01050004 CITY
I BUILL enc DIVISIolvND' CONTRACTOR INFORMATION:
PERMIT'
BUILDING ADDRESS: - - PERMITNO.
20200 LUCILLE AV 1-11-8 ROYAL: ROOFING 01.050004',
OWNER'S NAME: APPLICATION SUB DATE TRAMMELL CROW RES. SERVICE 1.345iVANDER WA1'., --05/0.1/2001
PHONE: _ SANITARY NO. CONTROL NO.
(408) 279-2332 r
O Z Z ARCHI'ITO'IYHNGINHERi 4 BUILDING PERMIT IN Poo
' •BLDG ELECT PLUMB MECH
Z O y i LICENSED CONTRACTOR'S DECLARATION JOb DeSCnpnOn
lherebyatftn dal la licensed underprovisions of Chvper9 lcommemmng- -
wuhSection TffO)tflhv r,7 fOheB all fs'ons GMc nal ray l'cc lira s 1
241=era isi fLimaallftee Ieff «� (o REMOVE ,SHAKES ;INSTALL 1/,2. CDX AND 30 Y
^�^�o�e u Dot f g}L'./,�r cnnlr,,emr ,{$ �p+w+w.r"SFI T.NGLF_ ' -
u�$u.y "1-" ARCHIIHO'S DECLARA )N '�!' s•r "'^' `.
t a O g 1 t round my I :shall us public revues.
$m
It II�
w pp -Lie a Professional - tJAN ,4 LUtJ?
o O\VNF.R-BUI ECLARATION
11 by H that I Ih C t t r:License e I for @c ,
t Z< Pollowing reason.Section 7031.5.l .ins:and PrpfCodc:Any city orrounty
Sd O wlthoxure. poems emtama ell P
'mro d I h pa wnu
eo
Y_ rt B11f S' gin';'^ -
pr rlsssauvnal quires the applicant. for such parndt file. ignu(smmncnt v --
mathcfnisherrmdpmrtantmtheproshshnlstd theCmntri ueemeLaw chapter 4 Sq. Ft. Floor Areu Valuation -
h ommencing with Section 7"1 or Division 7 of the Business and hofs»ions Ceef ,
m fair he is exempt Incumbent and the b:ni,for the alleged exempting Any violation' ,a s -1 -
afSeedongmL5hyany appucantfor4oplatanbjectsmeappheammacivnpenahr APN Number Occu '
of not more than Bve bundrtd dollar,WNW - ,
.
" ❑I,ns owner of the pro,wny,onny employees with wages m their sole campenmtion, _
will do the work,and the structure is not intended or offered for sale(Sec.IIID.
Boniness end Professions Code:Tic Cnmmctor's License Law does not apply to an _ 31.602094! .dt�dired Inspections�-
faster of propcny Who huildS or Lnproves thereon,and who docs such work amaelf
or through his own employers.provided that such improvcamea%am not intended or
offered for sine.If.however the building ret improvement is sold within one year or 305 +—, FRAME, ,
`
ofnpletin 1.t he o"'I'luilde,will ane me bur den of using that he dad ren auditor' - '
mproveforPtrpoacofaale.). 307' —• INSULATION
.. •,p ❑L its owner nflhu propsam exclusively eomraning with rceased connncmra m "_ '01 — ROOF, TEAR OFF'.;' +. ..
Lconstruct the project(Sec.7014.Business and Professions Cale:)The Conuactor's v'
icese Law does not apply to an owner of property whb builds or improves themom. - 602 ROOFPLY1400D NAIL_ .
_ incl who It unt'is Ibr such pmjcns with n cum acluus) Iicensal pursuant m k the ' ,. - y _ n
connaclorsLicensehw, 603: — ROOF BATTENS
0 tont exempt under Sec .B&P C for flus reason
60,4 '— ROOF,. IN=PROGRESS'
Owner- Dale a
_
WORKER'S COMPENSATION DECLARATION
s I hereby affirm under penalty of perjury one of the following declarations
Cl I ul,c I it will ofentain a Cenifi,tile if Couwat t t clhfiar Worker', .. 1
'Co upen'at nn. as pods tut for by Section 3700 of the LIE... Code, toe the
performance of the work for which this pemtit is issue. s -
hove and Is',
ill nuinwin Worker's Cumpc'nsatinn Insurance,a reyuircJ by Section a
7(X1 of the Lahr Cole,lin the performance of the work for which this permit is -
sued.MeyWmkcr'e Cnmpulnnion ln,uranco carrier and
pouf,rujuhhr,on:
carisr: rk -(-1 < f1 Pt•9'odeyNo.:
CERTIFIC\I'I)N 017EXP.MPI'ION FROM WORKERS' -
C(MPENSATIONINSURANCE _
(Thi,e11fut nee no be anmpleted if the Permit is It,;are Imadool dollar, ,
($100)or lees.(
1 eerily Ihit,in the perfamunce of the work for which this word I,issued,1
such nai'ellgdoy any person in any manner m as to berone wbject to the Workers'
Compensation"hies of Califeroo.Date -
Applicant ' -
NO I ICE TO APPLICANT':-If,tdicr making this Ccnilieam ut Excntplion;you should
.become obligor to the Worker's Compensation pruv s ons of the Irly Calc,you..at
QZ _
O forthwith cofnply with such provisions m this permit shall be deemed revoked,'
" s
- CONSem is er'ION LENDING AGENCY -
ai > I hereby alum(Ihis them iss need(Sec. lending agency for the pc'rfnmence .I ,
.of the work list which his permit is inmcJ(See.3I97,Civ.C.) - -
L,Q Lender's None Address Lender's Address
C) I,af y that l have read this application and sate tam the clove infornution is
Gz F. correct.1 agree to comply with all city and county ordinances and state Tawe relaling -
V
a.It dings nslmniun,oral hereby omhw'rre m,csonalwe;of this cilym amcr open
ky the above racusioned property 1 -peer n p rpu.s . .
(y, (We)agum otiose. rad nn fy gad keep hamalv,,the City of Cupenian attics,
rh liabilities, ly 1. ' .t:and vine 'I M1 ina, vat,way 'itain,l saidAPP + -
V z C'lYt c UNDERSTANDS
fthegrunt ngof tK pe t %///�� s ='
SOU (CANT UNDERSTANDS AND WILL COMPLY W'1lHALL NON POINT IssLICd b i. /�. �/�'`/ Di1IC D.
Sig .O ULA'1IONS �I— y'
Sig enfApplicaAZARDemr. � Dat• Re-roofs
IIAZARDOUS :RIALS DISCLOSURE
Will tit.appueofor mlaeebuilding a,it,cat 'are nnhandle ha.amansmaterial ' Type,ofRoof
a defined by the Cupertino Municipal Cads,Chapter 9.12,and tae Heahh and St
Code,Seselit
Ycs . �IjNn - ;• ,
All roofs shall be inspected prior to any roofing material being:installed.
Will tw apprcantorfuture With,oi,ct,efat ase el-ilbart it,desire,which If a roof is insstalled,without first obtaining an inspection, I agree to remove
n I factitious au conmm n:d,us:6f sed by the Bey Area Ail Q I'ly Manugemcm
Dt,H tall new materials for inspection. Applicant tinderstands and will comply with
El Yes, Q'No all'non-point source regulations.,
- 1 have read dam,f arnNoua materials requirements under Chapter 4.45 of the
California 11en111a&Sxrety,CashOSections25505,25577 and 25534.1 understand that '+
-it the building dims not currently have a tenon,that it is my responsibility to ramify We _
recupunl of the requirements which must be met prior to issuance of a Certificate of s ( 6
�r Occupancy. "
S' uf[ure of Applica .. � Date
0r orandaunted agan Deas , ' All roof coverings to be Class "B" or better _
.. OFFICE