01040121 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING A1jDR"E-0200 LUCILLE APTS 77 ROYAL ROOFING PERMIT NO.
010401
1'NER'S NAME: APPLICATION SUIT UATI:
STONESON DEVELOPMENT CORP THE 1345 VANDER WAY 04/223
I'HONIi: SANITARY NO, CONTROL NO.
(408)279-2332
C O ARCHITECGENGINEER: BUILDING PERML'IINFO
w- BLDG ELECT PLUMB MECH
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v LICENSED CONTRACTOR'S DECLARATION lob Description
m Iberehv0)0 that Iun,title,
in pan,ionsof Ch apter 9(coo.`acing P
P vJ(_W w-htia'linu9lX111)ul'Divi,iunJnf,Imc llurinussnnJ Pmfcssinns CnJe,nnJ nrymllecnne '
�xE i^iamllo,nennpol•, REROOF APARTMENTS. 77-80
,see„ I)iam CJ� C . S Q I.ic.p 7
a N D.meAI<CIIII'ECI"S UGC AIlA3'I)N I
I understand my plan,shall be used as from records
fir- Z�
ip`per LiccmcA Pn,icnsional v
eJ o
OWNER-BUILDER and
ProfRAI'IUN
u� 1 nertby ulliren Nat I am exnnpl trent Inc Conlmdnr's I.wvmve Luw fur the
t-z r whichlow requiresng a,Permit
co11.9, t,alley,and vet,demolish,
Code:Any city structure G ea which requires a fk'ad,o ne onsmrcl.alley,improve,dem ein t fi repair any saannot
e,1m per,tois lxnunl¢c.ulra rcynitu'Ihcxpplicanl turwchpclor', hle tien,,cl.etlndcmnn
d Nmneisbeen.edprnrrnitnmepa�e.;anxanneflueSt hies,cenwl,wlermer9 Sq. FL Floor Area Val anion
f°o
hot
is cwith Section..in tot Division Jof rime du,inczsendion.Any vi Gde)
a Ina he 7 31.5 b therefrom and Inc basis far Inc alleged esemptian.Any violation 1 171'
mf notmo than v any hundred
oll tis n pennll wnjun,Ina upplicum m a civil pcnuhy
or not mom than me haneree eauars Isstgd. A PN Number Occupancy Type
❑L a,owner of nue property,or my employee,o ah wages:,their sale courear,tion, 31602094. 00
will do 0e work,and the structure is Int imcnded or olmmd lin suck f5ce.91044,
B.dnesa and Pme,,mn,Code:'I he Common,s Lmer,c Law doses m9 apply m as Required Inspections
owner ofproperty Who Wilds orimpmvesNereon.and who doe,each wmkbbnsdf 305 — FRAME
or through his own empinyces.provided that.such impmvcnnenu art not intended or
offered Gia sale.Ifhowever,ale thudding ort imps vcm s sold within nnu rear of INSULATION
completion.tme.ne faidde,will nave Ne barren nrpmring that he did a,,,brdd or. 307 — LATION
°°pfowe let Purpose°f s''`" 601 — ROOF TEAR OFF
C]1.as owner it be crnnmch,lg with heem.ed eenlmelom u) 602 — ROOF PLYWOOD NAIL
Lmvruct the project(Secs]M4.Business and Pade„ion,C°-e:)The Commno,s
ic,ase I..w down,,apply toanironer ofpropenr who builds or nopmv``thereon, 603 — ROOF- BATTENS
and woo contracts liar such prnjeas with a cantrdao.I,)licanwd pursuant to the
CommeNrs I......2 Law' 604 — ROOF IN—PROGRESS
❑I am e¢mpm under Sec. .B A 1'C for this mount
Dune M) 11)
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w> S COMI•I?NSATI) UECLAItATION
1 M1ercby allin under pcnahY of perjury ane of the ndh,wing deelammimrv:
• ❑ I huv°and will mai.ullll it Ceniliea e of C.....cal ,n s,If-insure for Wenn',
Compensaion, as Provided Iia by Section 3700 of the Color Code, for the
performance of the work fm which this permit is issued.
VIMInave and will maintain W..km',Campe.Xalon firean n,c,as ovenimal by Section
of the Labor Cade,for the performance of Ne work for which this pemnil is
wed.My Worker's Compensation Insurance currier and Policy mmiber am:
cmier.AAA�ir:_man Pm rneeyN,:
-7d 70
ePwr11nCAnON OFEXEMPTION i%LMPTION PROM WORKERS'
COMPENSATION INSURANCE
I This section need no,be ri feted it Inc permil is lar one hundred dollar,
1E 10111 or less.)
I certify Lha is he Ped m once of Inc work lin which thb Iannit is Iswed,I
,hall nI enifecy any per any interior s,,un¢.Kron subject m the Workers'
Compensation Uses of California.Datevee
A,,Im.n1
NOI'ICH 10APPLICAN'1`:fl;afterneakin,thls Ccrirree of Exemption,yon.should
necanme subject am the Worker's Connpen,ation provisions of the I.oar Code.You mux,
Q O forthwith comply with such provision or this pemnit shall W deemed revoked
z —
HCONST RUC TON LANDING AGENCY
a 4 Ihcmhy afrrm thin lncrc is a conmmtion lend,.,agency far the performance
of the work for which Nis permil is issued(Sec.300,Civ.C)
0.. Q Lender's Name
z bends'`Add,'c„ t
V Q I lenity that I have read Nis applicminn nnJ slate that the above inlmorsoinn is
k. [.. counsel.I agree m.conmply with all city and county mdin:mces and late law.reading
O LJ to lumbidng enname,ion,aral hereby rununee remaamaivcu of tos city reenter upon
W the aMvonmmioned p,,i,.y for in.,e,itue purpose,.
E. M. (We)agree to save,indemnify and keep hanNess the City of Cupertino again%[
Z Lifelines,judgmcros,costs and estimates which may in any way acme agniart suid
City'at.....vey.awc of the s,ndlie,of hl,pedal. 7--�
APPLICANT UNDERF'L'ANDS AND WILLCOMPLY WITH ALI,NO POI Issued bye %e ��f/�G�AL.-IJ CG'` Date
SOD t cE REGol,nnoN . �3
s' moreofA,flimmfG000from /-can Re-roofs
HAZARDOUS NJ : ALC DISCLOSURE
Will tM applic°m or future building evesp rd sm a or handle hacvdmus material Type of Roof
as do Gored by the CrIm,e er Municipal Code.Chapter 9.12,and the Ilerlth and Safety
Code Seninn 25512(°)!
❑Ye, ,INa All roof:s'shall be inspected prior to any roofing material being installed.
Will the ap,lam,of mroren°ildrpecemna°t use eywpmem or devices which If it roof is installed without first obtaining an inspection, 1 agree to remove
�— coil le mohoe ah mmm....arms m-°tined by the day Arca Air Quality Mun.:,nncu
• Dmn.i all new materials for inspection. Applicant understands and will comply with
0 vet, CA. all non-point source regulations.
I nave read he nvindous romfials reLfuaneall tlllde,Clwpla,6.9,5 of the
California Health is Safety Cade,Sections 25505,25533 and 25514.1 understand that
rine building does not currently have a tenant.that it is my resPmsiniliy to notify the 4/2 31/
ocup:nn of the m,amcnnemis such at be not pour m is%mm.of a C,mr....of
oemlpaony.
`(f 3/61—
nature of Applicar Dale
wrier ,,m�thodledagent u.,I� Al 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: Rn9: Sub: Blk: Lo[:31602094.00
INVOICE DATE......: 04/23/2001
REFERENCE ID # . . .: 01040121
SITE ADDRESS . . . . . : 20200 LUCILLE APTS 77
SUBDIVISION . . . . . . .
CITY ........ . . . . . : CUPERTINO
IMPACT AREA .... . . .
OWNER . ........ . . . : STONESON DEVELOPMENT CORP THE
ADDRESS ....... . . .
:
CITY/STATE/ZIP . . . : CHICAGO IL, CA 60661-3693
CONTRACTOR ..... ..: MARK LAU BACH LIC # 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
'--------------- --- --------- ------------ _____------
BPERMFEE P 167.00 0.00 167.00
BPLANCHK A 62.25 0.00 62.25
BSEISMICRE P 1.10 0.00 1.10
• --------- ------------ -----------
230.35 0.00 230.35
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
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