01040122 CITY OF CUPERTINO
BUILDING DIVISION, PERMIT CONTRACTOR INFORMATION:
RJ IILDING AN)RISS. PERNIH NO. '
20200 LUCILLE A 43-56 ROYAL ROOFING 010401.22
VNER'S NAME: APPLICATION SUIT DATE
NDER WAY 04/23/2001
is PIIONE: SANITARY NO. CONTROL NO.
J
o e5 Z ARCH] BUILDING P12RMI'I INFO
W�❑O❑ BLDG F,LECIPLUMS MECH
FEW ICI Cl CI C7
aN
o Zw LICENSED CONTRACTOR'S mebDECLARATION
0 1 nynrhr,h.nnt 1 um 1iaued umle,pr,Wi,i...tx,trcnrpter9(,a,ouoaae;.,g Job Description
F=Cw with 1.11 or,land)ofect. nnJul'Ihc Huxlnaxs luul Pmfcsxionc Codc,; Amyliccns, `( 1
sin mull.reuantleecl. 73, 4 REROOF APTS. 45-56
K C a Liacnae CI' Lic.N_
O i O
The�}r (i�_ Commanr g
uKj 3 w v ARCHITECT'S DECLARATION
F=O 5 1 understand at,plans.hall he mad as Public recoils
I,im.ncJ I'.ufcsinnul
OWNER tBUILDER n the CoA'110N S/J
a7 1 naso affirm on I am exempt tram the Contractor's :Any v la,w for the
Esh Y a follow,Which re reason.(Section 701 L5.Business and sae.diaions Code:Any sin or county
p which it%issxnpemsl reronstheaper.improsuh atone t orrepair tryatenum
aimthat
poor he itxiswattee.nlso¢y ill,me:.,mr,ofor won Permitm111ea dgnedntatemem
thntheiaeingwitpursuant mthc prl Diiomnf the the Business Llcenml.,w(Chapter Code) Sq. FI. Floor Area Y11UffiIOn
lu.mmene isg with Section]INH lnl'Division 30l'the lluxincas and i...l Aly
Cole)
or Ina M In Dumpy therebsm.ant he breis in.'oc cisalle'ad applicant
Any violad,
of Section 7031.5 by naydleddolllot n5W), nubi,crc the nPPlicnm roucivil penalty
or nal mare [ran live nu.mlee dollars asuHl. - APN Number Occupancy Type
D L as caner of the pmpeny,or my employees with wages as their sole compensator,
will do the work.and the structure is not intended or offered for rale(See.70,14,
Basuto,and Price,wnx Cade:rhe Cainivewr'a Liecnw Lew docs aat apply In as Required Inspections
cne, pmpeny Who build, laprmes thereon.anti Who eoe,snob wed,hinvalf
a. uh.....gh Itis own employee........title Inas such imprnvcnrems are nal intended or
offered 1or,Ar,m
e.Ir,however, building sur improvement is sold Within ate yea,of 30.5 0 —
FRAME
impletion, the owner-milderanm,
will the burden of lving that he did nm build or 307 — INSULATION
improve Jet pa,—of sale.).
01.asawne,of propeny.amaaem.ively comrtedng With licensed contractors to 601 — ROOF TEAR OFF
m he project(See.7094.Htwire,s and Pr,fex,ions ewe,)Tm
he C..tnefor a 602 — ROOF PLYWOOD NAIL
1 m
. a nLawchasassu
h ,applyto ....tan o1'prn,Wnywhobuild,orimpro athamon, 603 — ROOF BATTENS
m t-,Livens.La
and wo n,Imns.mr such rooiro'with a ennba"n(,1 Items., Por,ant et the
Cal w.
D l um caimpt trader See. ,H&p C for trcrexsov 604 — ROOF IN—PROGRESS
w„eDae yOz 7v f
W COMPENSA'IIGN DIi LeRAI'ION
I hcmby alHrm talar pen,dty of ....cal lhe fAlowing Jedarnian,:
• ❑ 1 have and will maintain a Ccnilicere of Convent to wIr-incum for Worker's
Compensation, u, provide) for by Section 3700 of the Ltbar Cwe, for the
pedonnence of the work far which his permit i,issued.
r�uve:rod will maintain Walla s Compensation Insurance,its recoiled by Section
1 W.bc Labor Coote,for the Irrformaace of(ho work Em which this lcona it
1.My Wader's Co r,osatlo I Invnmmce..sumer ata Policy numher arc:
lama rr�
O Clk IFICAOPi PohcyNO ✓fgRWORKERS
COMPENSATION INSURANCE '
3$10(
(This sermon need not be on.adcard if the Permit is fm aha hundred dollars
(5R0)ur Ins'.)
I ccnily that in the peA,rm,ance of the work for which this panuit its issued,I -
shall nal employ any person in my natural so as n,beeame ntibrec,In the Walk,,i
Companion".Laws of California.Dude
Applicant
NOTICE TO APPLICANT:11:alter making this Cenilicae of 17aamption,you should
b --wbf,at to the Worker(,Covgtencation powiiin is ut the Labor Calc,yet mud
O Oecome
IbohW let compmix comply with wall alokimts sur wani,dall b,dw ecmrovok,d ,
z �
CONSI them KION LENDING AGENCY
C ' 1 hereby alhi,h that(here i is comd(See landing agency for the perh,tmunm
ofmewed for which this pemtil i,issued ISac.3107.Cir.Ch)
L` lender',Nada
z Under',Address 4
U O Icenily that.law,teat this apphaafla....md,mte that the tMwe inll,ro,aran is
k'+ P tom I I F' Pel)will,iill '.y and counly ordillanCeN and state err g -
O T..)
toen lJ g I li 11 by threpresentatives0this cityto
enter3 �ry,a
: M t adpen .pt p
G )ii,rce to
save.indemnify pharmless theCity oft7upartim,against
N liabilities,jJg c . r and cxK sh ch may in any say ucroc against said
O—A
City ninfir,ofilti,
APPLICANI UNDERSTANDS AND WILL COMPLY WITHAL1.NON-POINT
Date
SU'tCiRGI1A N5Issued by. y�Z
gnawrcof Applieram,nlroomr Dae Re-roofs
HA/ARDOU,' IAII DISCLOSURE
Willlbcapplicanorfnum ilding, upon.st(�mhawlcharmsmwHal Type of Roof
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Code,
e. yn 221.532(a)'rla -
°V° i°i" All roofs shall be inspected prior to any rooting material being installed.
Will hea,pficamormwlebuildimgacotpaallo,ryai,mmin...da,icexwnidt If a roof is installed without first obtaining an inspection, I agree to remove
•nit naandou,air contaminant,as defined by the Buy Area Air QUAIL,Management
•
"is el
all new materials for inspection. Applicant understands and will comply with
D Yes D,'C all non-point source regulations.
I have read the h;vurlous materials rnphretnchm,ander Chapter 495 of the
Calilbmi'a 11,4111.a,Sarmy Cute,Sections 255115,25533 aid 25534.1 l I...la limit
tithe huildingeonaoa cumenty hove it tart main isn,r,pnn,ilnlity ,,notify the O
cupam of me na,imar enl,whiab must be mn prior to isw;mw of o Cenilicae of
inaupancy. 1 iiature Dat
aroraumodredage.n — y/� > All 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: Rug: Sub: Blk: Lot:31602094.00
INVOICE DATE. . . . ..: 04/23/2001
REFERENCE ID 0 . . . : 01040122
SITE ADDRESS . . . . . : 20200 LUCILLE A 45-56
SUBDIVISION . . . . . 1 :
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 340.00 0.00 340.00
BPLAN CHK A 62.25 0.00 62.25
BSEISMICRE P 3.00 0.00 3.00
• ______ ____________ ___________
405.25 0.00 405.25
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
........ ............................ .._..... .....m......................
305 FRAME 307 INSULATION
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
603 ROOF BATTENS 604 ROOF IN-PROGRESS
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