01050013 CITY OF CUPERTINO -
w BUILDING DIVISION,, - PERMIT• CONTRACTOR INFORMATION:
BIIILDINGADDRP_SS: ' PERMITNO.
20200 LUCILLE UNITS' 1 ROYAL ROOFING 21:050013
OWNER'S NAME:, t APPLICATION SUB DA'Z'E
TRAMMELL CROW RES. SERV. CE 1345 VANDER 14AY 05/01 /2001.
., PHONE. ,_ SANITARY NO. CONTROL NO. :.
(408) 9-2332
-27 ',
BUILDING PERMIT INFO
_C o z0 ARCHIT ECI'/ENGINEER: - BLDG ELECT PLUMB MGCII
•
u ' '- 1=J I=
z y LICENSED CONTRACTORS DECLARArioN , Job DCScrlptlon -
OZ- Iheavily ch nmr
httl cunsed d p e 1Chanor 90con,nc ,g _ + ,
wd Set ,4IIIXIt fUv,' nl,flhoth ns dP f o,,Codeami lylcese !
aY� 1st tuft 0d a E�nOVE SNAKESs INSTALL • b/2" .CDX R 30 V
'iso 1. Ciro, 1 ' 1 ��� c FINAL Y
.3 LL u l —Jf-� p� . 'c I nrinr- Qiyal on _r.,, - - -
nlacnlTrcl"snrcfnRlt
C,� g _ I tmdchlll I my Ino,shall be teal as Anna,reemdx
JAN ,2 4'2002'
was .
w-O O LiccnncA I'lmle.x'innal -
6 pxx' thatOWNER-BUILDER tecoour the RATION
W I hereby.((Seth ono 1 vin eamnnt fsam the fissions c License Law for me BUILDING l
cS•z¢ whichingmars.".(,anion]ommuct.one, mprve,man Cr,, Any cityan or county - '
NFC which re"ciars v pemsl re quires tt a applicant
improve,demolish.Bre a lir any taucturc „
prior to its issuance,p ahs pursuant
in the the visions o for Coit Amort to rile s sigm+l statement
that the is with Seumn in of Division
the Cammnnes Licensrofewonal Ccr4 Sy. Ft. Floor Area Valuation
(commends co illi Semolfroon IX and
the basis o t the Business and ion.Any vi Gd=1 $30006
u Shat Section
is 31-5 b thcrcfmli and the boars for the alleged exemption.Any l Penalty
of a.,.n]Ith n v vary hundred
oil for a permit subject the applicant a civil Penalty
_ mfrmt more man Buil hmrdmd anlmr'tssltot. - APN Number Occupancy Type •
°E.a,owne"dthe Prnpeny,in,no,employees,ithwagesmillion suite compemalfon, 31602094. 00
will do the work,and the swcture is not intended or offered for cele(Sec,](LLT. -
Business and Professions Code:The contractors License Law does mot apply ,,alt Required Inspections
oner m propeny Who builds or improves thereon,and who does such work hhmaclf 305 - F RRME .
or through his own en,plwmc=.,provided that such improvements Bre not intended or s -
naeted for side.IL however,the huiming no improvement is xmd within one year mf 307 — I MSULA'f I Ohl
completion,the ownenill have wve the burden of proving that he did not auditor - - - -
I nprnverorp,lrpwemde.t. "' 621 • — ROOF TEAR: OFF ,
°1 t. 1 d , p ly a s love ly-contracting 'ul 1 i I 602 — ROOF PLYWOOD NA IL ".
...........dl p I 'l(S "D, jbol andP t.:'s, Cale bII C l t'rx t,
1 d -nor 1pidyt e 1p p ly h,huld , 11r ' dl ,r 603 — ROOF BATTENS .
and s Is I a 0, fur.such pn]eus With a contractors) licensed purxma m the '
cmlraelm,ai.lecn,cLaos. - 604 — ROOF' IN—PROGRESS`
01 em as,una under Sec. .0&RC holds myon -
Owner 'Dae J
W'ORKER'S COMPENSATION DECLARATION ,
.. a
I hcmby chain under wroky of fed.,one of le following dereasticii
• 0.1 have and will maintain a Cedihcine of Conant no cell-inzum for Werocr s
Compensalinn, e, provided for by Section 37W of the Labor Gdc, for the
performance of the work for which thin permit is issued -
4�„a have and will maintain Worker's Compensation Insurance,as riyuired by Section
0]W of the Labor Code,for the performance of the work for which this permit is -- -
issued.M,fykWorker's Compensation Insurance carrier and Policy number are:
Carricr..r�r.^_� rlf Alt-Ili Nn.:
CERriPIGYI'ION Or EXEMPTION FROM
COMPENSATION INSURANCE -
1'fhis",ci i lived not he completed If the permit is for on=hit bell doll,,,
0,100)or leas.(
I cern,11 1 la the pmnornwncc of the work for which this permit is Pseud,I
'hill Bol omploy any person in any n u nor so as m become aubjcet ,,me Workers' - - • " -
Com,onSnlinn Laws nth' Dole
California.Da
NONCE TO APHACAN L 11;afler making this Ccnifcmc of Exemption,you,hrnlld '
Q O haamu.subject to the Workers Com,ictation provisions of lie Labor Code,you must
ldhwilh comply with .on provisions m oris permit shall he doomed revnAnl.
y
F spa - CONSTRUCTION LENDING AGENCY • - •+
ai 7 I hemor which this(here ivs need(Seen leading agency hd,he perfunnuntt
0. of the work for which this permit is issued(Sec.4097,Civ.CJ -
1 Q under',Norte
= Z Lctidcr's Address - -
V C I codify that 1 Puce mud this'application and sure that the above information is
ka Fs cancel.1 agree v,comply with all city and county melmences and sate Iowa relining -
Q C,J to building combustion,and hereby authorize representatives of this city u,enter upon
the above-namiomos,t.,
ed propcny for inspection putp
;a,
pk, '(We)agree e,save,indemnify and keep harmless the City of Cupertino against
rn liabilities,judgments.costs and expenses which may in any way name against said
V City in consequence of the granting of this permit.. '
APPLICANT UNDERSTANDS AND WILL COMPLY WITS ALL NON-POINT'
SOURCE RE"I'LATIONS. Issued by:
ate
3/ A�
Si,mano 0,1,1 annvc II ,,✓✓ D •Re-roofs
HAZARDOUS MP�R1fLL5❑ISCI OSUR( _
Will'he PPfa I n bum gocnpanlslnmmL n 1 s railroad T)fpe.ofRoof',I, -
Y lasdd tad by meClpudlooMtn=plC,de Coupn,912 and meI lhb andsdely, s
Cuda,Sd'ain i 25532(a)'!
El Yes All roofs shall be inspected prior to any roofing'material being installed.
Will a roof is installed without first obtaining an inspection, I agree to remove
emit bnzanlou.air amtamimuns ax defined M1y the Hlry Area Air QudityMmegenem
_Disumrt . , alLneW materials for inspection. Applicant understands and will comply with
0ie` all non-point source regulations.
1 have mad the talismans material,"comments under Chapter 6.95 of the ,
California Hcalm&Safety Code,Sections 8505:25543 and 25534.1 understand thm- ' b
'if the building does not cuready have a tenant.that it u ndy resprnsibilityla rot the _
o occupant of the requirement,which must he met prior m iv nce of a CeniEcam of _
Occupancy. '
- gnuture of Applicgnt Date
D rn malood,od agcat rf�Dju Al gs to be Class "B"or better
OFFICE