99100042 101F]UPLIGAI It
CITY OF CUPERTINO
BUILDING DIVISION PERMIT CrON`LRAGTQRTIV 'ORIATTO
BUILDING ADDRESS: RENAISSANCE ROOFING CO INC PERMITN.59100042
OWNER'S NAME: PERMIT ISSUE DAIS
ONE: SANITARY 0. C OL N0.
ARCHITECnENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
p
YDO LICENSED CONTRACTOR'S DECLARATION Job Descri tion
y�+� 1 thereby affirm Nat 1 am licensed under romnsione of Chapter 9(commencing p
with Section]0110)of Division 3 of Ne Business and Pm(eWau Code.and my license is
I.full to.and affect. ASPHALT SHINGLES TO SAME
S g a License class Lac.g
Dau Corer
ARCNDECI'S DECLARATION
I understand my plana shall Is,used as public mord,
iLicenced ProfrsJonal
OWNER BUILDER DECLARATION
I krchy.(Seco Nat I amI. exempt from dta Contranoo Lima Law for tk
p O fallowing moon.(Saito]031.5, 1.WWI.s and improve,
d situs Cade:Any city m county
$ which requires a purert mltd.m 4 alter.h^pmw,kmmah,m repair any structure
�^ priomiulsrrood t,Jaortquifre Novisiosofthe Con Actor's Eta ense Law ftstamenl Values[on
F$ O NJk lsllttusw purwam loth)of
Diaion of the Contractor's r'Wcenalaw ;Code)9 Sq.Ft.Floor Area
6 6 g (commencing with Section mfmm andl the
of al alleged
and Proon.My
Code)or
Net k u ewnpl tkrtlmm and rite halls far tk Jlegw tamptia.My violation of
Section 7031.5 by any applicant for a permit subjects Ne applicat On a civil penalty of 3.3404MLOW410 Occupancy Type
am more Na 0w hundred dolWa($500).
❑I.u awrtaraf the property.a mY employbu WIN wgus u dte'v al)compenstion,
and dotkwons soda: its Como tar's LMmse Law dolor apply
an
Business Required Inspections
and professions he Cade:Tits Improve,
manna Liana law don oat apply lf an owner of q p
Ducreywho bull ro or iml0.1 suHereonandwho aces ruche nkhimmifellInt ude his
own employees,pmWded Nal such impmwmats art oat you
araResw Intrude.
however.the building orimprowmatiscold did oro Weld of comp for Ne owner.
of
me.).
will have dta burden of proving that k did not build or improv(a purpose of
ssle.). )
❑LdeOwner ofct property.am(Sec.
Business
contracting with:)Thudmrtl ream
cmuwet tk project(Sec.]nano owner
of and y who sal Cade:)Thu Con amern. nd
Ll-
sou law dote not apply je an owner of propesty who builds or Improves Norton.and,
whoacu for such projects with a conumacr(s)licensed Duruunt m IM Contractor's
0License1 Last.
on exempt undo See .B d:PCfor Nb recon
Owner Data
WORKER'S COMPENSATION DECLARATION
1 Wrathy dfnm under penally of perjury one of rite fallowing declaoofon:
1 kat and will maintain a CeniOau of Consent to self-insum for Workers Cmopm-
sstion,u provided for by Suetion 3700 of We Lmor Cade.for the performance of the
work for which off permit Is ismad.
❑I have and will maintain Waken Camp mutton Inurace,a required by Section
3Tnn Of the Labor Code,for the perfnfaace of the work fm which this permit Islami.
My Worker Compenfldion Insurance cams end Polity numkr art: ,
Carries: Policy No.:
CERTIFlCAT60F EXEMPnON FROM WORKERS'
COMPENSATION INSURANCE
Olds cation rad not k completed if lk permit Is fmane hundred dollua(x100)
or lna.)
I certify Nat in Ne perfmmaae of On work for which Nis pesmh a Issued,l shall nm
employ any person i^any manner w a m become subject m Ne Woken Compensation
laws of caltfomia.Data
Applicant
NOTICE TO APPLICANT:If,after making this Cenifiuu of Exemption,You should
haeme mbjas m Ne Workers compensation provision of We,Taker Coda,you mute
z
forthwith comply with such Noorka a o this permit Mall k domed revoked.
ZO CONSTRUCTION LENDING AGENCY
j—r Ihereby affirm that then is a construction lending agency fm the Performance of
C> dta work for which Nis Demur is Issued(Sce.3097,Civ.C.)
W Q Lenders Name
z Lender Address
V I certify dot 1 have read ba appik.d^n and sou Na the shoos information is
W corrta I agree m comely with Al city and county ordinances and soon laws relating to
O buildingWe)areetoandhademniyoiw rtpma^utirsse Niacitymemesupnr N)
W anchy a.
W.-mendonw property for inpeeion purposes.
Cn (Wc)acmemsew.indemnifylddkeep lannices,in my
wCityofe againstclfor dWut
rn Ilabilitia,judgmenu.casu adexpensa which mayuany wyacera against sold City
Uz Nconsequence ofthe flooding ofthis permit. Date
t.r APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NOWPOINT Issued by:
SOURCE REGULATIONS.
Re-roofs
` Signervre al'AppliwnUConuacmr Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or futum building occupant store Of handle hate dous matadal
as dell^)d by tk Cupenla MunieipJ Code,Chapter 9.11.sad Ne HCJN and Safety
g0LCoW,Satiaa25531(W7 All roofs shall be inspected prior to any roofing material being installed.
OYn ON.
If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant of future Wilding Occupant tea equipment or devices which
fall hazardous air contsminats re defined by the Bay Area Air Quality Mangcmcm - all new materials for Inspection.
Danct7
❑Yn ❑Nu
1 have read the hazardous materials Wen imo ew under Chapter 6.95 of the Califor.
nia Health A Safety Cook,Sections 75505,15533 and MIN.1 undersmw Nu if the building
dos not comendy haw a tenant,dad it h my nnponcihility to amity the aapent of the
requirements which muck met poor to issuance of a Ccmrwau of Occupancy. Signature Of Applicant Date
Owner or authoovad agem Date All roof coverings to be Class"Bir Or better
PERMIT
APPLICATION FOR CITY of CUPERTINO NUMBER
INSPECTION DIVISION PERMIT EXPIRATION
REROOF PERMIT (408)777-3228 PERMIT EXPIRES IF WORK IS NOT STARTED
WITNIN 180 DAYS OF PERMIT ISSUANCE OR
1W DAYS FROM LAST CALLED INSPECTION.
BUILDING ADDRESS
ADDRESS/'' L
V-16 (� U y„ r✓l� RESIDENTIAL COMMERCIAL OTHER
OWNER'S HAZARDOUS FIRE AREA
/ YES C3I(yes—I undeaYend that a Clew A
NAME�`�/� /%U-e,// roof assembly is required.
NO ❑ Irdgal LC.B.O.Y
ADDRESS 2/ I// C0.4, yr 1140 a,rC- EXISTING ROOF COVERING
PHONE NUMBER OF EXISTING COVERINGS
CONTRACTOR'S
�
NAME (SSC[lg1cR r[�ITO BE REMOVED TO BE RETAINED
. /leHS•kl'�ci
ADDRESS )) TYPE OF ROOF COVERING
CITY a ZIP —�(Iz
/�Y� EXISTING
r PHONEIS� - to 9 Z BUILT-UP ROOF ❑LICENSE
-
NUMBER S9 X3.6 ASPHALT SHINGLES
LICENSED CONTRACTORS DECLARATION
I hereby affirm that I am licensed under provlelans of Chapter B(cormtenclrg with Section WOOD SHAKES
]000)of Division 3 of me Business and Proleeabm Code,and my license is In full force and
effect. 7n7 3 WOOD SHINGLES v
license GLIC
Class�J 7� .Number L
Date /n- -� Contractor OTHER (SPECIFY) D L
DI CL
OWNER-BUILDER RA OCT 7 1998 I
hereby affirm that am exempt hem the DeeCommodes License for the Idbwing mason. PROPOSED J
(Sac.1031.5,9usmeas and Professions Coda: A"city or county which requires a par of to
construct,alter,'rnprb%ar,demamh,or repair any structure,prior to is Issuance,also requires me BUILT-UP ROOF ❑ '
applicant Nor such permit to Iib a signed statement that he Is Ilcereed pursuant to the provisions B
at the Cantmctors license Lax(Chapter a(oormpnc ng with Section 1000)of Division 3 of me Y
Bustrass and Prolesalons Code)or Chet he Is exempt therefrom what me basis for the alleged ASPHALT SHINGLES
exemption.Amy violation of Sectim 1031.5 by any applicant for a permit turtimm the applicant to
a chrif penalty of not mare than five hundred dollars(5500).1:
01,as owner of the property,or my amploeas with wages as their sale compensation,will do WOOD SHAKES ❑ '
the work,and me structure is net Intended or offered for sale(Sec.104,1,Business am:Proms-
ams Code The Contractors License Law dose net apply to an avmer of property who builds or WOOD SHINGLES ❑
Improves thereon,and whe each work
o doshimself or through his own eme,provided mat
such Improvements are not intended or offered far sale.If.however,the aciading or Improvemsat
issoid witNn am year of completion,the owner-builder will have me burden of proving that he did OTHER(SPECIFY) ❑
rot build or improve for purpose of pale.).
❑I,as owner of the property,am excluslvey contracting Man kanaed contractors to conatnrct
the project(Sec. Business and Professions Code:The Contractor License Lew don,not PROVIDE I.C.B.O.REPORT NO.
apply to an owner of property cots builds or Improves thereon,aral wi o contracts for such prolects
with a contract«(e)lioemed pureutat to the Cohtrmlor i License lay. PROVIDE MFG R. INSTALLATION SPECS.
❑1 am exempt under Sec. ,B 8 P.C.for mill maul
Owner Date APPLICATION DATE VALUATION PERMIT FEE
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penally of perjury one of the following dedamibn: / r
as pr Ivied have br by will
3]00 Certificate
the LatbeoorlCoce for the performs a ohnew ,k fo rs Bhich Mi Building
permitsissued. Seismic �Q
pt I.have and will themaintain Workers Cope work
Insurance,cthis as requiredsu d.My 3]00'S l \ l
the bon of
Cotle,for the pedartrance of the work for which role permit is Issued.My Workerp / 2 7r /1y O
CompaneaAtlon Im_urerse caller e00 Policy nufnWr are: Tota J b
Camier 1/rC'aI xtY/Jre�tl/-PSrTIIo)!) pa.I'Yka� PERMIT AUTHO IZATION DATE
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE neN.CI]
(This section ed not be cocpletm II the permit s ro h
for one dollars(5100)or less.) >y'
I certify that In the performance of the work for which this permit Is Issued,I shall not employ
any person In any manner so all to become subject to the Worker •Cora"ahatlon taus of Cell. All roofg shall be inspected prior to any roofing material being
fornix. installed. If a roof is Installed without first obtaining an
Data /o'X97 Applicant inspection,I agree to remove all new materials for inspection.
NOTICE TO ARROGANT: If,atter making this Cert a xemptlm, u should become Applicant understands and will comply with all non point
subject to the Workers'Comsforthwith masemn prrnions of the or Code,you must fowith comply
with such provislons or this permit shall be deamed revoked, source regulations.
I certify that I have read this application and state that the above Information Is correct.I ogres
to comply with all dry and county ordinances and sista laws relating to clutc ing construction,and All roof CO Ed s O be CIaSA 'Or better
hereby authorize representatives of ms city to enter upon the above mentioned praperty for In.
speclion purposeo. G
(We)agree to save,Indemnity and keep harmless the City of Cupertino against liabilities, O'
judgments,costa and expenses which may In any way accrue against said Cly in consequence
_ of me granmq of rola perms. SI AT O LICA DATE
RE-INSPECTION: PLYWOOD: IN-PROGRESS:
�y INSP. DATE INSP. DATE INSP. DATE
TEAR OFF INSPECTION: BATTENS: FINAL:
INSP. DATE INSP. DATE - INSP. DATE
NOTE: OSHA APPROVED ACCESSTO ROOF SHALL BE PROVIDED FOR INSPECTION
OFFICEICOPY
INVOICE. INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO
. BUILDING PERMIT INVOICE OPERATOR: chrietya
mw
Sec: Twp: Rng: Sub: Blk: Lot:3561833.00
INVOICE DATE...... : 10/07/1999
REFERENCE ID H ... : 99100042
SITE ADDRESS . . . . . : 21641 COLUMBUS AVE
SUBDIVISION . ...
CITY ........ . . . . . : CUPERTINO
IMPACT AREA . . . .. ..
OWNER ....... . . . ..: DOELL
ADDRESS ..... . . ...:
CITY/STATE/ZIP ...: CUPERTINO, CA 95014 '
r CONTRACTOR .......: DADDARIO, STEVE LIC k 20739
COMPANY ... .......: RENAISSANCE ROOFING CO INC
ADDRESS . .........: 2292 LINCOLN AVE
CITY/STATE/ZIP ...: SAN JOSE, CA 95125
TELEPHONE ........: (408)448-0697
FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE
---- --- ----"'-- ------------ -----------
BPERMFEE P 137.00 0.00 137.00
BSEISMICRE P 0.80 0.00 0.80
--------- ------------ -----------
137.80 0.00 137.80
1' ID DESCR=PT ION VOICE ID DESCRIPTION
FRAME 307 INSULATION
ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
603 ROOF BATTENS 604 ROOF IN-PROGRESS
_'r
CITY OF CUPERTINO
I� } of 1 BUILDING PERMIT RECEIPT OPERATOR: nancyc
COPY $ 1
Sec: Twp: Rng: Sub: Blk: Lot:3561833.00
DATE ISSUED....... : 10/11/1999
RECEIPT 4. ........ : 10286
REFERENCE ID # ... : 99100042
SITE ADDRESS ..... : 21641 COLUMBUS AVE
SUBDIVISION . . .... .
CITY .. . . . .. ...... : CUPERTINO
IMPACT AREA . ..... .
OWNER . . . . ........ : DOELL
ADDRESS . . ........ :
CITY/STATE/ZIP ... : CUPERTINO, CA 95014
RECEIVED FROM ....: TIM
CONTRACTOR ....... : DADDARIO, STEVE LIC R 20739
COMPANY . . ........ : RENAISSANCE ROOFING CO INC
ADDRESS . . .. ...... : 2292 LINCOLN AVE
CITY/STATE/ZIP ... : SAN JOSE, CA 95125
TELEPHONE . ....... : (400)440-069]
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW DAL
BPERMFEE VALUATION 8,000 00 137.00 0.00 137.00 0.00
BSEISMICRE VALUATION 8,000.00 0.80 0.00 0.80 0.00
IsPERMIT 137.80 0.00 137.80 0.00
OF PAYMENT ___� ______UNT NUMBER
-- ------- _______
CHECK 137.80 16247
------------
TOTAL RECEIPT : 137.80
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
........ ............................ ........ ............................
305 FRAME 307 INSULATION
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
603 ROOF BATTENS 604 ROOF IN-PROGRESS
r
101F]UPLIGAI It
CITY OF CUPERTINO
BUILDING DIVISION PERMIT CrON`LRAGTQRTIV 'ORIATTO
BUILDING ADDRESS: RENAISSANCE ROOFING CO INC PERMITN.59100042
OWNER'S NAME: PERMIT ISSUE DAIS
ONE: SANITARY 0. C OL N0.
ARCHITECnENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
p
YDO LICENSED CONTRACTOR'S DECLARATION Job Descri tion
y�+� 1 thereby affirm Nat 1 am licensed under romnsione of Chapter 9(commencing p
with Section]0110)of Division 3 of Ne Business and Pm(eWau Code.and my license is
I.full to.and affect. ASPHALT SHINGLES TO SAME
S g a License class Lac.g
Dau Corer
ARCNDECI'S DECLARATION
I understand my plana shall Is,used as public mord,
iLicenced ProfrsJonal
OWNER BUILDER DECLARATION
I krchy.(Seco Nat I amI. exempt from dta Contranoo Lima Law for tk
p O fallowing moon.(Saito]031.5, 1.WWI.s and improve,
d situs Cade:Any city m county
$ which requires a purert mltd.m 4 alter.h^pmw,kmmah,m repair any structure
�^ priomiulsrrood t,Jaortquifre Novisiosofthe Con Actor's Eta ense Law ftstamenl Values[on
F$ O NJk lsllttusw purwam loth)of
Diaion of the Contractor's r'Wcenalaw ;Code)9 Sq.Ft.Floor Area
6 6 g (commencing with Section mfmm andl the
of al alleged
and Proon.My
Code)or
Net k u ewnpl tkrtlmm and rite halls far tk Jlegw tamptia.My violation of
Section 7031.5 by any applicant for a permit subjects Ne applicat On a civil penalty of 3.3404MLOW410 Occupancy Type
am more Na 0w hundred dolWa($500).
❑I.u awrtaraf the property.a mY employbu WIN wgus u dte'v al)compenstion,
and dotkwons soda: its Como tar's LMmse Law dolor apply
an
Business Required Inspections
and professions he Cade:Tits Improve,
manna Liana law don oat apply lf an owner of q p
Ducreywho bull ro or iml0.1 suHereonandwho aces ruche nkhimmifellInt ude his
own employees,pmWded Nal such impmwmats art oat you
araResw Intrude.
however.the building orimprowmatiscold did oro Weld of comp for Ne owner.
of
me.).
will have dta burden of proving that k did not build or improv(a purpose of
ssle.). )
❑LdeOwner ofct property.am(Sec.
Business
contracting with:)Thudmrtl ream
cmuwet tk project(Sec.]nano owner
of and y who sal Cade:)Thu Con amern. nd
Ll-
sou law dote not apply je an owner of propesty who builds or Improves Norton.and,
whoacu for such projects with a conumacr(s)licensed Duruunt m IM Contractor's
0License1 Last.
on exempt undo See .B d:PCfor Nb recon
Owner Data
WORKER'S COMPENSATION DECLARATION
1 Wrathy dfnm under penally of perjury one of rite fallowing declaoofon:
1 kat and will maintain a CeniOau of Consent to self-insum for Workers Cmopm-
sstion,u provided for by Suetion 3700 of We Lmor Cade.for the performance of the
work for which off permit Is ismad.
❑I have and will maintain Waken Camp mutton Inurace,a required by Section
3Tnn Of the Labor Code,for the perfnfaace of the work fm which this permit Islami.
My Worker Compenfldion Insurance cams end Polity numkr art: ,
Carries: Policy No.:
CERTIFlCAT60F EXEMPnON FROM WORKERS'
COMPENSATION INSURANCE
Olds cation rad not k completed if lk permit Is fmane hundred dollua(x100)
or lna.)
I certify Nat in Ne perfmmaae of On work for which Nis pesmh a Issued,l shall nm
employ any person i^any manner w a m become subject m Ne Woken Compensation
laws of caltfomia.Data
Applicant
NOTICE TO APPLICANT:If,after making this Cenifiuu of Exemption,You should
haeme mbjas m Ne Workers compensation provision of We,Taker Coda,you mute
z
forthwith comply with such Noorka a o this permit Mall k domed revoked.
ZO CONSTRUCTION LENDING AGENCY
j—r Ihereby affirm that then is a construction lending agency fm the Performance of
C> dta work for which Nis Demur is Issued(Sce.3097,Civ.C.)
W Q Lenders Name
z Lender Address
V I certify dot 1 have read ba appik.d^n and sou Na the shoos information is
W corrta I agree m comely with Al city and county ordinances and soon laws relating to
O buildingWe)areetoandhademniyoiw rtpma^utirsse Niacitymemesupnr N)
W anchy a.
W.-mendonw property for inpeeion purposes.
Cn (Wc)acmemsew.indemnifylddkeep lannices,in my
wCityofe againstclfor dWut
rn Ilabilitia,judgmenu.casu adexpensa which mayuany wyacera against sold City
Uz Nconsequence ofthe flooding ofthis permit. Date
t.r APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NOWPOINT Issued by:
SOURCE REGULATIONS.
Re-roofs
` Signervre al'AppliwnUConuacmr Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or futum building occupant store Of handle hate dous matadal
as dell^)d by tk Cupenla MunieipJ Code,Chapter 9.11.sad Ne HCJN and Safety
g0LCoW,Satiaa25531(W7 All roofs shall be inspected prior to any roofing material being installed.
OYn ON.
If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant of future Wilding Occupant tea equipment or devices which
fall hazardous air contsminats re defined by the Bay Area Air Quality Mangcmcm - all new materials for Inspection.
Danct7
❑Yn ❑Nu
1 have read the hazardous materials Wen imo ew under Chapter 6.95 of the Califor.
nia Health A Safety Cook,Sections 75505,15533 and MIN.1 undersmw Nu if the building
dos not comendy haw a tenant,dad it h my nnponcihility to amity the aapent of the
requirements which muck met poor to issuance of a Ccmrwau of Occupancy. Signature Of Applicant Date
Owner or authoovad agem Date All roof coverings to be Class"Bir Or better