01050039a
'CITY OF CUPERTINO-':
CONTRACTOR INFORMATION:
BUILDING DIVISION ;. PERMIT
BUILDINGADDIV., ':� -
ct6200 LUCILLE AV. -CAR 45--61'
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- ROYAL ROOFING
PERMIT NO. t-
01,050039,
OWNER'S NAME ' -
APPLICATION SUB DA'I I3
TRAMMELL•CROW,RES. SERVICE,,-
1345 VANDER WAY.:,
05'/'03/2001 i
PHONE: -
SANITARY NO. ' .CONI 'ROI. NO
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ARCHITECfENGINEF.R: -
BUILDING PERbfllINPO
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- BLDG ELECT' PLUME, MECH
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LICENSED CONTRACTOR'S DECLARATION
Job Description
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I hereby aEirea Inn, 1 am licensed under provisions of CM1apmr 9 (tt,mmeacitg
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with Section]W0) of Division 3 or the Business and Professions Code, and my license
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REMOVE SHAKES,
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Li"n cl« c"
Dane �jJ Comnuwr"a
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INSTALL. 1/v="' CDX 8
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,- lundemand my plan CAvll lc .sed npu licArtcnnk
FIN AL;EMYR, CERTAINTEED SHINGLE.
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Licensed Professional _
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OWNER -BUILDER DECLARATION
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JAN ,t gQOZ
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1 hereby affirm than I am exempt from the Convenor's Idcenm Low for the
following reason. (Section ](131 S, Business and Professions Coi Any city ar county
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which requires a permit to conswet, alma irnpmve, demolish, nr repair any svenum
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-pnonoiis issuance, also requires the applicant lonotch pennitto file a signedsmmmem
BUILQINaloorArea
.Valuation
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thatheislicensed pursuant mthe pnwi.sionsurine Contractors License Law (Chapter4
(mmn,encing with Senian]IXI0)nf Division lar the Ruxincss and l'm(e..iads Cartel
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or that he is exempt themfnnn and the basis for the alleged exempt inn. Any violation
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of Section ]031.5 by any applicant for a permit subjects the applicant m u civil penally
of not inure than five hundred dollars (s501). ..
APN Number -
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Occupancy Type '
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'''d ... $7300
01. r—orraoflh P peso Y can,loi with wages v the' c prm.mon
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Required Inspections -
t will do the k d the suracturic is not Intended or offered or sac (See ](N4,
'.B d P des: C I rh Lce,se d to
C,mrvuor's t pply an
owner of prof Whoh Ids or , aproncs thereon,and who does such work hi velf
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31, 602094 00
othrnugh his own employees, provided that such improvements arc not intended or
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offered for sale. If, however the building or iinptnve neat is sold within one year of
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-n,midetion, the i"it" midst will have the hurden est proving that fecal not build or
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improve for purpose ni stall.),
.305 — FRAME
o i; os owner ort6o pi son asel'sively contracting said, licensed Ouram"hre m
307 — INSULATION
%n- i nthei j, (S ]1144 B I P L I 'I n C ,mcu 'x
m Lewslue,oul' builds iniTooses there(,..
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�. 601 ROOF TEAR OFF
Myo.an owne—fipreparly who
and ( t, f 1 sic rs with a ma rix) licensed Pursuant m rbc
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"� !' 602 — ROOF PLYWOOD NAIL _
•❑ Ian excmmrude, Sce If& P C for l hi.lounen
f,03..:— ROOF•BATTENS -
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WORKER 5 COMPI3NSNSAI'ION I3ECLAIiA'1'ION
604 -' ROOF IN—PROGRESS
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I hembyeffinn, under pc 1'Y l rjoryouseefffic l II 16 1 t .. -
I13 1 and will bainuain a Ctic, ICoastal it) ell insure lot Wker-
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Co p t n as provided l r by Section 37011 or the Labor Code for the
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once ul the su it, for which this perp 1 s' ,sued,
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qr, have and will maintain Worker's Qunperi a0nn Insurance, as requital by Seelion
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3](10 of the Labor Code, for the perfnnnance of the work for which this permit is
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issued. My Worker's Comprnsanion Insurance earner and Policy number arc�:/1n�
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Cmricr:� A-tJr,' CY 4 policy Nm,:,rj 1'3Y Off _! ev er
CERI'IFICXUON OIs EXEMI1f1ON FROM WORKERS'
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' COMPLNSA'1'ION INSURANCE
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(This senion need not be completed if the permit is tin one hundred dollars
(This
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I certify than in the perfnm,ance of thu wad for which tM1ia pem,it is iwued, I
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spall Bat employ any penin in any manner w as m became subject to the Waders'
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Compensation Laws of California. Dam
Applicant
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NOTICE TO APPLICANT: If, after making this Certifiateof Exn„pnon, you should
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become Subject o the Workers L'ompensotion provisions of the Labor Code, you moat
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forthwith eomply with such provisions or this permit shall be deemed rtvokad.
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CONSTRUCTION LENDING AGENCY
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herby affirm that them is a construnion lending agency for the perfam,ance
of the work for which this permit is issued (Sec. 3(07, Civ. C.)
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Lender's Namc
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Lender'=Address -
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1 ocrtify, that 1 have mad this application and stale but the above information rs
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correct. 1 agree to comply with all city and county ordinances and some laws relating
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to building construction. and hereby amhorim repre.vnm,ivn of this city to enter upon
,he mMwe-memioned pmpeny for inxpec,inn
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sane. ind,nnify and keep harmless he City of Cupertino against
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liahilities, judgments costs and expenus which may in any way accrue against said
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City in ennmqucnce or the granting of this permit.
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APPLICANT UNDERSTANDS AND WILL COMPLYWITH'AL/I NON-I'OINT
SOUR E REGULATIO
--Issuedb /T// Date
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Re -roofs - -
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anti of AppLcanucurractnr 1lulc—
• IIAZAR ATERIAI.SDISCLOSURl3-
WII the applicant Imre houlding sampan, emu or handle hmmdnas nan,had
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Type of Roof
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as defined by the CuIrertino Municipal Code. Chapter 9.12. and the l lealt Wand Surety
Code, Section 25532(uy' r '
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All roofs Shall be inspected prior toany roofing material being installed.
.Will the applicant orfuture m,pd! vacepanluse c4nimrea,ordevie v id,
If roof is installed without first obtaining an inspection, I agree to. remove
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cialll I , t. as defiadby theIf yAmu Airy lityM ,g s n,
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all new materials for inspection. •Applicant understands and will comply with'
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all non -Din[ s ns.• source regulatio
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1 love read the I e,a d rateeirial, re,numances nall Ch pt 6.95 to the,
California Heallh & NallayC 1 Sections 25505.25533pral2.15341,n1r'On1 tui
'vt the h l l bd t ,ly basicat t 11 t ,y 1 '1 I,y, dy h,
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Pum f,I r garter as wbd, err, atp a t, a ,I Cenlr t d
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mature of Appli Date
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�:_ All roof coverings to belGass or better
ter imhari'M ageo, Date
. .. k .OFFICE." ..