R 5025•
0
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OFFICE COPY
PE R- 5025
APPLICATION FOR CITY OF CUPERTINO NUMBER
INSPECTION DIVISION PERMIT EXPIRATION
REROOF PERMIT (408)777-.3228 PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 100 DAYS OF PERMIT ISSUANCE OR
ISO DAYS FROM LAST CALLED INSPECTION.
BUILDING ADDRESS
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p�
aN0•\�'U�()'CYL
RESIDENTIAL COMMERCIAL OTHER
OWN 'S
HAZARDOUS FIRE AREA
Y T� Q`� Vim()
YES ❑ If yes — I understand that a Class A
NAME _ Y V->
roof assembly is required.
NO ❑ Initial I.C.B.O. k
SGS �-
EXISTING ROOF COVERING
ADDRESS
NUMBER OF EXISTING COVERINGS
PHONE `� -J a
CONTRACTOR'S
NAME
O a 1 ��
TO BE REMOVED TO BE RETAINED
—t
-
ADDRESS
TYPE OF ROOF COVERING
CITY 8 ZIP Q.t,%`--(�
EXISTING
)
Q
PHONE—�^-� — \
BUILT-UP ROOF ❑
LICENSE
NUMBER
ASPHALT SHINGLES
L ENSEDCONT ACTORS DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
WOOD SHAKES ❑
7000) of Division 3 of the Business and Professions Code, and my license Is in lull force and
effect,
License Claes_ �^ Lic. Num
WOOD SHINGLES ❑
OTHER (SPECIFY) ❑
Date Contract
PROPOSED JUL 31 1996
OWNER-BUI-DERDECLARATIO
hereby affirm that I am exempt from th Contractors Licena Lew for the following reason.
(Sec. 7031.5, Business and Professions C e: Any city or county which requires a permit to
construct, alter, improve, demolish. or repair ystructure, prior to Its Issuance, also requires the
applicant for to file he is licensed
BUILT-UP ROOF CI I Y ur i Z
such permit a signed stet ant that pursuant to the provisions
of the Contractor's License Lew (Chapter 9 ( mencing with Section 7000) of Division 3 of the
-
crt I BvU
Business and Professions Code) or that he. met therefrom and the basis for the alleged
ASPHALT SHINGLES
exemption. Any vleatlon of Section 70 1:5 by applicant for a permit subjects the applicant to
a civil penalty of not more than Ilve'tiu cited' i he 15500).):
❑ I, as awnerofthe
WOOD SHAKES ❑
prepeny,ormy a wlip wages as their sole compensation, will do
the work. and ins strucbi