALO ALTO, CA 94306 TELEPHONE ........: (415)493-6373 FEE ID UNIT BPERMFEE VALUATION BSFISMICRE VALUATION T. PERMIT METHOD OF PAYMENT ----------------- CHECK QUANTITY AMOUNT PD -TO -DT ---------- ---------- ---------- 1,000.00 77.00 0.00 1.00 0.50 0.00 ---------- 77.50 0.00 AMOUNT NUMBER ------------ ------------------ 77.50 10177 THIS REC NEW DAL --------- ---------- 77.00 0.00 0.50 0.00 ---------- 77.50 0.00 TOTAL RECEIPT 77.50 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 0 3 1�140 - V3 - 01 9 ogoanc PERM APPLICATION FOR - CITY of CUPERTINO NUMB] INSPECTION DIVISION PERMIT EXPIRATION - REROOF PERMIT (4G8) 777-3228 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. BUILDING ADDRESS /3 60 - - RESIDENTIAL_ COMMERCIAL OTHER OWNER'S HAZARDOUS FIRE AREA YES ❑ Il yes—Iundersfend Mata ClassA , NAME /�'y �• root asvemtly Is ragldtatl. - NO ❑, Irvfial LC.B.O.t EXISTING ROOF COVERING ADDRESS —' / O - NUMBER OF EXISTING COVERINGS PHONE/(p CONT RACTO /J /(/ TO BE REMOVED TO BE AINED NAME /yam //-- ADDRqSS CITU&ZI /C11Y- '•�Ik !. ' " EXISTING PHoNSE • r•�-63.73 BUILT-UPROOF LICENSE. NUMBER " �{�� 7t7 o ASPHALT SHINGLES- . ❑ WOOD SHAKES ILfI LICENSED CONTRACTORS DECLARATION d hereby aNrm that em with Section provlebre of Chapter B (cc ins eIs Pr 7000) of DlWabn 3 of the Buslrem and Prolesskxte Cade, and rtry license la In lull force end Business and In . I °g°a" 6 70 u WOOD SHINGLES I �I V3 Ucenm Cl LIc. Number G AUt4 3 0 1999 • .Date OTHER (SPECIFY) ❑ Conbeoon v OWNER -BUILDER DECLARATIO ' PROPOSED I hereby affirm Nat I em exempt from the Centra lole License Law for the following reason. (Sac. 7031.5, Buebess and Proleaabne Code: Any city or county which requires a permit to By mrtetmd, after.Improve,demolish, or repair any sbl prior to Its Issuance, all requkm the BUILT-UP ROOF ❑ appYct nt for such permit to file a signed statement titer he is licensed pursuant to the provisions - ol the Contmdore Lbeme Lew (Chapter 8 (commend with Section 7000) of Division 3 of the Busbms and Prolemlons Cade) or that he Is exemprlerefrom and the basin for the alleged - ASPHALT SHINGLES ❑ exemption. Any violation of Section 7031.5 by any applicant for a permit sugects the applicant to e dvil penalty, of not more Nen five hundred dollars ($500).): 1, the Nelr do SHAKES ❑ C] as owner of prop",, on my employe°°with "gee as oda compensation, will the work, are the structure 14 not Intended or offered for mie (Sec. 7044, Business and Prates. ,WOOD alerts Code: The Contractors Lkerea Lew does not apply to an owner of property who builds or WOOD SHINGLES ❑� Improves Hereon, are who does such work Mmaell or through his own empkgem, provided that Improvements Intended such are not or OHerad for code. If, however, the hulking or Improvement le mk within one year of completion, the owner-bulkier.111 he. the burdan of proving Net he ad OTHER (SPECIFY) net bulk or Improve for purpose of sale.). - C�7\J ❑I, as owner of the property, am exdusdvery contrectln with llceneetl contractors to construct the project (Sec. 7044, Business are Professions Coda: TPhe Contractor's Ucenus Lew does not PROVIDE 1.C.B.O. REPORT NO. appy to an owner of property who bulla or Improves thereon, and who contracts for such projects wIM a cmtrmtor(s) llmnW pumuant to tha Contractors Ucenae Lew. PROVIDE MFGR. INSTALLATION SPECS. F1 am exempt under Sec. ,B & P. C. for this mason owne, Date WORKER'S COMPENSATION DECLARATION APPLICATION DATE VALUATION PERMIT FEE Oft �� v�f7 (,/L/ I herapy affirm under penalty of perjury Dna of the following declaration: ❑ 1 have and will maIr In a Certlfbate of Consent to self -Insure for worker's Compenmikn, m provided for by Section 3700 of the Labor Code, for the performance of NW work for which Nie - Q�/�4 / . BUl din g perml7,lel°eued. 7� / /� S� czly have entl will m Workerrmanc'e C by Section 37ke 0r' tainPerformance Insurance, permit $elSfnlC I`1/�L e the work forwhich Is I t Labor Cotle, for Ne perfarmence of the work for which this permit le Iewetl. My Workers d. Total ComperuetioSygfMyq nnIfcy number are: Q ��_//ZS - PERMIT AUTHORIZATION DATE Carrier `•+`fl�t.y�(..y' Policy NZ - CERTIFICATE OF EXEMPTION FROM WORKERS' l ' COMPENSATION INSURANCE' N.CQ (This section need not be completed 1 Ne permit Is for am hundred delar, ($100) on Imo.) I rarefymlt Net In Ne performance of Ne work for which this p°rIs leveed, I shall not employ any penal b manner m as to baMa,ne wbject to the Workers Compensation Laws of Call- All roots shall be inspected prior to any roofing material being fornix h �• installed. If a roof is installed without first obtaining an Date Applicant Inspection, I agree to remove all new materials for inspection. NOTICE TO APPLICANT: If, after making this Certiecat 1 Exemption, you should become subject to Ne Workers' Compsmason provisions of me Lebon Code, you must brihwlth comply Applicant understands and will Comply with all non Dint PP P Y P with meh provisions or this permit Man be deemed revoked. Source regulations. . I comity that I neve mad this application end state that the Weave Information Is correct. I agree tion, eM to nifty au all rcityep and se county ordinances and enter upon rola fing to bova-bunioning c! property hereby apuripo a representatives of N4 city to enter upon Ne above-mentloned property for lot- speglon purpoeae. All 500 e to be C SS • f better. • /Q a 'O (We) agree M save, Indemnity and keep hermbm the City of Cupertino agelnst Ilebllltlm, lutlpments, Coate and expenses which prey In any way accrue against sem City In memquenm of the renfln of MIS permit. SIGNATURE F APPLICANT DATE PRE -INSPECTION: PLYWOOD: - IN -PROGRESS: INSP. DATE INSP. DATE 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 WVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE CITY OF CUPERTINO BUILDING PERMIT INVOICE OPERATOR: karenb Sec: Twp: Rng: Sub: Blk: Loc:32643019.00 INVOICE DATE......: 08/30/1999 REFERENCE ID 4 ...: 99080210 SITE ADDRESS .....: 21366 AMULET DR SUBDIVISION ....... . CITY .............: CUPERTINO IMPACT AREA ....... OWNER ............: YU KOU AND LEE -CHUM ADDRESS ..........: CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-1301 CONTRACTOR ....... : COSMOS, RICHARD LIC 4 18844 COMPANY ..........: COSMOS ROOFING ADDRESS ..........: 450 SAN ANTONIO RD CITY/STATE/ZIP ...: PALO ALTO, CA 94306 TELEPHONE ... ..... : (415)493-6373 FEE DESCRIPTION CHK --------------- --- BPERMFEE P BSEISMICRE P 0V E ID DESCRIPTION ................... FRAME 1 ROOF TEAR OFF 603 ROOF BATTENS TOTAL FEE PAID -TO -DATE BALANCE DUE --------- ------------ ----------- 77.00 0.00 77.00 o.so 0.00 0.50 --------- ----------- 77150 0.00 77.50 VOICE ID DESCRIPTION -------- 307 INSULATION 602 ROOF PLYWOOD NAIL 604 ROOF IN -PROGRESS 3 CITY OF CUPERTINO IO 1 of 1 BUILDING PERMIT RECEIPT OPERATOR: yvonnek COPY # 1 Sec: Tp: Rng: Sub: Blk: Lot:32643019.00 DATE ISSUED.......: 09/01/1999 RECEIPT #.........: 9960 REFERENCE ID # ...: 99080210 SITE ADDRESS 21366 AMULET DR SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ....... I OWNER ............: YU KOO AND. LEE-CHUN ADDRESS ...... .. ..: CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-1301 RECEIVED FROM ....: TIM CONTRACTOR .......: COSMOS, RICHARD LIC # 18844 COMPANY ..........: COSMOS ROOFING ADDRESS ..........: 450 SAN ANTONIO RD CITY/STATE/ZIP ...: PALO ALTO, CA 94306 TELEPHONE ........: (4151493-6373 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL ------------------------------------------------------------------------- BPERMFEE VALUATION 1,000.00 77.00 0.00 77.00 0.00 OMICRE VALUATION 1.00 0.50 0.00 0.50 0.00 PERMIT -----77 50 0.00 -----77 50 0.00 METHOD OF PAYMENT AMOUNT ----------------- ------------ ----- CHECK 77.50 10177 TOTAL RECEIPT ----•-•]] 50 VOICE ID DESCRIPTION ........ ............................ 305 FRAME 601 ROOF TEAR OFF 603 ROOF BATTENS UsizIOMN VOICE ID DESCRIPTION ........ .....................V...... 307 INSULATION 602 ROOF PLYWOOD NAIL 604 ROOF IN -PROGRESS