01050032 ,GI nUtO CUPERTINO CONTRACTOR INFORMATION.
PERMIT
BUn.DING A""Re`0Q. LUCILLE AV CAR 1.7--;R8, RoYAI_ "ROOFING _ PRRMrr Not Mj.050L�32, ,
i VJ
'OWNER'S NAM". t ! APPLICATION S UAT
RAMME_L• CROW RES._ SERVCE 1.345 VANDER WAY
/b3/2001 -
• PHONE: , f s SANITARY NO. CONTROI.NO.
•(408;) 279-2332,x
O O ARCHITECT/ENGINEER _ t BUILDING PERMIT INFO
'. - BLDG i ELECT PLUMB MECH
*dq. hI J
LICENSED
p y Z CONTRACTOR'S DECLARATION Job Description
O OZ'— I h by Ili O that 1 a f enecnl d p .of Chaplcr 9,aimm n ng
<F<=t(]W� vim s,fl :7( [IyD t,r.,_,n3 I'then :. d1 f C,de wmylcrose ' REMOVE ,SHAKES, . INSTALL, 1'42"..-rCDX 8-'30
J.'eccoccl ..
Date Confirm
G Ans hall:CI'S UGC ARA'I(3N F8 NIA Lito
understand my plans ha11115W m public rcerNe _
�r 2 4 2002
ce ce p O n11 Pmic"naref - - , ^JAN .
a�,�jj
OWNERHI111.DE1CLARATION
I, Iheresy fific thtl an,cmup,t the C , I Limeroe'La.tribe -
t: a fidlovink,reason.(Section 7031.5lba:ln sandPtfe: n'CJ Any city or County Bill ,
F a which requires permit t t I h p J I sh p y s, pure Yv )
i3 pct t ,. v e al r 9 : .th oppl t, hpc u-fl B J.,mmean '
hadhe is laccroWdpursuantt ,hep isi n' fineComessam's License La (ChaPtec9 Sq: t. Floor Area . ValugDta�l 00
(commencing with Section 7000)M Division fiddle Rusin us and Professions Code)
or that he i..exempt therefrom and the ha.is forme alleged aemption.Any violation '
of Seninn'1031.5 by any applicant for a per o subjecc the a,mbeanr,o a civil penalty -
afroamore manfive hundred dollars($500. APN NN I Ger0�1. Occupancy Type- _
❑I I Ih P rent Y n PI Y 1M1 ab. :th I p I n '� ,
will do the kand th structure I,mo intended it offered to, .to(Set.7014. `
B d P f a . Code BeC, I cin :1 n.�1 doe not apply t fired Inspections
.net of mo erty who builds or improves thereon,and who does such Work 1 uoilf - .305 — FR
i•IP( .
or through his own employees.promded that such impmvemenl,arc nm imendm or -' 307 — I NSULAT 11711il -
offered fm sale.If,however.the building or impmvemenl h sold within one year of
c'omplet'ion.me owner.hnadcr will base the burden of proving dial be didma build or •Er01 ROOF. TEAR 'OFF
Impro.•e for pour..c pf ale.l. '
'01,as Owner of the Property,nn1 e.acbrsim
vcly cirabowint with licensed cmann nto f-, G ROOF PI_YI.IOCID NAIL
eon,tmt,me project(See.71,14,Business and ProfeWonv Cede:l The Contractor, 603 — ROOF•BATTENS'. '
Llcenae Ww dins bill apply loan owner of pmpimm who wills or improves thereon, - - ,
and who contract,for such prejee s,with a contcacumv)licensed pursuant to the 504 .ROOF I N=PROGRESS
Contmtmrs Laen.e law- � ,
0 l am exempt under Se. .R&PCCar this ma.m r
Owl let Date
- WORKER'S COMPENSATION DECLARATION ' '
1 hcrchy affirm under penalty nl perlurY one of the lidlnwing Jedara,iom:
. 0 1 have and will maintain a Ccnifieute of Consent In self-ovare for Worker's
Compensation, :u provided for by Section 37M of he talar Code, IF the ,
pednoromwe of the work for which ibis permit is Issued, `
IIhave anwill neuma n Worker's Coinryn.ation Inwrunca,u,required by Section
AW of,he Lahor Code,for the Nri finance of the work for which this permit is
sued.My Worker's Compensation bru ease carrier and Policy number am: -
Carol QCA
In OFPolicy NO:
o �iR OJV3701
�'PCATONO(EMPHONROMW(
_
COMPENSATION INSURANCE -
;(This sec,intt need nm 11,lumpleted if t he penult is tai,ac hundred dollars
(Sl W)ot -
1 cmify that in the Wrformance ill work for which this permit is issnN,I
shall not employ any person in any manner so as to hecntne subject to the Worker.' -
Compcnsatinn laws of California.Da, _
Applicant '
NOTICE 11)APPIUCANT Ifftv,nutkhn,th Cconficalmor Bsenp,on you should -
Q Qhaamcohj,v1 , file N rk Compt,,malion pnovi,ioncof the Labor Com,y"unwsl '
I'onhw Ih comply with such provisions or this pernil shall be dee n ed revoked.
Fti CONSS'RUC'HON LENDING AGENCY
> I hcrchy li iren mut mem is a construction leading agency fir the Informal _
attic work for which his permit is issued(Sec.3017.Civ.C.) -
Under's Name
z LendeLs Address
` U 0 1 citify mat I have reed Iii.appIt....nn wall stale amt die above lnfarnmdon is r , -
ok f+ correct I suttee m comply wish all city and county ordinances and state laws mladng f I .t-
Q f,) m building comtiuctinn,and hereby authorize represenwtivev oflhis city to enter itpim ,
} W he parese-minnorindp pen,for ou,nonprem .
.F•t p„ (We)agree tosve,inderimily and keep h hov the City of Cupertino against r h
VI li Fl, s pubmalam,costs d es,me,width, Y in any way acerae against sad -
C„),7a City in conse(lucince ofth gractingof this Permit. - r
APPLICANT UNDERSTANDS A NO WILL COMPLY WITH AL NON POINT' Issue db � Date
SOURC' thfi l ILA'I IONS. y•
L NO -
s rc ofnpphcanvcomr clor 3' T Re-roofs -
a HAZs,RDOUS MA R[AM D]SCLOSURE ,
Willthe applicant or future wading mention stem orhandle bacandmismal l `type of Roof '
as defined by the Caperton Municipal Gude.Chapter 9.12.and,he Health and Safety
C den 25532(,)'1 E '•
0 YC4
All roofs shall be inspected prior to any roofing material being installed.
wurne applicant nr fmuren naimg ucmtpaa tse m equlpmeor device.whah 'Ifa roof is installed without first obtaining an inspection, I agree to remove
cmi,hmunlno<air cunmmimm�su OincJ by the Uny Area Air Qmdity Matmtcmeat - ,
oi"rivO all new materials for inspection. Applicadt understands and will comply with
Dye, Nr' I 1 till non-point source regulations.
1 have scall the Inuoun s materials requirements under Chapter 6.95 of,he
Cidifism.lheillhda s l defy Code,San n. that
it I, and 15534 1 unJemm�f the •. moi/
-fifth hutlo age e.00tcurre,Ilyhave am h I Lha t': y p TlaC nam or
1 tx pet Tali. up le bents Wil uh nm t he mel prior il issuance n[a cut lie mor
-Occupancy, .,
n:iture of Applica t Date.
o maumnnmdatem >„c .� . .ATI roof coverings to be Class "A” or better
OFFICE, . -
,GI nUtO CUPERTINO CONTRACTOR INFORMATION.
PERMIT
BUn.DING A""Re`0Q. LUCILLE AV CAR 1.7--;R8, RoYAI_ "ROOFING _ PRRMrr Not Mj.050L�32, ,
i VJ
'OWNER'S NAM". t ! APPLICATION S UAT
RAMME_L• CROW RES._ SERVCE 1.345 VANDER WAY
/b3/2001 -
• PHONE: , f s SANITARY NO. CONTROI.NO.
•(408;) 279-2332,x
O O ARCHITECT/ENGINEER _ t BUILDING PERMIT INFO
'. - BLDG i ELECT PLUMB MECH
*dq. hI J
LICENSED
p y Z CONTRACTOR'S DECLARATION Job Description
O OZ'— I h by Ili O that 1 a f enecnl d p .of Chaplcr 9,aimm n ng
<F<=t(]W� vim s,fl :7( [IyD t,r.,_,n3 I'then :. d1 f C,de wmylcrose ' REMOVE ,SHAKES, . INSTALL, 1'42"..-rCDX 8-'30
J.'eccoccl ..
Date Confirm
G Ans hall:CI'S UGC ARA'I(3N F8 NIA Lito
understand my plans ha11115W m public rcerNe _
�r 2 4 2002
ce ce p O n11 Pmic"naref - - , ^JAN .
a�,�jj
OWNERHI111.DE1CLARATION
I, Iheresy fific thtl an,cmup,t the C , I Limeroe'La.tribe -
t: a fidlovink,reason.(Section 7031.5lba:ln sandPtfe: n'CJ Any city or County Bill ,
F a which requires permit t t I h p J I sh p y s, pure Yv )
i3 pct t ,. v e al r 9 : .th oppl t, hpc u-fl B J.,mmean '
hadhe is laccroWdpursuantt ,hep isi n' fineComessam's License La (ChaPtec9 Sq: t. Floor Area . ValugDta�l 00
(commencing with Section 7000)M Division fiddle Rusin us and Professions Code)
or that he i..exempt therefrom and the ha.is forme alleged aemption.Any violation '
of Seninn'1031.5 by any applicant for a per o subjecc the a,mbeanr,o a civil penalty -
afroamore manfive hundred dollars($500. APN NN I Ger0�1. Occupancy Type- _
❑I I Ih P rent Y n PI Y 1M1 ab. :th I p I n '� ,
will do the kand th structure I,mo intended it offered to, .to(Set.7014. `
B d P f a . Code BeC, I cin :1 n.�1 doe not apply t fired Inspections
.net of mo erty who builds or improves thereon,and who does such Work 1 uoilf - .305 — FR
i•IP( .
or through his own employees.promded that such impmvemenl,arc nm imendm or -' 307 — I NSULAT 11711il -
offered fm sale.If,however.the building or impmvemenl h sold within one year of
c'omplet'ion.me owner.hnadcr will base the burden of proving dial be didma build or •Er01 ROOF. TEAR 'OFF
Impro.•e for pour..c pf ale.l. '
'01,as Owner of the Property,nn1 e.acbrsim
vcly cirabowint with licensed cmann nto f-, G ROOF PI_YI.IOCID NAIL
eon,tmt,me project(See.71,14,Business and ProfeWonv Cede:l The Contractor, 603 — ROOF•BATTENS'. '
Llcenae Ww dins bill apply loan owner of pmpimm who wills or improves thereon, - - ,
and who contract,for such prejee s,with a contcacumv)licensed pursuant to the 504 .ROOF I N=PROGRESS
Contmtmrs Laen.e law- � ,
0 l am exempt under Se. .R&PCCar this ma.m r
Owl let Date
- WORKER'S COMPENSATION DECLARATION ' '
1 hcrchy affirm under penalty nl perlurY one of the lidlnwing Jedara,iom:
. 0 1 have and will maintain a Ccnifieute of Consent In self-ovare for Worker's
Compensation, :u provided for by Section 37M of he talar Code, IF the ,
pednoromwe of the work for which ibis permit is Issued, `
IIhave anwill neuma n Worker's Coinryn.ation Inwrunca,u,required by Section
AW of,he Lahor Code,for the Nri finance of the work for which this permit is
sued.My Worker's Compensation bru ease carrier and Policy number am: -
Carol QCA
In OFPolicy NO:
o �iR OJV3701
�'PCATONO(EMPHONROMW(
_
COMPENSATION INSURANCE -
;(This sec,intt need nm 11,lumpleted if t he penult is tai,ac hundred dollars
(Sl W)ot -
1 cmify that in the Wrformance ill work for which this permit is issnN,I
shall not employ any person in any manner so as to hecntne subject to the Worker.' -
Compcnsatinn laws of California.Da, _
Applicant '
NOTICE 11)APPIUCANT Ifftv,nutkhn,th Cconficalmor Bsenp,on you should -
Q Qhaamcohj,v1 , file N rk Compt,,malion pnovi,ioncof the Labor Com,y"unwsl '
I'onhw Ih comply with such provisions or this pernil shall be dee n ed revoked.
Fti CONSS'RUC'HON LENDING AGENCY
> I hcrchy li iren mut mem is a construction leading agency fir the Informal _
attic work for which his permit is issued(Sec.3017.Civ.C.) -
Under's Name
z LendeLs Address
` U 0 1 citify mat I have reed Iii.appIt....nn wall stale amt die above lnfarnmdon is r , -
ok f+ correct I suttee m comply wish all city and county ordinances and state laws mladng f I .t-
Q f,) m building comtiuctinn,and hereby authorize represenwtivev oflhis city to enter itpim ,
} W he parese-minnorindp pen,for ou,nonprem .
.F•t p„ (We)agree tosve,inderimily and keep h hov the City of Cupertino against r h
VI li Fl, s pubmalam,costs d es,me,width, Y in any way acerae against sad -
C„),7a City in conse(lucince ofth gractingof this Permit. - r
APPLICANT UNDERSTANDS A NO WILL COMPLY WITH AL NON POINT' Issue db � Date
SOURC' thfi l ILA'I IONS. y•
L NO -
s rc ofnpphcanvcomr clor 3' T Re-roofs -
a HAZs,RDOUS MA R[AM D]SCLOSURE ,
Willthe applicant or future wading mention stem orhandle bacandmismal l `type of Roof '
as defined by the Caperton Municipal Gude.Chapter 9.12.and,he Health and Safety
C den 25532(,)'1 E '•
0 YC4
All roofs shall be inspected prior to any roofing material being installed.
wurne applicant nr fmuren naimg ucmtpaa tse m equlpmeor device.whah 'Ifa roof is installed without first obtaining an inspection, I agree to remove
cmi,hmunlno<air cunmmimm�su OincJ by the Uny Area Air Qmdity Matmtcmeat - ,
oi"rivO all new materials for inspection. Applicadt understands and will comply with
Dye, Nr' I 1 till non-point source regulations.
1 have scall the Inuoun s materials requirements under Chapter 6.95 of,he
Cidifism.lheillhda s l defy Code,San n. that
it I, and 15534 1 unJemm�f the •. moi/
-fifth hutlo age e.00tcurre,Ilyhave am h I Lha t': y p TlaC nam or
1 tx pet Tali. up le bents Wil uh nm t he mel prior il issuance n[a cut lie mor
-Occupancy, .,
n:iture of Applica t Date.
o maumnnmdatem >„c .� . .ATI roof coverings to be Class "A” or better
OFFICE, . -