01050014 CITY OF CUPEWFINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS PERMIT NO.-
20200 LUCILLE UNITS 9 ROYAL ROOFING' 01050014
Oix iR'S NAME. APPLICATION SUB UNIT:
TRAMMELL CROW RES. SERVICE 1345 VANDER WAY '; 05/0112001.
I'I{ONE:' •- .-• SANITARY NO. CONTROL NO..
(408)279-2332 •
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i7a AHCI{I'IECrIIiNGiNEIiRBUILDING PERMIT INFO.: s BLDG ELECT PLUMB .MECH
IvF
• . . .
ICI NSI D CON I RACTOR S DI CI ARAI ION' "
z 5 v� I I ny ll t In t i li d 1 p Kell >(nue e s '1 - ' lob Description
OZ_
with LijinS 901(11 iD 3oftheI II Pass ( de,.ni ,yl ase v r. � y _ ,
liulneeu II i 7/. 6. �'� � ', REMOVE ' SHAKES, INSTRLL. 1/2" ,CDX 8• 30 Y
3 LL Dnlc, /- It 9HCI11TEC1"S DFCI1AIIA'TIO� ��Contra
^ - e .-
C a O g 1 trade...a d my plans shall be used us Public recoNs
oo Licensed Prefe,sional JAN 2A 2002
OWNER-BUILDER DECLARATION
1 hereby nllina Ihat I am exempt from the Contractor's License Law for the ` - • _
]_a fol owing reason.(Section 703 1.5,Business and Professions Cede:Any city or county g.UILDI
'E Cz o which acclaims a permit to consume,,after,improve,demolish,or repair any stnlcmric
NG
in 0 prior t°its issumce.a.so mitirea the applicant for such perorino file a signed statement
22 the he is licensed pursuanto the provisams of the Conmctor's License Law(Chapter 9 Floor Area FtValuation
ation
.
(commencing with Section 7000)of Division 3 of the Business unit Professions CNet lu anion
or that he is exempt therefrom and the andel,far the alleged exnnption.Any violation -
20000
of Section 703 1.5 by any applicant for a pnmil suhjects the applicant to a civil penalty
of nal come than Five huNred dallam($500). APN Number• Occupancy Type
❑I,a,"iotmepmpenr.mmycro' swith wage...their...let nttpanmli°n, 31602094. 00 -
will do the k aid dic fracture is out intended or oft and or rate•ISa.7(Wy,
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Bt Irl b:Code TI C I r i I pply In I. Required.Inspections ' r
11 1 city nild,t apo m n I -i khino.11' 305 — FRAME
mit-r alt his r vi v doyce pnv dol but such l aprnvo umi r l iu,adcd nr -
mnarad for sale.Bt however he hnndinp as far.......and ls,bld willrm one ya;n dr - 307 -- INSULATION
n I'detion.the owmrhuilder all11 have the burden of proving iron rte did con handl
imtprnva rmpriHna cele°l`) .601. — ROOF TEAR OFF _
01,a-wour of the property,am exclusively contracting with licensed emnamelms 0,' —
cn simet the fa i ISce.]1144,Imarres,aad Pram..i ms CNComm
et)The Comcmr's - 602 _ ROOF 'PLYWOOD LYWOf1D NR I I_
Lincrac Lmv doi not apply to no owner ofinate"Y who builds or amprows thiceor, 603. — ROOF BATTENS
and wmhomnr.cocontractsfor such projects with a cnntrnanor(s)licensed pursuant to the ,
CnmLieers.Law. 604 — ROOF- IN—PROGRESS
01 Int exengn under see. .B&1'C f..this ancon .
Owner Date -
WORKER'S COMPENSATION DECLARATION
I heathy affnn under penally id pepury racial the followingdecl.mnimna:
• 0 1 have and will ani a Ceri fenm of Consent to self-insure far Worker's
Carol, tion, :is provided for by Salton l]fNl of the Labor Cede, for the
perfnnnmtee of the work Car which this permit is issued. - -
T1111Khove lout will I aine in Worker's Comma uilon Insurance,as myalrad by Fallon
s 6
1 of fle Labor C,xla,for the performance of the work In which this 1vrntit is - p
isauuL My�W�mker'u Co;nponnt Ire lamounce card,,andd�Pulli�icy nand,.are: a. `
Canis:l_L"11CC_tCr�+.l____Ar��hcy sho F '"—��23:$7a1 ' - • `
ChNI'iIICALONN OP BXIiMYTION ROh1 W(RKIiRS' ._ '.f.Y
COMPENSATION INSURANCE - `
1'I hi.xciiou need not be completed if the Mrmit is for one hundod dollars r -
ISII(Bnrlex..) �
1 cenifY Hour in the i erfnmmnce of the work for which this permit is issue,1 ' r -
shall sou employ any person in any manner so as to become subject In the Worker,
CompensutienLaws or California.Date ,
Applicant -
NOICB 9T)APPLICANT.If,after making this Certificate of Gsemptirn,you should
become subject to the Wocrs Compensation provisions of the Labor Cede,you must "
z O fanhwith inutility with such provisions or permit shall be donned revoked. -
F 4 CONSTRUCTION LENDING AGENCY. - -
a .� I hereby affiml that Phe.is a cnmwction lending agency for the perGmnunce ,
W of the work fur which Phis permit is iwued(Sec.1897,Co,C.)'
QLenders Naim
z Aildnes, - - -
"'Vy� I IcIdly that I have acaddhiv ppli,mnn nd xn le thus he rinveit tylion L. I s - -
'Wouc,n.Ic uwa,ly wih in cry.,to roomy odttu 1,II Fasni in,
OV Int 'I lib nlruclint ind hereby uslborlw repmecnwt ve I'll : ly¢,enlenpit - n. - +'
W malluve-oundi edp t,16, nol' pmpuc,, ,
`
91. (We) pni adinumniOnndk pl the Cly of Cupen mug rot
.F. fA fiabilifics,judgesens,voi,ts and expenses whichmaya ny way accrue.aptnsl.aid
V Ciry in c n. ,Imre r f the b'ming.1 his mil �• .,- ' ,
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON.M)ROF
SOUR eREGULATIONS Issued by: - Date
aturcol'APplicanADale Re-roofs
IIAZALARDRDO ALS DISCLOSURE
Wllda,ythe Cticanturf aniure b,mlCode,Chding m9.12,same ad
haromadoHealth
Safety Type of Roof '
as dcline by the Cupertino Municipal Cede,Chapter 9.12,anJ rhe Heuhh nM Safety
CNa Section ZSSl2(u)'
�)" IN° � All roofs shall be inspected prior to any roofing material being installed.
Will the apPllcmt nr future building«eupant sax eyaipment or devices which If a roof is installed without first obtaining an inspection, 1 agree to remove,
unit Ian;Nous air conmmirems.a fated by the Bay Area Air Qual ity Management -
Di.trict, /�, all new;materials for inspection. Applicant understands and Will comply with
17 y. �"'"" ' all non-point source regulations.
I have rcud the hazamons nmredals n alrement,under Chupmr 0.95 of the -
calfiloori, I ldh d25534.I namicaiyIn.
I II h I' li 1 t Ply l' moult: nyrc'I n.lh c. I Ci fy the
' I' t III 1 '........I h hmu.cdh met Pr nr lo's d, Qui Ic ofO"r
naWreofApplicant ',Date
/i
aro analunxed igen, AI ngs to be Class`t`B"'or better
. . OFFICE -