00070152CITY OF CUPERTINO •.
CONTRACTOR INFORMATION:
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BUILDING DIVISION PERMI•-V
.. BUILDINGAIIDRESS: :•."
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PERMITNO.,
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OWNER'SNAME:.a,
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APPLICATION SUB DATE
1,11061 2-,' CANYON VISTA DR
ROYAL ROOFING. "
¢0070152:,,.
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SANITARY NO: .;.' CONTROL NO.
WEST RUTH E
r, .1345 VANDER WAY
07/c,4/20Qi0
ZO ARCHITECT/ENGINEER: i`
: yBUILDING PERMIT INFO
'I'PLUMH
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- (408) 279-2332 BLDG ELECT MECH
LICENSED CONNI ACT UR'S DLCLARArION{
''Job Description
I ncrenyalrl'm that local Tenseduleerprov sensof Cnapt, 9(coincmng.
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ofihe Bu dP f me Co2dc uWmJ fee-
wduS I 71)gqf�!D"Ia/�
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San full force a nI
• Cless _�
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J DYIe CeECLLAr
1 dr,mndnlyplan, hill be used spublicme she -':
'.: - , HOT'HOP TOSAME
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zLicensed l - f . I
OWNER -BUILDER DECLARATION
Ili by ff NII' contain form II C 1 If License Le.
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NALED
y , follo g (Section 70315 Ru nnesInd1 f,:' Code Any ten .... tn�
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w"'t,uI m- J Ili p Y I Imre
hi h q' Far
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- prn I I I. y Ir th IPI' If hp --u 11 'g d,tmement
t. Floor Area -'
Valuation'f.•'
' "'m 'a en._dp reu(Chart"9'
(con g 'thy t 7110Ip fD"' 3 flh Hu.'n- nl Pn on, Code)
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orih t he's en pl 0 e from ,Ind the basis for the alleged c npi on. Any vfolaron
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ofSeel nn 7011 5 by,an PPI' jaw IM1e aPPI' a I l dvil penally
nt On,,W I h of
nn, nitre ma I live n a a Ihtrc (sslyd)
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PN• Number -
BUILDING
- ' Occupancy Type'
- p 1, os ooncm of the prop •ty writ y employ es W lh wegw oa lh ompen i lion,
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ai36mm"
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Required^Inspections
will J IM1 k an I th 'II I. I t' dal ff ed for evle f5en
a,, ,,Pr f:. to
ply In
list I',property
p tyWh b Id. p II d h J kh' Iif
-mprnum
e 35628040.00'
oflhrough tis non er 11 yees. pnrvldW IM1 I . II. a nuc nwldcd or
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offered f s If H e u Ili h I I'ng or impnne nem'." I I ll' Ie ye ,f
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I' th b dd II have the burden of Prov ng that h did rtm build
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Aompl
mro for par neae or I.). -
,-305-=' FRAME a-:'.,r.,t •.r
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x307. — TNSLILAT I ON •—
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rsca I ll 1 1. l (S 7Utd thinness d P b . L d) T CmI t r:
License Law I l apply I I proppAy ch. b Td. 'in,meast th-, t
601 -- ROOF TEAR, OFF
and h t I: f u pmlale with ntmcmgx) licensed I n to Ili
Com I c Law.
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p,0' — ROOF 'PLYWOOD, NAIL'
O1 ctoplaIdem Sec . BR'PCfonthi,s u m
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607 ROOF BATTENS"
wDate
ner
WORKER S COMPENSATION DECLARATION
fT
',.604'•-. ROOF'TN—PROGRESS
•I herehy afi rn drpenall,ofpaj y nitthe Boil yd lamtiese
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I h d `II onl,lIu certificate 'If Coal I li sII s�-f W k'
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Conpmetmn ,s prm i,'d I& by Spin n 37f10',1 the Ubu, Cud,, for Br.
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perf - 'of the work for which this pe ft I. eumd.
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❑Ili d will maintain Worker's Compensation I: - -larel by Seton-
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37k) of the E,hcr Cod fnr,,hc perl'or„ner oflhe work for which thisPermit is
- 'f •, - ty ,
issued Nfy W rrker. G p d i I ra r and Pul y h
nl,
C'ur'r- jPJ'ie' Policy Na
CERI'1'[CAIION OF EXEMPTION FROM WORKERSIaNS•,
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INSURANCE
(TI section read tbecorpleand Linep t is I hundred dl1
($IOU) or least
n '
I f1Ya t' II p f fll kr xl lh p I': ':: d i
♦ tI Is ,' a
shell nor aniany , Y mourcer so us to been in u tt ❑in Workers
Cone p I L fC li Data - r
An
f "•
s
Applcam -
NOT ICL TO APPLICAN d:If. ft union,fit C,nimitalue ol fiveramion, yea 1 Id ,
l a 1 - i
become subjeat tire Worker Comp,reeti prior . fthe Labor Code, you must
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forthwith i ly vollf such pI this Patout Il li d drevoked.
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CONSTRUCTION 1 FNDINC AGENCY
o 1 hereby Glint, [Lot there I t ndng age ) f ❑ peflorican,a,
if the work for Inch this permit s. ned(Sea 3097, Cid C)
Ledc 'Nonial
Leader's Addess
yI certifyInduct Ihave mind this a"i l del ,h nh b f l
-
cor r tel 8 t P1, Ili II 'ty d ly d d.l t I I l g
to building eonslNemmand hereby larthurisc raptea naives,f this city t, enterport,
- -
ll han, as
lhc h f r,ol I ryf r .p o
,
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y (W)g t: Indemnify dkeep l less the City fGlrt against
n drflhj lilies judgnens,t sts and enle.ee '[itch nWy'l any ;leers, against:aiJ
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e , -
City In umvequela of the gra nmg of thle pmon
APPLIC ENDERS T DSANDWILLCMPL WrrH ALL NfyG PGfyf
EOULATI , �j�/ �
Issuedb Date `
Y
- Re -roots
Sig r,nfApplies /Con ,elm Dae -
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HAZARDOUS MATERIALS DISCI OSUkE I
Will flat'a,pleadon funar, building 11-ammu.1 i art dl d material
Type of ROOF
;is Refined by the Cupertino Mm'cipal Code, Chapter 9.12, and the Health and Safety.
•
Code. SiteI' 235321n? , I I_
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°V-,-, 9"° '
All roofs shall be inspected prior to Hity roofing'material being installed` 1"
Will (be applicant or ficampe buildna, nn. t :e a,mr I erd .'whin
If a roof is installed without tid st'olitainmg an inspection, I agree to remove -
7nilbrad ,m fume, a, deflW by ,] ay Arco A' Quality Mamgenmu
imrlc is
'
all new -materials for,inspectlon.'•Applicant understands aridl,will comply with
-
r ❑,Yca_v - s' 'ONot
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all non 'ntsourceregulationS.' - - " "
I I d Ili h /aM I: I 9 n: order Ch pt C 95 or the
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Calif..,. Health Safety Code Stations 25505 125534 d .I d Ilial
n-aC fry
�� 212
if t s o t it is Y P 11
a, I Ian prior
d,lh biddingJ t which
Import fIM1 requirements h h ail be ,p'or to sa f' C rfilc t f
'
captaincy . ^
Sf�nature of Applicant s• - t Date,
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' -All roof coverings to be Class B" or better ) ;o-•
Ob, Dale
per I authorized agent,
.,