01040034 „ CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10807 E ESTATES DR GROMO ROOFING COMPANY 01040034
OWNER'S NAMIi, APPLICATION SUB DATE
KATHY CHEN 1.21 W WASHINGTON AVE 04/09/2001
1`IIONG: SANITARY NO. CONTROL NO.
(408)746-2075
z Y ARCHILECTlENGIN1iER:
O O BUILDING PERMIT INFO
ss t❑F�
BLDGELECT PLUMB MECH
O 5 y j LICENSED CON'TRACTOR'S DECLARATION
= l teeny m imm teat l am licensed under pm,a,lons of Chapier v(commencing - Job Description
F.0 with Section 70tk0 of UivisionJof the❑usinos and Professions Neandmylieense
<x � mmmne+reeana set 33h 3 TEAR—OFF SHAKES
O n F llatc (pf —— Cunmanor �1 ”
�aLLH ARcu1TEC1gD1:c1OAR INSTALL 30 YR. SHINGLES..
`z I S I undcmnnd ni Plans shall he orad ux pohla,records '
c;88-1 O O Licensed Pmfecsiomd
OWNER-BUILDER DECLARATION
I 1 hereby uffrn in.,I am eaempt from the Contractor's License Law far the
F-te 6 following rtavm.(Section 9031.5,Rudnea and Pmfesxions Code:Any City or county
F❑ ,blah requires a permit to construct.aper,improve,demolish,nr repair any structure
iB= pnorto its issume,alo requires theapplicmn forsuch permit to file usigncdsumemeat
that he is licensed....'xoom,,the prevision,of are Conmhdors Licanxe Law(Chant 9 S Ft. Floor Area
ce+threading With Seelm17oB(uafulmieiml3orOne Bnsinexsnm+IPmfa,slon,Coda) q' Valuation
o that he is exempt therefrom and the basis far the allegetl.xemplion.Any violation
of Section ren 5 by any applieamr for a pc.oil.objects me applicant to a civil penalty
of..,more Old.file hundred dollars($50B. APN Number _ Occupancf$�pM0
D 1,as awact
of the pr,penb ar my emp)oyee,with wages as tbeirsale rompereanion,
will do the xrrk.:ntd the srueture is not intended or offered lin sale(Sec.7W4,
Emirs,and Prnfesxionx Code:The Cannot, r s License Law docs am apply,o eco - 369220] ft(o0ed Inspections
r of ptalwny Who builds or improve,there...,and who dose,,,od,work himself
-11.0
hu awn vnpluyces.provided'hat such an's."i, ems tau not Intended or
- offered for sue.IL however,the building or impruvemem is sold within One year it
campl=tion, haewncrhuilderwHlhave the burdenafprovingthathedid mobuild ar 31715 — FRAME
improve far purpose of sated.
❑1.a,—act or the properry.am exclmevmy commni.g with licensed commcmrs m 307 — INSULATION
.aname he project(Sec.7R4,B.dnass and Prefeslam,Cube:)The Commcmrs 601 — ROOF TEAR OFF
theme Law owe oat apply m no owner It popery sena mann.or(,sprats,thereon,dhe 64 2 —` ROOF PLYWOOD NAIL,
aced Who comms,Tar xnsh project.said,tI co.,ramara)1i.<I,aca parxnum m ms �� .
Cnntadm'x Licata"Lnw.
'01 ton aaempt andel See ,0 Re P C lor,bis re,,an 603 — ROOF BATTENS
own== Dat=
WORKER'S COMI•IiNSA'1'ION DECLARATI(3N 604 — ROOFPROGRESS
I reach,liffirent under penalty of eiryaryon,of,he pollovshn,Je tans
❑ 1 have ,,at v,11 madoosm a CarldrIcall ot Consent m. ,nom fee Workers
Cm n' I r+ l f by Sccl L 39th) d ren I'1 r Coca, for ,hc
u c ��
Iwrl m f the a Work I h it n hitt:pa t' �. d. - -
❑1 h J ill maintain Worker's .:C ape t Insurance.asrecored by Sceuon C7
37M of the UAW,Code,for the performance of,he work for which this pavan is
issued.My Wtakker,^Comp owition Insurance carrier
�a_add—fPenl�icZnnu�mhar ml
Cartiee�(�a IOL—
' Polly,Na
CIH lI4CAT10N OI'l : FROM WORKER e KER
CUMPENSA9IUN(he a 9
ece/
(This stion I¢eJ not he completed it the perm n h rerx dha
Iesx.)
I Cavity 1112L in the performance of the work for which this permit is issued.1
%hall not employ any Person in any manner xn nit to become,object to the Worker(
Compensa,icn Lu of Califomia.Data
Applicant '
NOTICE TO APPLICANT:If,a0cr making this Cenifienm nl Bxenptiun,you should
beem suhjenet to the Wndsrn Comm
pcnsun,pm ,hm
v s of,ne I,uM1nr Cale,You mull
ZZ �
O I'unmhw ire comply with such provisions to this permit shall he deenmd revoked.
(• h CONS them iCf10NLANDING AGENCY
� > 1 hereby%hirm that them ixs ttmed scs, lending agency for the performance
ryt of the work for which this permit is ixumJ(Sec.3(197.Civ.C.1
L ❑ Lender's Name
z LenJecLC Address ,
:.1 1 c olfy malt I hale'I'd this applicntinn and.tam mut Ire uMv..inOmnaion is '
;iW correct.I agree to comply with all city and County nrdlnam es and sate laws relining
Q f) to building connmction,and hereby mailable representatives of Thin city to enter civil
D7 the above mentioned Pmpeny for inspection purposes.
F. L (WO)rime b+saw,indemnify and keep ham,less NC City of Cupeninn agaimt '
01 liabilities,judgments,ensu and expenses which may in any way neem,against said , l
C.1 Zi CRP in CANT of the gamt
granting of this permi
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-MINT 7
SOURCEVULIATICNS. ' „ Issued by: Dale
n,mmd"Txpp`�nuconmemr T' Data Re-roofs
I1A%A RDOUS MA'1'IIIf IA1 S DISCLO SURIi
de, ,I fuare Wilding Occupant store or handle hacvdm,s material Type of Roof
as darned by the Cuperino Municipal Core,Chapter 9.12,sad the Health sad Safe, ..
Csde.Seninn 25512(a17
°vex 0N All roofs shall be inspected prior to any roofing material being installed.
Wi l l the applicant of mute had Eding OCL ulmnwae equ iptncm or devices wn'Iel, If a roof is installed without first obtaining an inspection, 1 agree to remove'
omit to zadom,air unnlnminnmx 11 ddlncd by he Bay Area Air Quality Manage em
Piano?ass . ON. _ all new materials for inspection. Applicant understands and will comply with
all non-point source regulations.
I have read the locomesh.,materials requirements under Chapter 695 of the
Califomia Health d Safety Code Sections 25505,25533 and 25534.1 umdemard that 5 n /
if the Wilding dues mm curemly have a tewnL that it is my respmeibili,y m notify the -
acupam or the requirements which mux,be met prior to issuance of Cenificate of ��s..�!
cenp ney
nI�_n S! 9 m Sig store of Applicant Date
- -frrOrmalioi,ed.,a., Data All roof coverings to be Class"B" or better
OFFICE
„ CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10807 E ESTATES DR GROMO ROOFING COMPANY 01040034
OWNER'S NAMIi, APPLICATION SUB DATE
KATHY CHEN 1.21 W WASHINGTON AVE 04/09/2001
1`IIONG: SANITARY NO. CONTROL NO.
(408)746-2075
z Y ARCHILECTlENGIN1iER:
O O BUILDING PERMIT INFO
ss t❑F�
BLDGELECT PLUMB MECH
O 5 y j LICENSED CON'TRACTOR'S DECLARATION
= l teeny m imm teat l am licensed under pm,a,lons of Chapier v(commencing - Job Description
F.0 with Section 70tk0 of UivisionJof the❑usinos and Professions Neandmylieense
<x � mmmne+reeana set 33h 3 TEAR—OFF SHAKES
O n F llatc (pf —— Cunmanor �1 ”
�aLLH ARcu1TEC1gD1:c1OAR INSTALL 30 YR. SHINGLES..
`z I S I undcmnnd ni Plans shall he orad ux pohla,records '
c;88-1 O O Licensed Pmfecsiomd
OWNER-BUILDER DECLARATION
I 1 hereby uffrn in.,I am eaempt from the Contractor's License Law far the
F-te 6 following rtavm.(Section 9031.5,Rudnea and Pmfesxions Code:Any City or county
F❑ ,blah requires a permit to construct.aper,improve,demolish,nr repair any structure
iB= pnorto its issume,alo requires theapplicmn forsuch permit to file usigncdsumemeat
that he is licensed....'xoom,,the prevision,of are Conmhdors Licanxe Law(Chant 9 S Ft. Floor Area
ce+threading With Seelm17oB(uafulmieiml3orOne Bnsinexsnm+IPmfa,slon,Coda) q' Valuation
o that he is exempt therefrom and the basis far the allegetl.xemplion.Any violation
of Section ren 5 by any applieamr for a pc.oil.objects me applicant to a civil penalty
of..,more Old.file hundred dollars($50B. APN Number _ Occupancf$�pM0
D 1,as awact
of the pr,penb ar my emp)oyee,with wages as tbeirsale rompereanion,
will do the xrrk.:ntd the srueture is not intended or offered lin sale(Sec.7W4,
Emirs,and Prnfesxionx Code:The Cannot, r s License Law docs am apply,o eco - 369220] ft(o0ed Inspections
r of ptalwny Who builds or improve,there...,and who dose,,,od,work himself
-11.0
hu awn vnpluyces.provided'hat such an's."i, ems tau not Intended or
- offered for sue.IL however,the building or impruvemem is sold within One year it
campl=tion, haewncrhuilderwHlhave the burdenafprovingthathedid mobuild ar 31715 — FRAME
improve far purpose of sated.
❑1.a,—act or the properry.am exclmevmy commni.g with licensed commcmrs m 307 — INSULATION
.aname he project(Sec.7R4,B.dnass and Prefeslam,Cube:)The Commcmrs 601 — ROOF TEAR OFF
theme Law owe oat apply m no owner It popery sena mann.or(,sprats,thereon,dhe 64 2 —` ROOF PLYWOOD NAIL,
aced Who comms,Tar xnsh project.said,tI co.,ramara)1i.<I,aca parxnum m ms �� .
Cnntadm'x Licata"Lnw.
'01 ton aaempt andel See ,0 Re P C lor,bis re,,an 603 — ROOF BATTENS
own== Dat=
WORKER'S COMI•IiNSA'1'ION DECLARATI(3N 604 — ROOFPROGRESS
I reach,liffirent under penalty of eiryaryon,of,he pollovshn,Je tans
❑ 1 have ,,at v,11 madoosm a CarldrIcall ot Consent m. ,nom fee Workers
Cm n' I r+ l f by Sccl L 39th) d ren I'1 r Coca, for ,hc
u c ��
Iwrl m f the a Work I h it n hitt:pa t' �. d. - -
❑1 h J ill maintain Worker's .:C ape t Insurance.asrecored by Sceuon C7
37M of the UAW,Code,for the performance of,he work for which this pavan is
issued.My Wtakker,^Comp owition Insurance carrier
�a_add—fPenl�icZnnu�mhar ml
Cartiee�(�a IOL—
' Polly,Na
CIH lI4CAT10N OI'l : FROM WORKER e KER
CUMPENSA9IUN(he a 9
ece/
(This stion I¢eJ not he completed it the perm n h rerx dha
Iesx.)
I Cavity 1112L in the performance of the work for which this permit is issued.1
%hall not employ any Person in any manner xn nit to become,object to the Worker(
Compensa,icn Lu of Califomia.Data
Applicant '
NOTICE TO APPLICANT:If,a0cr making this Cenifienm nl Bxenptiun,you should
beem suhjenet to the Wndsrn Comm
pcnsun,pm ,hm
v s of,ne I,uM1nr Cale,You mull
ZZ �
O I'unmhw ire comply with such provisions to this permit shall he deenmd revoked.
(• h CONS them iCf10NLANDING AGENCY
� > 1 hereby%hirm that them ixs ttmed scs, lending agency for the performance
ryt of the work for which this permit is ixumJ(Sec.3(197.Civ.C.1
L ❑ Lender's Name
z LenJecLC Address ,
:.1 1 c olfy malt I hale'I'd this applicntinn and.tam mut Ire uMv..inOmnaion is '
;iW correct.I agree to comply with all city and County nrdlnam es and sate laws relining
Q f) to building connmction,and hereby mailable representatives of Thin city to enter civil
D7 the above mentioned Pmpeny for inspection purposes.
F. L (WO)rime b+saw,indemnify and keep ham,less NC City of Cupeninn agaimt '
01 liabilities,judgments,ensu and expenses which may in any way neem,against said , l
C.1 Zi CRP in CANT of the gamt
granting of this permi
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-MINT 7
SOURCEVULIATICNS. ' „ Issued by: Dale
n,mmd"Txpp`�nuconmemr T' Data Re-roofs
I1A%A RDOUS MA'1'IIIf IA1 S DISCLO SURIi
de, ,I fuare Wilding Occupant store or handle hacvdm,s material Type of Roof
as darned by the Cuperino Municipal Core,Chapter 9.12,sad the Health sad Safe, ..
Csde.Seninn 25512(a17
°vex 0N All roofs shall be inspected prior to any roofing material being installed.
Wi l l the applicant of mute had Eding OCL ulmnwae equ iptncm or devices wn'Iel, If a roof is installed without first obtaining an inspection, 1 agree to remove'
omit to zadom,air unnlnminnmx 11 ddlncd by he Bay Area Air Quality Manage em
Piano?ass . ON. _ all new materials for inspection. Applicant understands and will comply with
all non-point source regulations.
I have read the locomesh.,materials requirements under Chapter 695 of the
Califomia Health d Safety Code Sections 25505,25533 and 25534.1 umdemard that 5 n /
if the Wilding dues mm curemly have a tewnL that it is my respmeibili,y m notify the -
acupam or the requirements which mux,be met prior to issuance of Cenificate of ��s..�!
cenp ney
nI�_n S! 9 m Sig store of Applicant Date
- -frrOrmalioi,ed.,a., Data All roof coverings to be Class"B" or better
OFFICE