The URL can be used to link to this page

99080175 t � L� A,( R 326- Z7-0z3 7ul S-t (S i L, PIE All D,-- ► APPLICATION FOR CITY OF CUPERTINO NU ■fir INSPECTION DIVISION PERMIT ExPIRAn n REROOF PERMIT (QOB)777-3228 PERMIT EXPIRES IF WORK IS NOT STARTED r WITHIN 190 DAYS OF PERMIT ISSUANCE OR • 190 DAYS FROM LAST CALLED INSPECTION. BUILDING ADDRESS RESIDENTIAL COMMERCIAL OTHER OWNER'S n n HAZARDOUS FIRE AREA L/ �/,// YES ❑ It yes—rmfas assert reqthat uired. NO ClassA NAME / CSN noel a95emk1Fy rs required. No ❑ Initial LC.B.O.R ADDRESS4—:5 0 EXISTING ROOF COVERING PHONE - NUMBER OF EXISTING COVERINGS / CONTRACT / Q TO BE REMOVED TO BE RETAINED NAME ADDRESS TYPE OF ROOF COVERING CITU&ZIP / 1 N ie PHONE �7 '7 ? BUILT-UP ROOF El NIUMBER (i(/^7! J ASPHALT SHINGLES El DCENSED CONTRACTORS DECLARATION I hereby affirm that I am floensed under provisions al Chapter 9(commencing with Section WOOD SHAKES �' 7")of DMalon 3 of the Business end Professions Cade,are my license Is In full force and . affect. e/a ZZ7 WOOD SHINGLES Els Ucensa Class Jo Number D OTHER(SPECI Elate Contractor OWNER-BUILDER DECLARATION PROPOSED I hereby aHlrm that I am exempt from the COMrectorb License Law for Me lollowmson. g rea (Sec.7031.5,Business and Professions Cada: Any dty or county which requires a pemdt to ^ Q construct,alter,Improve,demonsh,or repair my structure,pprior to lis Issuance,also requires the BUILT-UP ROOF I I D applicant for such permit to file a signed statement that ter le 9consnd pursuant to the provisions of the Contraclore License Lew(Chapter 9(commencing with Section 7000)of Division 3 of the . Business and Professions Code)or that he Is exempt therefrom and the basis for me alleged ASPHALT SHINGLE �l AUG r :ggg exemption.Any violation of Section 7031.5 by my applicant for a permit subjects the applicant to 'LI III e civil penalty of not more than five hundred tldlem(5X00).): H ❑L as ovmer of the property,or my employees with wages as their sole companaatlon,will do WOOD SHAKES ❑ the work,end the structure is not mtenced or offered for sale(Sec.7004,Business and Prafes- sbrmCode:Tre Contractor'sUceruaLaw does,not al lytoanOwnerofpropertyviWideor WOOD SHINGLESBy rl improves therm ,end who does such work him i or through his awn employees,provided that Y- such Improvements are not Intended or offered for sale.It,however,the building or Improvement Is sold within one year completion,the owner-builder will have the burden of proving that he did OTHER(SPECIFY) ❑ not build Or Improve for purpose of sale.). ❑I,as owner of Iter property,em exclusively conteckrg with licensed contractors to construct Me protect(Sec.7044,Business and Professlona Cade:The Correctors License Low does not PROVIDE I.C.B.O.REPORT NO. apply to an owner of property who builds or improves Maraca,and who contracts letsuch projects with a conimctori licensed pursuant to the Contradorb Ucense Law. ❑l am exempt ander Sec. ,e s R.C.for hus reason PROVIDE MFGR.INSTALLATION SPECS. owner Date APPLICATION DATE VALUATION PERMIT FEE WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declaration: - 0 ❑I have and will maintain a Certificate of Consent to self-Insure for Workers Compensation, Building as provided for by Section 3700 of the Labor Code,for Ne perform ei of rte wank for which Nis g perntlt is Issued. I o7(' 11 have and win Meta In Workers Compensation Insurance,as required by Section 37W of 8{ O Seismic r the Labor Code,fi the performance of Ne wvrk for which this permit is Issued.My Worker's 7/) Compensation mroa carrier icy number ere: �� )/ Total 1��! Carrier PolicyNo./J-diiPERMIT AUTHORIZATION DATE CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION I NSURbiNCE N.C.0 (This section need not be co a lined if the perrMt is for one hundred dollars($100)or less.) 1 cantly clot In the performance,of the wcr for which this Permit S Issued,I shall rot employ any person In arty manner so as to become subject to IM Workers'Compensallon Laws of Ca1F All roofs shall be inspected prior to any roofing material being fornlo. �'9 a Installed. If a roof is installed without first obtaining an Dale Applicant / Q �Z,.�(72/1 inspection,I agree to remove all new materials for inspection. NOTICE TO APPUCANT: If,after making thls 66'rtifirbrue of F= nr prion,you tunc id became Applicant understands and will comply with all non int subject to the Workers'Compensation provlsbns of the Labor COde,you must forthwith comply pP P Y PO with such provis ci or Mls permit shall be deertred revoked. source regulations. I canny that I have read this application and state that the above Inbmnatlon Is comect.I agree to comply,with all dry aural county ordbonces and state laws relating to buildng construction,and All roof coverings to be class°C°Or better. herebyauthorize representatives of this dry to enter upm the above-menibrmed property kx In- spacliortn Purposes.oses. ✓/�v1r"_/A�1 —Z Z'• ` S . (We)agree to esus,Indemnity end keep harmless the Gy of Cupertino against Iledlitles, judgments,coiner and axPrnses which may In any way accrue against sale City In consequence SIGN TURE OF APPLICANT ANT DATE of the granting of this pemnit. 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 INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE CITY OF CUPERTINO • BUILDING PERMIT INVOICE OPERATOR: nencyc Sec: Twp: Rng: Sub: Blk: Lot:32627033.00 INVOICE DATE...... : 08/23/1999 REFERENCE ID H ... : 99080175 SITE ADDRESS ... . . : 10100 MARY AV SUBDIVISION .... .. . CITY . . . . . ........ : CUPERTINO IMPACT AREA ...... . .OWNER . ........... : AVERY ET AL ADDRESS ........ . . : CITY/STATE/ZTP . . . : CUPERTINO CA, CA 95019-1502 CONTRACTOR . . . . . . . : FOLK, DIETER LIC # 20389 COMPANY .. . . . . . . . .: OLD COUNTRY ROOFING ADDRESS .. . . . . . . ..: 387 UMBARGER RD CITY/STATE/ZIP ...: SAN JOSE, CA 951112055 TELEPHONE . . . . . ...: (908)362-1111 FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE --------------- --- --------- ------------ ----------- BPERMFEE P 127.00 0.00 127.00 BSEISMICRE P 0.70 0.00 0.70 --------- ------------ ----------- 127.70 0.00 127.70 VOICE ID DESCRIPTION VOICE ID DESCRIPTION .. ............................ ........ ............................ FRAME 307 INSULATION O1 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 603 ROOF BATTENS 609 ROOF IN-PROGRESS