01050033 CITY OF CUPERTINO '
CONTRACTOR INFORMATION:
f. QUILDING DIVISION PERMIT ;
BUILDING ADDRESS: . ' PERMIT NO.
20200 LUCILLE 'AV CAR 29- 34 ROYAL ROOFING 01050033 -
OWNER'S NAME: • APPLICATION SON DA'1'G
TRAMMF_LL CROW- RES. . 8F_RV CF_ 1345 VANDER WRY T 05/03/2001
., _• I'IIONIi: ^Y a 1Ap� }. 5•• SANITARY NO. 'CON'I'ROLNO
�'(4 08)27.9,-2332 ..
a o ARCHITECUENGINEER: BUILDING PERMIT INTO.,
mF BLDG ELECT ' PLUMB Mr:CH
.,u
traN l
a LICENSED CONIRACI OR'S DECLARATION
oz$E Iherehyamrm than lam liccnwd under provisions of Chapmr9(commeard., 10b.DCSCrIptlOn
�_t; withS r 7000)of 3 of B .:andProfes.ionsCode.andmyncemm REMOVE SHRKES,.
I n tall I ce v R t
E�rc a 'L 1 a 7(,4' 3�—f l-n -
xI, 3
a°LL y Dat c n1T IVSTAI_L ] /?" CDX &,
ARCHI1'1 C9 S UI CI AH
�yp°g a II,ler,t,rdmypl r,sh,ube,nedaxpvh emnrds ��� LED "''',30- YR. CERTAINED "'SHINGLE s
a�oo I.ie II f: -
OWNER BUILDER DECLARATION
I hereby affirrat that 1 am excield front the Connector"act License L``��fftt1D}.vt�Im 4 2002 .
ti< following reason (Section 703L5Itu,inetsand Pmfessom Cuk Any ciy Flltint
5 2❑ which oriuma,a permit m cnnatrvel,eller,improve,demolish,or mpuir uny simcmrc
x°613$ prior to its issuance.also myuires the applicant lm such permitto file v signed sm¢ment
that he is limnuJ pursuvnno me pmvisitn>of NC Comrecmrs License 1.13
hat DIN sq. Ft. Floor Area . - Valuation
(commencing with Section 7")of Division 3 of the Business and Profess
,,,,hot he is exempt therefrom and the basis far the alleged exemption.Any violation
of Section 70315 by any applicant for a permit subjects the applicant to a civil penalty
ornot�mrm mar rvenamaredeolmea(5s(gp, APN Number Occupancy Type
El $7300- ,
i,net
wore. eed finsole(Sm.7Wn, - , ,
$7300,-
will do me work.and ns ode:11n,is oat (mended or offered Ibe snot(sal.71N4, - - -
:wneee..and Professions Cdso:'flmrover thereon,and
Law ssuamork bine an -. - 'Required•Inspections '
ofpropertylm,oa em nmw.m ir.dred II.,such and woe doe.rc n wink ni d.1 31 602094. 00
wit
m through My own employees. building
that such vera.m is of am not intended of .
udbred for sale.If,however,me having or improvement n sold within one year of •'
' nn,pldion,the owner-builder will have the M1UNen of proving that he did urn build or - -
impmveforpurporeofsale.).• - 305 — FRAME
❑I.as owner oftne property,amcxelusively coarcting with licensed conuanor 1. 307 — 1NSUl_ATT.ON -
construct the pmjw(Sec.70,11,1.Business and Pmfesions Cedn)The t3mwntru" .
License law does not apply to an owner of pmpmy who builds or improve,themon, - 601 — ROOF 1-EAR OFF' . - ..
and who mitres(or such projects wish a commands)been.md pursuant In the -
Contmcto„LicenseLaw. 602 ROOF GI_YLJOOD PIAII_ .
131 ani exempt under Ser. ,B&P C for tbi ,ctlln
6,017, -. RGOF• BATTENS'
I. aw,ef :an10 ROOF
Omf Y' f1
WORKER'SC(1M11P1iNSAI'IUN I3r.CLARATION 604' �',- RCJF - .T.N— ROGP.ESS '
I hereby allirm under,penally of Perjury one of the following declarations: -
❑ 1 have and will maintain a Certificate of Consent to.elf-insure for Worker's 'I
Compcmmtion, us pmvi&d for by Section 3701 of the LnMn Code, for the
performance of the work for which this permit is mvwd.
y.�1 hare aN wiR"amnio Worker's Compensation Imamate,as"I iced by Section
/39W of the Labor Lath,for the perfnrnunm of the work focwbich this pcon it is r -
issued.My Workers Compensation Innrence CB trier
and Policy numbeerr am:
comd,.AY e; G•'1 •Policy Nn: 56ROD�2. bl 't ,
CERTIFICATION OF 4XIiM1410N FROM WORKERS'
-'COMPENSAI'RN INSURANCE
(Thk sectimt necd'net M1c enmplemA II tau permit iv nor one Hundred dollurs
(Y llgll oNms.) �
I certify that in the perfumnance a the work for which this permit is issued,I • ,
shell not employ any pecom in anyrammer no as to become subject to the Winkad _
Compensation laws of California.Date
Applicant -
NOTICETOAPPLICANT:If.afrnnnvking thisGenian of Exemption,you should
decome subject m the Workers Cnmpenpro
vuluen visions of the Labor Ctule,you must -
G OO limhwuh comply with sueti provisions or this permit shall be deemed-Inked. a
G7 w
F CONSTRUCTION LENDING AGENCY ,
ai I terra,toll...I don then, n.tt f Ind' g agency nor run pert n,nee _ • ,
�
G>:1 ofd work which Our lu rots vu A(Src 3097 Civ.C) - "
Q I. Nom' z 1.t Iv e vAJAress �
U O
I mg agree
that I
c.. aJ this 11voy, adc county
role find the 'no-,re ,t lis _
OW U nto bank 1ggree mco plan 'heall muuninmmy.oN Han J tet tawser upo6 , -
t> the Anoe-conimnedrpNherebyavmnrixmpsof thisatymenmr arum
} fy the nMvcmemmned pmpcuderoul,and inspection purposes.
Immure -
0. (N'el agree m sate,and a,ow,ala huday to the way.C..erg o against
said
• Vi liabilities,sertenms,core and expenses which may in any way accme again..sail _ ['
[„)
City :cd encetfnegnnmgDofthis WILL CO _ .
API LICANIUJLATh0ANDSAND WILL COMPLY WITHALLNON/.POINT Issued by: DBIC
S(IURC RfGULATIO ��, y - -
vi fnpplearl?Connclnr, D,m
HAZARDUI3 AI IIRIAI.S DISCLOSURE
Will m opplamoor n lonildin, .cpausmremharn horom , off"ill Type of Roof t
n lel nod ny the Capers nn Muti c'pul C Nc.Ch,prof 9.12,and the Hcuhh and S.Jdy -
Ctsle,Scnion 2553200"
a Oyes " All roofs shall be inspected prior to any roofing material being installed. '
Will theappncamorfmtrewamng«'eapan,use cyaipmeatmdcvicn,wNch If a roof is.installed without first obiaining an inspection, I agree to remove
emit hourdous air contaminant,as defined by the Bay A.Air Quality Management
District? – all"new materials for inspection. Applicant understands and will comply'with
1 °Yes }/ all non-point,source regulations.
I have cad he n buts note,ml,merimnars underChtfuc,6.93 of he •
Clr {Slth&Sfty Cml,S err :2550525533 yd 2por,hl lyJ n 'ndtme -
Itl 1 tI II tle. to tl h ,rot ant , q
w:. neap t rdereta r1 ,ttnc ,ctPH" xn Censmor
°c°`p'"y' gnature of'Applican - ` , Date
fur awhodeed agent All roof coverings to be Class`Br' or better
O Uate 6 r
OFFICE .
CITY OF CUPERTINO '
CONTRACTOR INFORMATION:
f. QUILDING DIVISION PERMIT ;
BUILDING ADDRESS: . ' PERMIT NO.
20200 LUCILLE 'AV CAR 29- 34 ROYAL ROOFING 01050033 -
OWNER'S NAME: • APPLICATION SON DA'1'G
TRAMMF_LL CROW- RES. . 8F_RV CF_ 1345 VANDER WRY T 05/03/2001
., _• I'IIONIi: ^Y a 1Ap� }. 5•• SANITARY NO. 'CON'I'ROLNO
�'(4 08)27.9,-2332 ..
a o ARCHITECUENGINEER: BUILDING PERMIT INTO.,
mF BLDG ELECT ' PLUMB Mr:CH
.,u
traN l
a LICENSED CONIRACI OR'S DECLARATION
oz$E Iherehyamrm than lam liccnwd under provisions of Chapmr9(commeard., 10b.DCSCrIptlOn
�_t; withS r 7000)of 3 of B .:andProfes.ionsCode.andmyncemm REMOVE SHRKES,.
I n tall I ce v R t
E�rc a 'L 1 a 7(,4' 3�—f l-n -
xI, 3
a°LL y Dat c n1T IVSTAI_L ] /?" CDX &,
ARCHI1'1 C9 S UI CI AH
�yp°g a II,ler,t,rdmypl r,sh,ube,nedaxpvh emnrds ��� LED "''',30- YR. CERTAINED "'SHINGLE s
a�oo I.ie II f: -
OWNER BUILDER DECLARATION
I hereby affirrat that 1 am excield front the Connector"act License L``��fftt1D}.vt�Im 4 2002 .
ti< following reason (Section 703L5Itu,inetsand Pmfessom Cuk Any ciy Flltint
5 2❑ which oriuma,a permit m cnnatrvel,eller,improve,demolish,or mpuir uny simcmrc
x°613$ prior to its issuance.also myuires the applicant lm such permitto file v signed sm¢ment
that he is limnuJ pursuvnno me pmvisitn>of NC Comrecmrs License 1.13
hat DIN sq. Ft. Floor Area . - Valuation
(commencing with Section 7")of Division 3 of the Business and Profess
,,,,hot he is exempt therefrom and the basis far the alleged exemption.Any violation
of Section 70315 by any applicant for a permit subjects the applicant to a civil penalty
ornot�mrm mar rvenamaredeolmea(5s(gp, APN Number Occupancy Type
El $7300- ,
i,net
wore. eed finsole(Sm.7Wn, - , ,
$7300,-
will do me work.and ns ode:11n,is oat (mended or offered Ibe snot(sal.71N4, - - -
:wneee..and Professions Cdso:'flmrover thereon,and
Law ssuamork bine an -. - 'Required•Inspections '
ofpropertylm,oa em nmw.m ir.dred II.,such and woe doe.rc n wink ni d.1 31 602094. 00
wit
m through My own employees. building
that such vera.m is of am not intended of .
udbred for sale.If,however,me having or improvement n sold within one year of •'
' nn,pldion,the owner-builder will have the M1UNen of proving that he did urn build or - -
impmveforpurporeofsale.).• - 305 — FRAME
❑I.as owner oftne property,amcxelusively coarcting with licensed conuanor 1. 307 — 1NSUl_ATT.ON -
construct the pmjw(Sec.70,11,1.Business and Pmfesions Cedn)The t3mwntru" .
License law does not apply to an owner of pmpmy who builds or improve,themon, - 601 — ROOF 1-EAR OFF' . - ..
and who mitres(or such projects wish a commands)been.md pursuant In the -
Contmcto„LicenseLaw. 602 ROOF GI_YLJOOD PIAII_ .
131 ani exempt under Ser. ,B&P C for tbi ,ctlln
6,017, -. RGOF• BATTENS'
I. aw,ef :an10 ROOF
Omf Y' f1
WORKER'SC(1M11P1iNSAI'IUN I3r.CLARATION 604' �',- RCJF - .T.N— ROGP.ESS '
I hereby allirm under,penally of Perjury one of the following declarations: -
❑ 1 have and will maintain a Certificate of Consent to.elf-insure for Worker's 'I
Compcmmtion, us pmvi&d for by Section 3701 of the LnMn Code, for the
performance of the work for which this permit is mvwd.
y.�1 hare aN wiR"amnio Worker's Compensation Imamate,as"I iced by Section
/39W of the Labor Lath,for the perfnrnunm of the work focwbich this pcon it is r -
issued.My Workers Compensation Innrence CB trier
and Policy numbeerr am:
comd,.AY e; G•'1 •Policy Nn: 56ROD�2. bl 't ,
CERTIFICATION OF 4XIiM1410N FROM WORKERS'
-'COMPENSAI'RN INSURANCE
(Thk sectimt necd'net M1c enmplemA II tau permit iv nor one Hundred dollurs
(Y llgll oNms.) �
I certify that in the perfumnance a the work for which this permit is issued,I • ,
shell not employ any pecom in anyrammer no as to become subject to the Winkad _
Compensation laws of California.Date
Applicant -
NOTICETOAPPLICANT:If.afrnnnvking thisGenian of Exemption,you should
decome subject m the Workers Cnmpenpro
vuluen visions of the Labor Ctule,you must -
G OO limhwuh comply with sueti provisions or this permit shall be deemed-Inked. a
G7 w
F CONSTRUCTION LENDING AGENCY ,
ai I terra,toll...I don then, n.tt f Ind' g agency nor run pert n,nee _ • ,
�
G>:1 ofd work which Our lu rots vu A(Src 3097 Civ.C) - "
Q I. Nom' z 1.t Iv e vAJAress �
U O
I mg agree
that I
c.. aJ this 11voy, adc county
role find the 'no-,re ,t lis _
OW U nto bank 1ggree mco plan 'heall muuninmmy.oN Han J tet tawser upo6 , -
t> the Anoe-conimnedrpNherebyavmnrixmpsof thisatymenmr arum
} fy the nMvcmemmned pmpcuderoul,and inspection purposes.
Immure -
0. (N'el agree m sate,and a,ow,ala huday to the way.C..erg o against
said
• Vi liabilities,sertenms,core and expenses which may in any way accme again..sail _ ['
[„)
City :cd encetfnegnnmgDofthis WILL CO _ .
API LICANIUJLATh0ANDSAND WILL COMPLY WITHALLNON/.POINT Issued by: DBIC
S(IURC RfGULATIO ��, y - -
vi fnpplearl?Connclnr, D,m
HAZARDUI3 AI IIRIAI.S DISCLOSURE
Will m opplamoor n lonildin, .cpausmremharn horom , off"ill Type of Roof t
n lel nod ny the Capers nn Muti c'pul C Nc.Ch,prof 9.12,and the Hcuhh and S.Jdy -
Ctsle,Scnion 2553200"
a Oyes " All roofs shall be inspected prior to any roofing material being installed. '
Will theappncamorfmtrewamng«'eapan,use cyaipmeatmdcvicn,wNch If a roof is.installed without first obiaining an inspection, I agree to remove
emit hourdous air contaminant,as defined by the Bay A.Air Quality Management
District? – all"new materials for inspection. Applicant understands and will comply'with
1 °Yes }/ all non-point,source regulations.
I have cad he n buts note,ml,merimnars underChtfuc,6.93 of he •
Clr {Slth&Sfty Cml,S err :2550525533 yd 2por,hl lyJ n 'ndtme -
Itl 1 tI II tle. to tl h ,rot ant , q
w:. neap t rdereta r1 ,ttnc ,ctPH" xn Censmor
°c°`p'"y' gnature of'Applican - ` , Date
fur awhodeed agent All roof coverings to be Class`Br' or better
O Uate 6 r
OFFICE .