01050036 ITY OF CUPERTINO
^,)
BUILDINGDIVISION ' PERMIT CONTRACTOR INFORMATION:
�s BUILDING ADDRESS: - PERMIT NO.
20200 �LUCILLF_ AV CAR 35 42 ROYAL— ROOFING : /01050036
OWNIiR'S NAMB. - APPLICATION SUR DAI'E
TRAMMELL CROW RESSERVII E.S' 1.345.VANDER. ,WAY - -.- ;: _05/03/200,1. ' _
• PHONE: r - SANITARY NO, CONTROL NO.
(408) 279-2332
z z ARCHI'IEC(ENGINIif:R: BUILDING PERS111 INFO)
U O t .t - BLIX'i HLECr PLUMB a MECH
z = - LICENSED CONTRACTOR'S DECLARATION Job Description '
O z_ 1 herehy alTrm that I am licensed under pnsvlsiom or Chapter pronouncing
,IF-ed wish Section 7010)of Division 3 of the Business and Professions Cale,and my license
<=f� i.ihrolmmea rfe RE-ROOF REMOVE SHAKES. 8 INSTALL,.1/2" A
r z se Q License Lic.g G
x�w" nate I>, �i ennlmetnr ,i LED CERTAINTEED SI'IINGLF_S'. CARPORT
m 3 i F ARCHITECT'S DI_CI.ARA
1 understand my plans quill be lived a,public norma
2� 4 2002
ed c O Licensed professional - s
I OWNER-RUILDER DECLARATION -
.¢� 1 herehy ailuro that,1 on essanpt from the Contractor's License Law for the
I_z fallowing reason.(Section 7031.5,Hromess and pro esions Ctdo Any city{{7ys,.(k' WING
E s O, which requires a permit m consumer,alter,improve,demolish or repair"fro
i3°—e prior to its issuance.atm inquires the.,,[Iran,hrmch perti"a file a signed v AT7ement
that he isteen.sedpursuant in she Moi.ionsrdmeContractors License Law(chataer9 Sq. Ft. Floor Area Valuation
(commencing with Section 7(W of Division 3 of the business and P..[.1ions Cade) —
or that,he is exempt therefrom and the basis far the alleged ewnpdsrs.Any violation -
of Section 703 LS by any applicant for a,mail sobjecti she applicant m u civil penalty
of am mote time Cote hundred dollars asr(R. APN Number. - Occupan
O 1,as owner of Ihe property,or my employees with wages to their sole compensation,
will do the work,and the naucture is not intended or offered for sale(Sea 7(W4, ;3160209
Business and Professions Code:The Conumcav:.s License Law does not apply to an _ RE ' fired Inspections
rof property Who hui Ids or insprt
roves Ihenn,urn su
who does ch work himself
orvthrough his awn employee..provided that.such improvements are not intended or
'oneree for sale.if,however,the homing or ilnprovrnamr is Sold within are year dr 305' — FRAME
complmiml,the owner milder will nave the I uMm of powing hm he board build or •-`r' w
• armuoeforpatpomo ode.), - r?iQl7 ' —. IhlcSLILA'I IIJtd' ' '
❑ : 'hlu exclusively t tg with l' t, conotr
601: ROOF- TEAR OFF
construct tP 1 IS H.blrc:aod Pocci%iod, (Klc:)The Curar
Licit Lawdsesoa,ply
,I,a 'mcnywholudiceti prtvestef. n. 602 ROOF PYlJOOD
PAIL
and h t 'Ach"oicciwdIh11 .numrss d I - .m m le
c t :
• I- -
Licenso Low j603 — ROOF- BAT,TENS'.
❑1 car astan"Aund"Su N h lie fdr this,reason I, • .
604 - ROOF 'I1V=PR0GRESS
p ne, lime A ..
WORKER'S COM PUNSA'I'ION DI!CI.ARA'I'I IN -
. Ih by elljououstale,
pnllY-Ip Y ftl John,in,_IeCh ani
a
❑ I ha e kind will anAmadin A Certificale ol Consent t If r Worker s 7
C counsellor. m Po"idul n by Se .... 3700 nl' s. Riot Clila Ito Ihe' - -
perfumunc.ol'le work far which this Pc.nl it is i"anal
I have and will nmintain Worker's Com�ewmion hnu.Aram;I,required by Section
tNl of We Luton Cuda,Iia Ihe I<roaman:c°f she wn.k4o,which lis permit is t issues,1.My Worker'a Connpenvmion Insurance carrier And Policy rairbserraare:
CamierH iP'r4-i Policy No.:
• CFRTT171CATION OP EBHMIG ION FROM WORKERS'
COMPENSATION INSURANCH - -
(This section need not he esplesed if the permit is far,rine hundred dellen S -
,ISI00)nrins.) -
1 cenify that in the performance of the work or which this permit is issued,I '
shall not nnpdoy anyperson in any manner m as to sectors,subject m the Workers
Chmlenedion Was of Cnlifnrnia.Date '
- Applicant ••
NOTICE TO APPLICAN P II:utrue nuking this Cambiums,of lammplion,you should +- -
Q Obecome subject .,he Workers Compensation provisions at the labor Calc.You muss '
forthwith comply willn such provisions or this perch shall be Camal revoked, -
F-Z t CONSTRUCTION LENDING AGENCY -
� ' I herehy uRirm that lural if a eomametion lending agency lura the fedomunee
of the work for which lis permit is issued(ties.3097.Civ,C.)
L (_, Lumber's Name
o'z Lender's Address
V Iec'ifyt,bar l have and his aStIi,mins and scam that the anorc information is
li F. C.I.1 agate to comply with all city and county ordinances and state laws miming
" Q V to building construction,anti hereby amhoriee representatives or this city to enter upon
W the move-memloned pmpeny Iia inspection purposes.
[ti 4 (We)agree to save,indemnify and keep hanudess the City of Cupertino against
VI 'Imbididin,judgment,costs and Is, . ,which may in any way see n....must said -
V z 'City in consequence of the grunting of this permit. -
-n APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL ttt��y'ON.11 If issued by: ' � JPO
SOURC:RGGULATIO S •d- 2� 2 Y Date
.3 O
si reofAppb.mAZARDOor )me 'Re-roofs
HAZARDOUS h1 ra d storeOSURE
Will the a Ctr,am or fmuni bd occupant man nr huddle haardnus m Safety Type of Roof i ..
as de.mee by the Cupeninn MunidlzJ Code,charm.9.1z,and the Ilcull nnA safety .
Calc,sccti.n 2553200'! -
0yes- uEl All roofs shall be inspected prior to any'roofing material being installed.
Will -
Wtheapplicamdrtt hudddngtreupanlupeequlpmetttordevice, rich If a roof is installed without first obtaining an inspection, I agree to remove
"air lialmdom,III, al mimust mdefided by lh Itay Arae Aur Quality Management
Looks?'t I 'all new materials for inspection., Applicant understands and will,comply with.
1:1 ye, N a all non-point source regulations.
I bus end.h I ( at:i�oc,,firawras limier Chaps-6,95 of the _ o
Calif II IIhMSIIyC S t u255052h5Ttn 125534 I auscouttht • t
if[lie h ld ge c:n Ica idyl n un.Ihu its ry :p 1 lityt Ily the _ G
"nt ncsdPulf ofrise tvq: nncns which ens.heat prom''Inane ole Ccr'Irde or
• O gnatureofApPIicant f Dude '
t munitmrisrd ugcm' - Uwe - f coverings[O be Class"B",OI'better "
• OFFICE '
ITY OF CUPERTINO
^,)
BUILDINGDIVISION ' PERMIT CONTRACTOR INFORMATION:
�s BUILDING ADDRESS: - PERMIT NO.
20200 �LUCILLF_ AV CAR 35 42 ROYAL— ROOFING : /01050036
OWNIiR'S NAMB. - APPLICATION SUR DAI'E
TRAMMELL CROW RESSERVII E.S' 1.345.VANDER. ,WAY - -.- ;: _05/03/200,1. ' _
• PHONE: r - SANITARY NO, CONTROL NO.
(408) 279-2332
z z ARCHI'IEC(ENGINIif:R: BUILDING PERS111 INFO)
U O t .t - BLIX'i HLECr PLUMB a MECH
z = - LICENSED CONTRACTOR'S DECLARATION Job Description '
O z_ 1 herehy alTrm that I am licensed under pnsvlsiom or Chapter pronouncing
,IF-ed wish Section 7010)of Division 3 of the Business and Professions Cale,and my license
<=f� i.ihrolmmea rfe RE-ROOF REMOVE SHAKES. 8 INSTALL,.1/2" A
r z se Q License Lic.g G
x�w" nate I>, �i ennlmetnr ,i LED CERTAINTEED SI'IINGLF_S'. CARPORT
m 3 i F ARCHITECT'S DI_CI.ARA
1 understand my plans quill be lived a,public norma
2� 4 2002
ed c O Licensed professional - s
I OWNER-RUILDER DECLARATION -
¢� 1 herehy ailuro that,1 on essanpt from the Contractor's License Law for the
I_z fallowing reason.(Section 7031.5,Hromess and pro esions Ctdo Any city{{7ys,.(k' WING
E s O, which requires a permit m consumer,alter,improve,demolish or repair"fro
i3°—e prior to its issuance.atm inquires the.,,[Iran,hrmch perti"a file a signed v AT7ement
that he isteen.sedpursuant in she Moi.ionsrdmeContractors License Law(chataer9 Sq. Ft. Floor Area Valuation
(commencing with Section 7(W of Division 3 of the business and P..[.1ions Cade) —
or that,he is exempt therefrom and the basis far the alleged ewnpdsrs.Any violation -
of Section 703 LS by any applicant for a,mail sobjecti she applicant m u civil penalty
of am mote time Cote hundred dollars asr(R. APN Number. - Occupan
O 1,as owner of Ihe property,or my employees with wages to their sole compensation,
will do the work,and the naucture is not intended or offered for sale(Sea 7(W4, ;3160209
Business and Professions Code:The Conumcav:.s License Law does not apply to an _ RE ' fired Inspections
rof property Who hui Ids or insprt
roves Ihenn,urn su
who does ch work himself
orvthrough his awn employee..provided that.such improvements are not intended or
'oneree for sale.if,however,the homing or ilnprovrnamr is Sold within are year dr 305' — FRAME
complmiml,the owner milder will nave the I uMm of powing hm he board build or •-`r' w
• armuoeforpatpomo ode.), - r?iQl7 ' —. IhlcSLILA'I IIJtd' ' '
❑ : 'hlu exclusively t tg with l' t, conotr
601: ROOF- TEAR OFF
construct tP 1 IS H.blrc:aod Pocci%iod, (Klc:)The Curar
Licit Lawdsesoa,ply
,I,a 'mcnywholudiceti prtvestef. n. 602 ROOF PYlJOOD
PAIL
and h t 'Ach"oicciwdIh11 .numrss d I - .m m le
c t :
• I- -
Licenso Low j603 — ROOF- BAT,TENS'.
❑1 car astan"Aund"Su N h lie fdr this,reason I, • .
604 - ROOF 'I1V=PR0GRESS
p ne, lime A ..
WORKER'S COM PUNSA'I'ION DI!CI.ARA'I'I IN -
. Ih by elljououstale,
pnllY-Ip Y ftl John,in,_IeCh ani
a
❑ I ha e kind will anAmadin A Certificale ol Consent t If r Worker s 7
C counsellor. m Po"idul n by Se .... 3700 nl' s. Riot Clila Ito Ihe' - -
perfumunc.ol'le work far which this Pc.nl it is i"anal
I have and will nmintain Worker's Com�ewmion hnu.Aram;I,required by Section
tNl of We Luton Cuda,Iia Ihe I<roaman:c°f she wn.k4o,which lis permit is t issues,1.My Worker'a Connpenvmion Insurance carrier And Policy rairbserraare:
CamierH iP'r4-i Policy No.:
• CFRTT171CATION OP EBHMIG ION FROM WORKERS'
COMPENSATION INSURANCH - -
(This section need not he esplesed if the permit is far,rine hundred dellen S -
,ISI00)nrins.) -
1 cenify that in the performance of the work or which this permit is issued,I '
shall not nnpdoy anyperson in any manner m as to sectors,subject m the Workers
Chmlenedion Was of Cnlifnrnia.Date '
- Applicant ••
NOTICE TO APPLICAN P II:utrue nuking this Cambiums,of lammplion,you should +- -
Q Obecome subject .,he Workers Compensation provisions at the labor Calc.You muss '
forthwith comply willn such provisions or this perch shall be Camal revoked, -
F-Z t CONSTRUCTION LENDING AGENCY -
� ' I herehy uRirm that lural if a eomametion lending agency lura the fedomunee
of the work for which lis permit is issued(ties.3097.Civ,C.)
L (_, Lumber's Name
o'z Lender's Address
V Iec'ifyt,bar l have and his aStIi,mins and scam that the anorc information is
li F. C.I.1 agate to comply with all city and county ordinances and state laws miming
" Q V to building construction,anti hereby amhoriee representatives or this city to enter upon
W the move-memloned pmpeny Iia inspection purposes.
[ti 4 (We)agree to save,indemnify and keep hanudess the City of Cupertino against
VI 'Imbididin,judgment,costs and Is, . ,which may in any way see n....must said -
V z 'City in consequence of the grunting of this permit. -
-n APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL ttt��y'ON.11 If issued by: ' � JPO
SOURC:RGGULATIO S •d- 2� 2 Y Date
.3 O
si reofAppb.mAZARDOor )me 'Re-roofs
HAZARDOUS h1 ra d storeOSURE
Will the a Ctr,am or fmuni bd occupant man nr huddle haardnus m Safety Type of Roof i ..
as de.mee by the Cupeninn MunidlzJ Code,charm.9.1z,and the Ilcull nnA safety .
Calc,sccti.n 2553200'! -
0yes- uEl All roofs shall be inspected prior to any'roofing material being installed.
Will -
Wtheapplicamdrtt hudddngtreupanlupeequlpmetttordevice, rich If a roof is installed without first obtaining an inspection, I agree to remove
"air lialmdom,III, al mimust mdefided by lh Itay Arae Aur Quality Management
Looks?'t I 'all new materials for inspection., Applicant understands and will,comply with.
1:1 ye, N a all non-point source regulations.
I bus end.h I ( at:i�oc,,firawras limier Chaps-6,95 of the _ o
Calif II IIhMSIIyC S t u255052h5Ttn 125534 I auscouttht • t
if[lie h ld ge c:n Ica idyl n un.Ihu its ry :p 1 lityt Ily the _ G
"nt ncsdPulf ofrise tvq: nncns which ens.heat prom''Inane ole Ccr'Irde or
• O gnatureofApPIicant f Dude '
t munitmrisrd ugcm' - Uwe - f coverings[O be Class"B",OI'better "
• OFFICE '