01050008 CITY OF CUPERTINO - -
nmLDING DIVISH N PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: - PERMIT NO,
20200 'LUCILLE AV/CARP ROYAL ROOFING. 01050008
OWNER'S NAME: •' - APPLICATION SUB DATE' '
TRAMMELL CROW. RES. SERVICE 1345. VANDER .WAY'. - 05/01/2001. :
PlION17:- - - > SAN[VARY NO'... CONTROI-NO. .
(408,)279-2332
G Ore ZZ ARCIfI'1'ECT/ENGINHER: - e BUILDING_ PERMIT IN170r
of p - BLDG ELECT PLUMB- MECH
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�t-�b Z LIC(NSED CONTRACTORS DECLARATION lob DeSCfIPIl011
Z Z q 1 I mhy uRrm that 1 m I tensed J p on, f ChaPt 9 f bone ad.9 - _ '• ,.
FEJCW withS i 71x10)ofD 1 fNoN a 11 (.. is unit my Treace , t +,
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�aLL� License Cl -3`1 IIr « 7 f` ALeNOVE ,SHAKES AND INSTALL .-1/2!!t CDX CER
X 3 LL N Date / ,p-f CummLARA 0.
ARCHITECT'S D[CLARA 1 JAN Z
G ili to 1 understand my Plans shall h used m Public rtcnNs _ 900
�C O Iterated Prnfesviowl _ `
OWNER-BUILDER DE CLARATION u
as- 1 hereby (Seca hat 1 ata exempt from the Cssionsmr's License Law for the .� / 11 .�
.(:'ZQ fall m, a, IS t 70315 Rosario, tlP f CsI:An,city enumy ` ry
5 C uqi h r 4 Pe t I .i I It p 1 1 P' Y:tincture e
3$ pn t l: I. raptures Ih p(tl tf hpe a fl -6nd taremcm
to to 1 dp tt N p t.nn' (OcC nt tar L . I (Chapter9 .Sy. Ft. Floor Area Valuation
(commencingwtb Scotian70011)ul'Div's t3dlhr Ismul ':and Pr fission,Craft) - _or that he is exempt therefrom and the basin for the alleged exemption.Any violation - -
ofSection703I.5by my applicant for a print auhmI%Neapplicantmacivilpsarafy APN Number - ^
' /nf tars more man fivghendred dollar.(a51xn. - Occupancy Type.
0 (if the property, Y employees with F their1 compensation. - 0 71
• -
w11 do li k J he arrouromm6 net intended or offered far sale sec. Bata - - e -
B ,ad l f :C J I C l t :l I d - t p ply man Required Inspections t. ,
owner of'property Whu builds or improves thereon. J wou does such work himself
cor through his own employees.pros ded that such impmvemem,am not Intended or 305 — FRAME offered Inr.rade.If,however,the building or improvement in held within one year.1
nngdefinn;We nwaer-hwmer
war have me Barden of proving that be did not build or 307 ." INSULATION. '
ampowe for initiative f. I ) E@ 1 — ROOF ' TEAR. OFF
-OI ts own ofthe property,
amIia Iycontracting.nleeenr'
conmin the Stu auxin : rd PrfesioCae)The Contractor's
odm t is 602 ROOF 'PLYWOOD NATL .
'
Livesc awdoesnotapplytoanownerofPropertywhoWildsorimprove.thereon. 603 —• ROOF :BRTSENS '
and who cmm�¢tn far such pmjeca with a ommnul(s)licensed pucmam m,thv t, I
Co.[rm,o;xLicra,eLaw I 504 — ROOF IN—PROGRESS'
01 am exempt under See. .B&P C for this reason
It WORKERS COMPENSATION DECLARATION '-
' • I hereby ff ander penalty f perjury f Ili f ll 'ng J clarai n :.
0 1 1 a and 11 n C r t t f C ase t t : If forWorker's
Compensation. n rnvNed for h Section 3700 of the Labor Code, far the -
pe a p Y .. 5•
a
er0n numco of the wnrA I'or which Ihix rr mit is ixwcJ.
I
V have and will maintain Worker's Compensation Insurance,as requited by Section
. 37M of the Lahar Care,for the performance of the work for which this Penna in
oa,d,MAAyW�..aa'I Compensation lnaa Fane come,and['(they number are:�i-I"w - -
Carricrd7l•1;�1-L'lL«�Policy No.:i caV A0z�X70i
-,'CERIC 1:1 CATION UP EXEht I'I']ON FROM WORKFRS' - . .
COMPENSATION INSURANCE
(this section need not he completed if the persalt i.Inr one ImnJled dollars "t • -
IS1001arless.l -
- I certify thatin the,crfnmmrae of Ne work for which this permit is issued,I -
nhall nut employ any person in any manner nn ax it,hecanm salbgrl m the Workers'
- Cumpcasatwn Luwsof Culifamia.Date w '
Applicant -
PP
Ncoloc TOAPot the NT:e.tCarmekingthis ,kam,mol Exemption,yuunh_nuld + i ,.
M1no nc st hject It No W rke.C tapeta t p t Ins of the Lahur Code,yea mart
C) O forthwith comply with.such P .w.... petrot shall be deemed revoked ` -
n r
CONSTT RUCHON LEN DING AGENCY '
1 hemby affirm that there is a con.wetion lending agency for the Terminate
W of the work for which this permit i.issued(Sec.3097,Civ.C.)
t.erma's Name
z Leader's Address "
V C 1 unify thou I have read this application and state than the above information is ,
conn,1 agree ,,comply wbh all city and county adinannn and lone lawn,rekm in8 _ - - - • ,
, OV to hu ildi ng construction,and hereby authorize tepresentativu of this city to enter upon
> W the above mentioned propomyl inspect _ -
L.tly ', •(We)agree to mderr fYam!keep h� I..the City of Calmar eg st
F•t V] i lad t c.,fudy nan s t ode prmx which t y in any way tame uga " said
U Z City to consequence of the Gram ng of do,pc +t .�
^ APPLICANT UNDERSTANDS AND N11.1.COMPLY WI of ALL NON-POINT Issued by: /ii/Z .<
SOU ',ERBGULATTO „ y' DaIC"
, O
mmrc of APPlicaMCnmms Dam 'Re-roofs
HAZARII RIAhS DISCLOSUkEs -
Will me,q�plirdnt o ,addmlg nrapanl dna m hanmc std=amaaa nnllrrial' Type of Roof .
as dermad by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety - )
i Code.Section 25532hof -
°Y �" =.:' All roofs shall be inspected prior to any roofing material beinglinstalled.
- Will Neu Iieamnrfuture holiirt am neve ui mentor Jediceswhich
rn g�weu T q p If a roof is installed without first obtaining an inspection, I agree to remove'
emur[O? dour nv mntemiw 1.ns defined hy'Ihe Ntry Arca Air Qu'vlily Management - �f,.. g p g
1r.trict" "all-new materials for inspection. Applicant understands and will comply with
ova. rra all non-point source regulations_.
` I ace icad shot hazardaux materials requirtntmds under Chapter 6.95 of the -
CaliforniaHealthtlrSafety Code,Sectiuln25505.25533and25534.1 understand Nal �f/� �/
if Ne building drca nm currcndy lime a oramo that it ism,re,unsibilily m mary th, _ r/
acaapam of the agniau
nnu which must priori M1r amt pIo i...co a ofa Cenir"am of
°CpaT°°`y' gnature of Applicant �' Date `
1of "Al roof coverings to be Class r`Bor better
owner n. -red agcm � �7etr g � .
'.' OFFICE; .,t