01050040f't. PY OF CUPFRTINO
BUILT NG DIVISION PERMIT
BUILDING ADORES: '
20200.,LUCILI-E AV C 1.13-
OWNIiR'S NAME: `
TRAMMELL_ CROW RES. SERV
PHONE:
= O 0 ARCHITEC'IIENGINEIR:
�UC
�6U
Z N z LICENSED CON]'RACIOR'S DECLARATION
O - C Thereby o iron that I am licensed under previsions of Chapter 9 (commencing
with Section 7") of Dietitian n of the Rust nesn and Profession, Cole, and at, license
6 ,j Is a full force apJ0 6�—p—
aG0 a. License (� - i,ic. M 7
a. V Dum �- Cnlllm LA _
�++ 3 w AHCfII'1'ECI'S ❑ECLNt ON
C a -e C I utie Iloced Iny plans shall hu meet as odlie need, .
_ v o Lineosel rmrncnlinm ,
S o ,OWNER-ltDI1DEN m the Ci DECLARATION
vi 1 mason.
on I am exempt from the motions Ca License city
rnr
follow(_ZQ which
sreuis a lernot t 7031.5. nici.t their,
Promotions Cnlc: Any city nr county
i S C which requires a pemsi, m ronswet, alma i t for such
demolish, or repair any ewewm
as this he islcemncpursuamgothemoi ll¢applianfthe Co perminoicese LawJuumnuni
that he in licenced munition she pf Di%im of the Commend Lind P law (Chapter miCod 9
(commencing with t therefrom
oro an of Division o if the Business geeand ion. Any ci Coley
or has heis31,5 by
merefrom:md the basis for she alleged optmmiinn. Any violation
of not
Ir L56y anyapplicunito, alkrmit nuhjeccs sac applicanuoacleat peachy
of nm more than use lundreJ dollars ISSINB. i
•. ❑Lits twimr ol'the propeny,Jnny employees with wages as heir nclo ouTemution,
r
,It do flue work.d he Chu,um is uq 1 J' offered r (Set.71144
B d r f i, C I Il c I I: L I 1 I PUy It 11l
orr of progeny Who h I t, o, npnry : dhim, n and wh . d such work h 1 self
mmugh us own employees. provided that such'inlprovemm¢ are not nnended ur
offered for ogle. If, bri,mer, the building or Improvement Is sold within om,car of
completion, she ocirrmhuiWer will huve the burden of proving that hedid not build or
improve far purposeof nate 1.
01, os mvncr of she pmpeny, am enclusivdy contracting with licensed connote mic to
consumer the project (Sm. 70,14, Business and Professions Code:) The Conmator's
License Law does not apply to tet owner it progeny who builds or improves hereon,
and who contracts for such projects with a conuocmnd licensed pursuum m ho
Cinwcurts I.iecnse Low.
C I tun cxenpr under Sec. . R & 1' C for this reason
Ovo e - IIAne '
WORKER'S Cc]MITNSA'I'ION DECLARATION
•
I beirch,'fion under penalty nl'pa.ri ry tthe rll ,d I' tit ::
❑ I leave and dl'maintain a Cedilcale of Cars in to self c In Worker's
ICon,cm,ittiort, a, havided f by Section 17M of the- Labor Code. f.. the
na
,serf e f the work for whimh this Permit is Issued
iyl7
leave and II maintain Worker's Compensation Insurance. as hosaired by Section00 of the Labor Code, for the perfirtmarm of the work for which this pent t is
issued. My Worker's C pen. I n Insurance comer and P Icy nmol r c
CONTRACTOR INFORMATION:
@ ROYAL ROOFING
:F_' 1345 •VANDER. IWAY
(408);2797-2332
aRhaT No.
01050040
PPLICATION all A' 1 '
5 Il/ 3l3% 2001 .
%NITARY NO. 7 CONTR(ILNO.
BUILDING PERMIT INFO
BLDG . ELECT PLUMB MECH
' Job Description -
'REMOVE SHAKES,
INSTALL 1/2" CDX &
30'Y.R, CERTAINTEED.SHINGLE.,,
NALeo
n,r -
v.0—ING
Ciro,,JJ' ,r. Cr h
CERTIFICAHONOEIi%EM111'10 RO WORKERS'
COMTENS A I' ION INS UIIANCE !. ,
(flits section need not he completed if he pennll in fiat one hundred delli-
' ISIlkll ar less)• -
1 minify that in he performance of the work for which his permit is issued, 1
shall not employ any person in any manner so as to become subject u) the Workers'
Compensation Laws of California. Data
Applicant
N(U ICE. TO APPLICANT:If. after making this Certificate of Exemption, you should
Neon object subject m he Worker's Cnm,semasion provisions of he L bar Code, you must
�Q 0 fnnhwith comply will such provisions ur Ibis permit shall be deemed revoked -
c^ Vi CONSTRUCI'If IN LENDING AGENCY
1 mob, ohrns mal farm Is u fonamintion IrnJing ugeney far the pshouniancc
i7i ry A he .,,,it or which thia pennll la minted (Sec. 1097, Civ. C.)
I.endo" Naris .
.� z Lmmeic Addrn.c' - 4
QIcertify het I have read Illi,h,bi,mion and,me that the above inter Inuou is
;:comet. 1 agree to comply with all city and county ordinances and owm laws reading
rJ to uildingeongmetion,uWhembyamhurirempmsenlali.esofshisciiymenierupnn
} k: the imme-memioned property fir impeeion Itimp o.
A. (We) agreem case. indemnify .uad keep harmless the City of Cupertino against
rn liabilities, judgments, costs and exlmnser which may in any way acerae uguiml said
C.7 z , City ,inconsequence " of the gmming of this permit.
n" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT - �
ISSuediby: Date
Re -roofs -
Type of Roof
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without'first obtaining an inspection, I agree to remove
all new materials for Inspection. Applicant understands, and Will comply, with
all non -point source regulations.
SA
Silgriature of Appli nt t bate
All roof coverings to be Class -"B" or better •-
Area
rfN INmuucr - occupant; I c.
8i,
Regqw�ired lnspection's
31.602094. CIA
305 - 1FRAME
307 - INSLILATION
601. - ROOF TEAR.' OFF
602 ROOF PLYWOOD NAIL'
603. -' ROOF .BATTENS,
EtZl4 ROOF `IN -PROGRESS.'
i
WIII We upPlicuni or fuuirc' hifJ�liny omgmni s,...e m hamlle huvarJous nam"al
us defined by she Cupmimi Municipal Code, Chapter 9.I n, and the l leylth and Safety
Code, Section 25532fo)7
❑ Yeo
Will he appiicmit or fm re building iecupmt use equipment or device.+ which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
Diq e0
I ❑Yea No
1 Ir d m h zI J e l ml requirements 2J Ch punderstand
O5 of the
G f II to
& S f Iy C Je Sectors n , d under
C i I nJ ihaL
II'd h II g dose hot currently hvcareturn[. tht t. my .m slbil lady Ric
ap f they Il a is which at , he owl ani no'c wort Cmh c le 0
u pi icy.
.gear
OFFICE