01050012 CITY OF CUPERTINO
BmI.DING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMITNO. ?
OWNER'S NAME: APPLICATION SUB DATE
20200' Ll1CILLE AV # -109—: 112 ROYAL ROOFING.' 01.050012
PHONE: , "! SANITARY NO. CONTROL NO
TRAMMELL CROW RES. SERV: CE 13451VANDER WAY' 1 . .05/01 /2001
�u O O ARCHITEC"GINF•ER: f s i - • - BUILDING PERMIT INTO
(.408.).279-2332' BLDG ELECT PLUMB, MECH
LICENSED D CONTRACTORS DI s l ARxrION pl '
n n by ons t �u
n i r see a P. I. I,al Chapter (,(,,1cr in, -. Job Description
�,�t8 whh S6cto 7(XXbci Dana l3afdarn ,s unJlntlL.vson Cada and myllecm6 ' s at '-
j$$ iv In lull fa/qr�`a ff C
ct
Opt; Date DECLARATION .I
w 3".lin ARCHITECT'S DECLAR,�IIR�Tt17
0 I mdcrstand my plans shall he used as public reeords RE-ROOF REMOVE, SHAKES• & -INSTALL -1/2" C
t!i 59p Lie ..IP r -odd - - CERTAINTEED SHINGLES. CARPORT
°' . OWNER BUILDER DECLARAI ION
Est= l b by IT 11 t I ore exe p,f t Colon t r. L iO t. 1 a n,,the '
6 loll g a (9 !it
I 7031.5,Urinous,a II I, C An, tyru ny
Oca q pe n tot h pr e l n l h r pa my metre
pmt rt 1:ren ce s I p pplrntf hp II Ila-gned.lalle,I)
her ntr la,isdp inion th p lith t nl 1 r 1 (ns Coda) Sq. Ft. Floor Area Valuation
-(cummmmmg wnhbectumseen d Dnrsmn3om .Husmessend...A.ons Cnion
or that io is exempt therefrom and flue.Reis for rbc alleged ,plica 6n.Any satiation _
of Seaton 90A5 by try applicant for a permit wbjuu the applicant a a civil penalty
nrnmnever,than five nantarendonarsfsswltAP.N Number I Occupancy Type '
❑1.m owner of lb reparry,or my employees with wages as their sale conspenanion, ,
w lI do letk I lln 1 t i t d l ft ed bal al Ni 91144,
B d l r.. , I TI c I l 1' I w le: 1 pply It .Ina • . � � Requireda�Inspections $3663 .
war ofpmperty Who hands(it unlir-es therm, and who de. ,uch work hnvelf.
to through his on employees.pnivided that such improvements are Dol intended or -
offered for sale,If.however,me building ar improvement is sold within one year of 31 C-02094. 00• '
completmur the owner-holder will have the harden of paving that he did not build nr -
improve Co.,porri of sale.). _ -
❑1,as owner ofthe pntpeny am reclusively canmaeting with licensed'camramol:n' 305 •——FRAME.
.
FRAME .
1.1111.1t1.1111.1tthe project(Sec.7014,Business and Professions Cade:)The Contractors -
LicenseLaa :alpplytowner-fpPerrywh..buld. p smerean . 307 — INSULATION .
unit h e t I: bar p J tswuh 1 ends) d Frustum a 16e ' 1 , .
01 our csemptdei See t n&P C fmmis mL.an t •,l " 60.1' — ROOF TEAR OFF
Owner Date 602 — ROOF , PLYWOOD NAIL
WORKER'S COMPENSATION DECLARA'I'[ON 603 — ROOF BATTENS. -
. Ihereby effimnmderPenalty offed., as fdrefallowingdeclaration.: 6g4 — ROOF IN—PROGRESS
❑ I ha a.and will neuntrift a Cenificme of Consentto self maure for W,rker's is
-C rep t. tion, nv p 1 d lin'by Section 19,81 ,, 1116 Labor Cade Ii,r the I -
m ormmoce of the walk Ila which lhix perms ns i.vsuca. ,
(lalcmtdwill n' 1 ' W Ar:Cmap :ad .Iq ' .IbySccti6t
1](m f the Labor Codo.'fra the performance Itthe work for which this pariont's
ssued.My Worker's Cmnpemulion Insurance currier anti Polley number etc -
Canrier:3 _J_LkLm Policy No:.5apR,0023 x'701 y m r
CERTIFICATION OP"EMETION FROM WORKERS' t _
COMPENSATION INSURANCE
(this mcdoa need nut he mrmAcre l if thc pcmtit is for no hundred dollars
(3100)6,loss.) _ - • ,
I cattily than ir I prallon o Illthe walk l which 's pe 't is issued.I a'f_t r
'IY" sl I l
not enank y am, r,ri,in in any Is ,,bec r ne radical In aha Warms' -
Compensation Laws rel California.Durk ,• - _
Applicant
NOTICE TO APPLICANT:IL after making this Cenilicute al Exemption,you should
herniae subject m the W6rket,Compensation pneekk r,9f the la sur Cade,you must
Q O fnnnwith comply with stat provisions or this Island,shall be deemed revoked.
F-4 CONSTRUCTION LENDING AGENCY ,
1 hrrchy infirm that there is a construction lending agency for the pednnnonce
,of the work for which this permit is Issued(Sec.3097,Civ.C.)
A 'Lender's Name'
ZLender's Address s
I eerily that I have read his application and state than the above inhmnation is ,
W. E. enrrcaj.I agree to comply with all city and county ordinances and.state laws relating
Q•(J to building coaamction,and hereby Indians representatives ofthis city to enter upon -
�, �] the alcove-mentioned parp my for inepostinn purposes. ,
C6 ' (WI)agreemsave.indenaifyand keep Ill the City of Cupenina against
wF. IA liuhildics,judgments,cods and"Kates which may in any way ac me again l said -
V•z City in caused,ANTU D of She ANS miningof this permit ,—
'••n APPLICANT UNDERSTANDS ANI)WILL COMPLY WITII AEI. ON OINI' Issued by: Date 1"(— ,—
SOUI �REGULA'I'I S— r � D ,. y� .
S areorAppLcanALI A Datr Re-roofs
-
a IIAP S MATERIALS DISCLOSURE .
Wdi th6 applicant or moon buuding ocaup;mt same an handle barnrdous miner al - Type of Roof .
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Slfery -
Cone,Section 25532m)l
°Yes c''° All roofs shall be inspected prior to any roofing material being installed.
Will the applicant f t Inde g p t se egapmemar deuces which If a'roof Is installed without first obtaining an inspection, I agree to remove
limn boreidous airs muminunl'is deEned by the Ray Area Air Quality Management I
n t all new materials for•inspection. Applicant understands and will comply with
°Ve all non`•point source regulations.
a'..1 have read tire hasnb us ruDer Is aNtrunament,under Chapter 695 of the
if the of Hg lth does Safe,,Caly haveSection,rant.that it is I and 25534.l undersand 111th
... if theholdingof t Jas nm monody have must he met
it is
my suanceiof a Co nmify the
Occupant of the requirements which must be met prior a issuance of a Cenifica¢of
°rip'a`y'
Sifniature of Applica` Date
o nr autnaa,m Igen, i' All roof coverings to be Class `aB",or better. -
, ' - s OFFICE r