01040119 ITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
;IC
ILISING A13DRIi.SS: FERMI'f NO.
'1 -00 LUCILLE APTS 57 ROYAL ROOFING 01.0401,19
NF.R'S NAME: APPLICATION SUB DATE
PMENT CORP THE 1345 VANDER WAY 04/23/001
PHONE; SANI'1'ARYNO, CONI'ROI.NO,
(408) 279-1=332
MCO ARCHI'niCIB3,NGINFER: BUILDING PERMIT INFO
BLUG EL[Cr PLUMB MECH
N;C 1-1 I_I u 1=1
G I hereby aifinn,hm 1 am h cuad undo,n;�liq n,of IDN Job Description
y=' LICENSED CO p
Chapter 9(cmm�mncin�
:_w with Section]I«gB of DivinionJof the Bnzincss Lind Pmfasions Qdc.and mylici.
is in full,soonn6cff5,.l Lie.«_or 3�� RE—ROOF
a°LL H Date � _,O r enntraetn_:! . �<iw•. :3
- a shall
I?CTS DECLARATION
5 dersmnA Iffy Platt,shall M f )11 puh'RATION` !//
u_�} /7/
p!O Licensed Professional
°'c OWNER-BUILDER DECLARNHON
'-" I hereby alArm that 1 um exempt brain the Contractor's Liccnm Law for the /
1=z�, following rr, r.(Section 7031.5.B nine mut Professions Cole:nor city nr county a/
i!❑ which rslohe,a permit m annsuuct,alter,Improve,demolish.or repair any mounare
,teas- primfoii,hsuunce,oho reyuitcs the.pplicunl knarch perntifooblea,igned ararnncnt
bar lie islicensed parallel nthepowt,sun,if he CortraartoraLicense Law(Cnapter9 Sy. FL Floor Area Valuation
(commencing with Section v(««0 of Division 3 of the Business and Professions Clad
or that he is exempt there.fmm and the basis lar the alleged exemption.Any violation $20000
of Section 7131.5 by any applicant for a Permit subjects the apprcnnt to a civil penalty
of am none than me hundred dolars($5(«n. A PN Number Occupancy Type
❑1,ns nwmer nr me prnprtr,m II,y en,pinyeea wire wages a,meir.nw cnlnpcln,atim,,
will do the work.and the structure is nor'Intended or ordered to sale(Sec.9044,
Busines,and Profession.Cole:me Contractor.License Law does not appy tu air Required Inspections
owner of property Who build,or improves,ncmon,and who docs such work himself
.'monolith his own employees,provided that wen improvements mil not intended nr 305 — FRAME
offered for sale.If however,the building or improve hent is sold w'thm one year of
mpinion,Pic ownor-haimerw.If have In,hunlen of moors tom he did nm nacho. 307 — INSULATION
improve fill pamn,e of xlde.,,
601 — ROOF TEAR OFF
❑Las owner of the property.am exclusively it Pumping wire licensedri comtcmms m
Salinas,
nn,troct he mnjecr(sur.7044.Basin,, oil IhnRc,irns etde;)o'rne Contractor-, 602 — ROOF PLYWOOD NR I I_
Liccnm Low docs not apply to an owner of property who builds or improves thereon.
and who contracts fm,ash project,with a mntractur(s)licensed pursuant to me 603 — ROOF BATTENS
Contmnota Lieenxe L'''' 604 — ROOF IN—PROGRESS
❑Ih+mr�¢cxctnpl utWcr lies � "J/2-3/tis'
.Btt l'C firs this l'casun
aER'S �ECLARATION
• I hereby affirm under p"afyll Pap uy oncofine following declamtionr.
❑ I hove and will II intuin a Cenifcnto of Couwnt m sell insure for W uket.,
Compensation, is provided for by Section 39011 of the Labor Code. for lie
prfomn:mce of the work fm which Iiia pemrit is issued.
(IGI have and will maintain Wader's Compensation Insurance.a,requited by Section
3900 of the Labor Code,for the performance of the work for which this permit is
sued.My Worker's Cn;.lmns:nion Insurance eerier
raand Policy number are:ar7
Camcr:p!A•{CLGf2-'i_Qrol'ul icy No.: ,�J&_ 4JD_(V
CIBfop[CA1'ION OF EXEMPDON FROM WOR BURS'
COMPENSATION INSURANCE.
fl'his section need not be completed if the permit is for oris hundred dollars
($I on or less.)
I lend,hal in fie Ixdonnancl of the work for which til,permit Is jawed.I
shalt not employ any peruse in any manner see as to become subject to the Workers'
C..mpnsminn Law,of Cdiharoia.])all
Applicant
NyfICE TO APPLICANT:If after malting this Certificate of lixemptin..you.hauls
became I,t,h',,,t In he Workers Compos inn provision,of the Labor Code,you itmst
Q
birth,11,amu,ly will Inch pn,v'Isim,s or ods permit shall he deetmed focused.
ffi CONST RUCTION LCNDI NO AGENCY
a1 hcieby alarm that there is a amsuunion]code.,agrawy forthe pdorinurce
w of the work lir which his pari,is issued(Sec.300,Civ,C.)
L Q Lcndcis Nemo
7 Lender,Address
V 0 1 eerily that I have rend this uppllcnlmn and state Ihnl Iic.hnve infnrocarem is
[^.. cored 1 agree it,comply with all city and county urdinences and stare laws relining
Q ;) to building cnnstmcrion.and hereby amhorim represenminei of this city to enter upon
} me..hove-mentioned pmpny for inspection puHxnes.
E.. 4 (We)agreemsave,indctnnify and keep htioni the Cifyof Cupertino against
V) liabilities,judgments,amlx;,,it e,erov,which may in any way accrue against said
U $
City innm,aptcncc of the"oniirg oftbi"wrni.
^ APPLICAN1'UNDERSI'ANDS AND WILL COMPLY WI'1'It ALL NON-POINT IssUedb �� GI Date
SOI' CEREGUI.A ON, l� U! y
�nm..mn'T'id andcnmr - s' Da,e Re-roofs
HAZ RDOl1S MAIERIAI S DLSCLOSURE
WII IIIc Ilppbeammfltarenmmiingrwnm:,m,atom nr,amus na.uNous mvl¢'ti;tl Type of Roof
its defined by the Cupertino Municipal code,Chapter 9.12,and the ILAth and Safely
Code.Section25532(e)'! .
All roofs shall be inspected prior to any roofing material being installed.
go Will he applicant or future Wildingswcumn use equipmenor desire,which If a roof is installed without first obtaining an inspection, I agree to remove
emit ham Ihm,air amuminant,as defined by the Hay Arca Air Quality Management.
D'....wit all new materials for inspection. Applicant understands and will comply with
Yr _ all non-point Source regulations.
1 have read the hazardous materials requirements under Chapter 6.95 of the
Cut,[ on.Health tu Safety Coda Sections 25505,25533 and 25534.I understand that
if the building does not currently have a tenant,that it is my reapoirmility to notify the H � 3�
cupant of the rcquinments which must be,net prior in issuance of a Cenilicme of - Z,is
Occupancy. Ignature of Ap 'eatf Date
neroraahori.ed alien,
Pa II roof coverings to be Class"B" or better
OFFICE
INVOICE • INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
. CITY OF CUPERTINO
BUILDING PERMIT INVOICE OPERATOR: nancyc
Sec: Twp: Rng: Sub: Blk: L0t:31602094.00
INVOICE DATE. . . . . . : 04/23/2001
REFERENCE ID H ...: 01040119
SITE ADDRESS . . . . . : 20200 LUCILLE APTS 57
SUBDIVISION . .... . .
CITY . . . . . . .. . ....: CUPERTINO
IMPACT AREA .......
OWNER .. . . . . . . . . . . : STONESON DEVELOPMENT CORP THE
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . ..: CHICAGO IL, CA 60661-3693
CONTRACTOR . . . . ...: MARK LAU BACH LIC 4 21491
COMPANY . . . . . . . ...: ROYAL ROOFING
ADDRESS . . . . . . ....: 1345 VANDER WAY
CITY/STATE/ZIP ... : SAN JOSE, CA 95112
TELEPHONE ...... . . : (408)279-2332
FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE
--------------- --- --------- ------------ -----------
SPERMFEE P 77.00 0.00 77.00
BPLANCHK A 62.25 0.00 62.25
BSF.j SMICRE P 0.50 0.00 0.50
139.75 0.00 139.75
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
LD Q �
MAR 2 3 2001 '
By