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CONTRACTOR INFORMATION:
BUILDING DIIV�'ISIONNO PERMIT '
BUILDING ADDRESS:
PERMIT NO.
19220 STEVENS CREEK BLVD
ROYAL ROOFING
OWNER'S NAME:
APPLICATION SUB DATE
HALL TOM L AND ELEANE
134S VANDRR WAY
PHONE:
SANITARY NO, CONTROL NO.
4087731400
SAN JOSE, CA 95312
1
Z ARCHITECT /ENGINEER:
BUILDING PERMIT INFO
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BLDG ELECT PLUMB MECH
* NO COND= *
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i LICENSED CONTRACTOR'S DECLARATION
Job Description
1 hereby affirm that l am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of[he Business and .3..sions Code,andmylicense
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is in full c��v d
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U
me Contractor
ARCHITECT'S DECLARATION
3 I understand my plans shall he used as public records
Licensed Profession
NER- BUILDER DECLARATION
1 hereby v 1 16m'Rim?xempt from the Convectors License law fm Ne•
v' folboving reason. thin 703 n d.Professions Cad A y [y o co my
O which requires a con IrPCt, g11y mp54vt dental h or rtp any t 1
$ ..pct rt ,. oyes - Ilcan {fp ulhpemy pRka gnMrutc t.
— drlla yaraaanmin�' noshc mictailLidiaalaw(Cnpt 9
hSec ion? i flhm li ion .Code)
Jq..FLFloor,Area :'r ^,•,• Valuation
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( mac g : m _P, ,
that he l f e b eg a I n Ali a a�•n'
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' • APN Number
u. Occupancy Type
-of S. on7031 t a in set v aroma' I a10-`.z
of not mom than five hu a a.1. (s
pl, as owner ofNe prapeny.mmy amp ecx withw see eir sal
- -- - - -' -
Required Inspections "
- will-do the work; and Ne xrrvor. is not ilended n d -far ( .7
Business and ProPossions Code: The Contractor's License w d« t ly to im
owner of progeny Who builds or improves thereon, and who dtns s if
or though his own employees. provided that such improvements
'bReredfdr sole. If.- however, the building or improvemem ie sold'wilhin one Ye f
'
cainpletmn, the owner- builder will have the burden of proving Ih I he did not build ar'
Improve for purpose of atlle.).
d
O, L as owner of the grope., am contracting with licensed contractors m
•'c the project (Sec. Business and Contractor's
Business and Professions Code) The
yes
License to a thermq'
License law does not apply m on owner of property who) lice
and-who seimproves
(Low. .Projens..wi0 a commnor(sl licensed pursuem.to.Ne:..._.
- --
is License
" Contractor's License Low.. ..
' ❑lam exempt under Sac,' - ,B &PC for this reason
01 on
LI5r
'Owner .,• Data
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,., WORKER'S COMPENSATION DECLARATION
o
/ _
" Ihertby affirm undo pewlty.of perjury'one pf the following dedamliom: --
/
❑ 1 have vad will- mainmin a Cenificme'of Consent to aelf.imure for Warker's
Compensation, for by Section 3700 of the Labor Code, far the
-. as provided
performance of the work to which this permit is issued;
L/
01 have and will maintion Worker's Compensation Insurance, as required by Section
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3700 bf the Labor Code, for the performance of the work far which this permir is
issued rMyW kern Cnmpmora [[,,'{{.�nn...sure currier and put¢ynumbcr
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Corner° S "PSI
CER I I ATION OF EXEMPTION FROM WOIK S "\
s COMPENSATION INSURANCE"
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/ .— — ---- - - -• -- --
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(Thasocilim need not he completed if the permit is for a hundred dollars
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1 cenify that m rh pert sneer of [hc rk for wh h Ih s pern a ie issued, I
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shall nodes.)
Compensation I anon L any person m any manner so as to become subject ro the W rkms'
- COm n Law. 61 C I f m o. Data ''
Applicant '-
__- - ? - -._— - - _ — ••
NOTmQETO APPLICANT: IL Candidate of f Exemption, you
yuhmulst
Z bechwithc Subject Compensation Labor de,
Workers Compenmthis permit
shall ravokeou'Ihusr
forthwith comply with such pmvisiam m this permit shall be deemed invoked.
ply it
_
y- ' • ^ "` CONSTRUCTION LENDING AGENCY
I hereby affirm that hert is a conswction lendingg agency for the perfnmmmce,
.
r 'af Ne work for which this permit is iuued (Stt. 3097 Civ. C.1 '
- - --
.�... Laro r Nam -. -
Z Lender s AdJ ,
an la
1 have nod application d that the above information
I rectify to
I
ostate
ail m ling
correct. I agree to c only he ll aY ri county d and late law
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I
construction, dhertbya Ih z representatives of this City to actin. upon
ta building enter
the above mention d. pony r r myna 1 purposes. ,
},] too.- rod.red
y (W)agmemmc dmnipe dk «ph ti Cryoacruenlnodg strut
yin d
A liabilities. judgments. costs d expo which yin y way accrue against said
1
Z C tyy� n donvequence of the immong of th pe r
r IT WILLC POINT
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APp11CA UNDERSTANDS \IPLYNITH nLC NOS
y�r - P "
Issued by: Date
90UR F FNLA]ION
y �nr LAIION
Signi ofAppleadoConve r .' D e,;
-
Re -roofs '
HAZARDOUS MATERIALS DISCLOSURE . "' '
Will the applicant or future build ng «c pot stoic or handle hazardous marenal
., . Type of ROOF . , - - -. • •- •� - •" • • -' ^- - -^ -- --
defiircd by the Cupertino Municipal Cade Chapter 9.13 and the Health and Safety
Code, OY n 25532(.)?' �Na nl -.S'
•.'
:rt t.
All roofs shall be- inspected,pnor- to,any roofing material being installed,--.--.
.
wlltheaPpueantorrur.re wilding «cupantuse equipmentordeviceswhich
-
If a roof is installed without first obtaining an inspection, -I agree to remove
emit hazardous eir conmminants as defined by the Be, Area Air Quality Management
District?
all new materials, for inspection. Applicant understands and will comply with _
• oY� ;caa- -
p''
alCnon -po' C ource regulations.. - -.
1 hove read Ihe',ho,ardous materials rcgnirtments under Chapter 6.95 of the
-
Culdiand. Health & Safely Code, Sections 25505.25533 and 25531. 1 understand that
-
if the building does not currently haw atenanCthatitismyrespmi
obilit Y m natify the
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,aocupdn[ of the nc a nts which ..it oe at prior to issuance of a Cmtificme of
Occupancy.
Sig u III Applicant D
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All roof coverings to be Class "B" or bett r
owner or .Jaen[ ,e
.. - .. • _. .. . -- . — - - - OFFICE