01050055 CITY OF CUPERTINO
nmLmNG DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING Al)`TJ28 PRIMROSE WY .TIM KRAUSE ROOFING PERMrr NO,
01050055
OWNER'sNnm UZUKI' NOEL N. AND JUDY M E31.@ DIANA AVE nrrLlcArl"Ni�°1103/2 01
PHONE: (408) 779-0704 SANITARY NO. CONTROL NO.
❑n'Z ARCIII'IP.CDIiNIIINIiIE: HGd.GItNG PERMI'1'IN17O
yOI O 1 iAxll LLEC'I' PLUMB MUCH
(j wt 1=1 LUI IJ r-1
G
y= hICliNtiiiD CONTRAC!(lR'S DECLARATION Job Description
pZ 4 O heresy nlGnu Ihm lure Ii,Anad undid pmvi,io t,of Chuplmr 9(,ommcnemi;
F" with s,ainn 7agm Di,i,mn 3"1 lie lb"mea..and rrnf o:,C:dc.und lily iiecn." 'f/0 SHAKES.
��a< ,°^° ir"I'dCti �9 RESHEET 1/2" CDX R 30 YR. FELT &
o i° Ube_Io j commnm
ARC1111''t, OEC ARATION — — 40 YR. CELOTEX COf1F'. SHINGLES.
t ib°,� I undcowad my plans d:dl he used a.,probe Acord,
d <$ Licensed Profc,annel
OWNER-Ii U11JAiR DECLARATION
=' 1 hereby atHnn Ism I am creopt from IM Con facto',License Law for the
F following reason.(Section 7031.5,Business and professions Cure:Any city or county
s F c hich requiresiscrout Io construct,aller, p 1 r,n or repairany structure
ire pr: N W 'l 'nh� t 11 Imo g ,Iwe nen
moll I dlornII the po,i,I of he Counneado,4 License Low(Chatted Sq. Ft, Floor Area Valuation
(commencing with Section 700b of Dr.eimt 3 of the Ensue.,and Prolec,ion,Code)
or that he is exempt Exemptions and the Iasi,for the alleged esemption.Any violation
of Section 7031.5 by any applicant for a permit subjects the applicant m u civil penalty
ill tot room man to,hundred delmr,($500Y APN Number Occupancy�@@@
Typp
S1� e
❑I,to owner lir dm Epaty.lir my clopiny,,,wits verge,a,thmh,ole ellttpn,mntlt.
will do the work,and oIhm structure i,nal intended or offered for sale(Sec.71H4,
Brollies and Profession,Code:The contractor',I.iceaw caw doe.,nor apply In an 1 8@@9 R�cRlired Inspections
ner of ppcny Who builds or improves memo and who does such work himself 366 II�O
ocam
f mrorgh he we employees.provided that such improvements me not intended or
on'emd fors,,II:however Ino build'mg or unproven 1.1 1,sold within ante Year of
nnpledon.theowmr-builder willbavomehrmennfvm.msmmhedid lot brBdor 3@5 — FRAME
un
f.r prgrse nLwle.).
01 fthc proper, 1 ai IYcontractingwithlicensed contractors to 307 — INSULATION
rn:I I thep )cl(s 7141 B d I rte:i r,Cd ., @e contractor, 601 — ROOF TEAR OFF wyS
License I does Ply t lir I a pnY I t ) IJ' P c,lto it ��
: it I does ) I. w II I I (,)1 ve,fee m, _
Coublicoc,Loch,lye„ pj ' - 6@2 ROOF PLYWOOD NAIL
O lam exempt under Sec. .use p e for his rear 603 — _ROOF BATTENS
Owner Date 604 — ROOF IN—PROGRESS 7
WORKER'S COMPENSATION I)FCLARATION
I hereby union under penally of perjury one of the following declaration, D/
. 0 1 have and will nminmin a Cenipcme of Comsenl Io sdr-inmre for Worker's
Contpmation, an pmviJW for be Sccant 370() of the Labor Code, rill the
prfumlattice.1 he work for which This pcolor i,lobed.
k_Q1tI haver and will nminmin Worker's'Contpn,atlon In.wranec,n,required by Section
l]'.)ul the WMn C d,for the rerl'nmmnce of the work for which this pnnir i.,
issued.My Workers Compensation In.sumnce carrier and Policy number are:
Currier:_ _Policy No,:
CliI(I'IFICCCA'I ON OF EXEMPTION FROM WoRK17RS'
COMPHNSAI ION INSURANCE
(Thi,section need not be complete)if the pnnir is for one hundred dollar
(SI00)or less.)
I ,oir,Bou n tlw l....b
ttce of the work for which this i h „red,I -
ehull not employ boy Person in any nntnner a,m or hcenme,nhjcat to the Worker,
con"o,olion i of Cdifnmia.Date
Applicant
Not ICE'1 O APPLICANT.If,once making this Cenilicate of Exemption,you should
lmconm subjcc ,,the Worker's Congtcmntion provisions of the Labor Clde,you nr.I
Qfunhwith cntnply will x,,,h trust,:.....or Ihi,pnnir x1,11 hedccnmd Avaked.
FCONSTRUCrioN LENDING AGENCY
I hereby o iem that them i,a construction lending agency for the prfomumce
W of the work for which Ihi,pnnir is issued(Sec.3017.Civ.C.)
❑ LenJcr's Nam,
5 z Len der',Addrl,
V 1 rectify Thal I have mail Ihi,application and slam that the above information i,
coma.1 agree,m contply with aft city and county onllnance,and nate law,retain,
U rebuildingronmruaion,and herehy until representatives of this city rt enter upon
Lti the shovcmenlioncd pmpny for inspection purpose.
y (We)agree at save,indmnnily mW keep hnnnlc,,the City of Cupertino against
tZ) lialublic,,judgmm..is,coot,and expense,which nl:Iy In any way acrrbu a,......,hid
V z City in eon T UNDERSTANDS
of do,TAgranting of this pnnir.
SOURCAM UNIIIiRSTANIIs 's WILL CUMI'.1'WITH ALL NO'}'I'C NT Issued by: Date
SOURCE REGULATIONS S/�!IO�—
signal vol Applimum2optacm- — 1/Ire Re-roofs -
IIA2AR000S n'lERItAIS IIISCLOSUIiB
Will dr,apphr; ar farm nuildingrecupnm oomor handle hwallous materia/ Type of Roof
e detined by the Cupnino Municipal Code Chapter 1.12.and me Health and Safety
Crile.Section 255320)'!
oyes All roofs shall be inspected prior to any rooting material being installed.
will dm:prpintn lir ullor,build'illg neeo ,ion tt,ecgbgomcm mdevi,e,whhlt If a roof is installed without first obtaining an inspection, I agree to remove
."blaln
rnNou,sir oontatninanl,:u'detlne ny th,[toy Amu AirVwlly Mnnugnncnl
Diarl"! all new materials for inspection. Applicant understands and will comply with
h
0Y, all non-point Source regulations.
Itr ' ads h C autumnal, 4 n CI'pt 695 rte, / p
Caleb ' H l IIh ffi, Ir C S sir '25511i 21533ly 1,loo, I a ,tire r]' V�p
illi Id bJ,x,n II>1. •lit tth t't':Iny p .1 C ,aneof 3
c Pam of the rc m t,whh muq M amt poor no nsuanw ora Ccnirc:ec al
(xcr
r Signature of Appli ant Date
s/3��/
1Twlt,r...natlmr cd:Ig—til D t, All roof coverings to be Class "B" or better
OFFICE
CITY OF CUPERTINO
nmLmNG DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING Al)`TJ28 PRIMROSE WY .TIM KRAUSE ROOFING PERMrr NO,
01050055
OWNER'sNnm UZUKI' NOEL N. AND JUDY M E31.@ DIANA AVE nrrLlcArl"Ni�°1103/2 01
PHONE: (408) 779-0704 SANITARY NO. CONTROL NO.
❑n'Z ARCIII'IP.CDIiNIIINIiIE: HGd.GItNG PERMI'1'IN17O
yOI O 1 iAxll LLEC'I' PLUMB MUCH
(j wt 1=1 LUI IJ r-1
G
y= hICliNtiiiD CONTRAC!(lR'S DECLARATION Job Description
pZ 4 O heresy nlGnu Ihm lure Ii,Anad undid pmvi,io t,of Chuplmr 9(,ommcnemi;
F" with s,ainn 7agm Di,i,mn 3"1 lie lb"mea..and rrnf o:,C:dc.und lily iiecn." 'f/0 SHAKES.
��a< ,°^° ir"I'dCti �9 RESHEET 1/2" CDX R 30 YR. FELT &
o i° Ube_Io j commnm
ARC1111''t, OEC ARATION — — 40 YR. CELOTEX COf1F'. SHINGLES.
t ib°,� I undcowad my plans d:dl he used a.,probe Acord,
d <$ Licensed Profc,annel
OWNER-Ii U11JAiR DECLARATION
=' 1 hereby atHnn Ism I am creopt from IM Con facto',License Law for the
F following reason.(Section 7031.5,Business and professions Cure:Any city or county
s F c hich requiresiscrout Io construct,aller, p 1 r,n or repairany structure
ire pr: N W 'l 'nh� t 11 Imo g ,Iwe nen
moll I dlornII the po,i,I of he Counneado,4 License Low(Chatted Sq. Ft, Floor Area Valuation
(commencing with Section 700b of Dr.eimt 3 of the Ensue.,and Prolec,ion,Code)
or that he is exempt Exemptions and the Iasi,for the alleged esemption.Any violation
of Section 7031.5 by any applicant for a permit subjects the applicant m u civil penalty
ill tot room man to,hundred delmr,($500Y APN Number Occupancy�@@@
Typp
S1� e
❑I,to owner lir dm Epaty.lir my clopiny,,,wits verge,a,thmh,ole ellttpn,mntlt.
will do the work,and oIhm structure i,nal intended or offered for sale(Sec.71H4,
Brollies and Profession,Code:The contractor',I.iceaw caw doe.,nor apply In an 1 8@@9 R�cRlired Inspections
ner of ppcny Who builds or improves memo and who does such work himself 366 II�O
ocam
f mrorgh he we employees.provided that such improvements me not intended or
on'emd fors,,II:however Ino build'mg or unproven 1.1 1,sold within ante Year of
nnpledon.theowmr-builder willbavomehrmennfvm.msmmhedid lot brBdor 3@5 — FRAME
un
f.r prgrse nLwle.).
01 fthc proper, 1 ai IYcontractingwithlicensed contractors to 307 — INSULATION
rn:I I thep )cl(s 7141 B d I rte:i r,Cd ., @e contractor, 601 — ROOF TEAR OFF wyS
License I does Ply t lir I a pnY I t ) IJ' P c,lto it ��
: it I does ) I. w II I I (,)1 ve,fee m, _
Coublicoc,Loch,lye„ pj ' - 6@2 ROOF PLYWOOD NAIL
O lam exempt under Sec. .use p e for his rear 603 — _ROOF BATTENS
Owner Date 604 — ROOF IN—PROGRESS 7
WORKER'S COMPENSATION I)FCLARATION
I hereby union under penally of perjury one of the following declaration, D/
. 0 1 have and will nminmin a Cenipcme of Comsenl Io sdr-inmre for Worker's
Contpmation, an pmviJW for be Sccant 370() of the Labor Code, rill the
prfumlattice.1 he work for which This pcolor i,lobed.
k_Q1tI haver and will nminmin Worker's'Contpn,atlon In.wranec,n,required by Section
l]'.)ul the WMn C d,for the rerl'nmmnce of the work for which this pnnir i.,
issued.My Workers Compensation In.sumnce carrier and Policy number are:
Currier:_ _Policy No,:
CliI(I'IFICCCA'I ON OF EXEMPTION FROM WoRK17RS'
COMPHNSAI ION INSURANCE
(Thi,section need not be complete)if the pnnir is for one hundred dollar
(SI00)or less.)
I ,oir,Bou n tlw l....b
ttce of the work for which this i h „red,I -
ehull not employ boy Person in any nntnner a,m or hcenme,nhjcat to the Worker,
con"o,olion i of Cdifnmia.Date
Applicant
Not ICE'1 O APPLICANT.If,once making this Cenilicate of Exemption,you should
lmconm subjcc ,,the Worker's Congtcmntion provisions of the Labor Clde,you nr.I
Qfunhwith cntnply will x,,,h trust,:.....or Ihi,pnnir x1,11 hedccnmd Avaked.
FCONSTRUCrioN LENDING AGENCY
I hereby o iem that them i,a construction lending agency for the prfomumce
W of the work for which Ihi,pnnir is issued(Sec.3017.Civ.C.)
❑ LenJcr's Nam,
5 z Len der',Addrl,
V 1 rectify Thal I have mail Ihi,application and slam that the above information i,
coma.1 agree,m contply with aft city and county onllnance,and nate law,retain,
U rebuildingronmruaion,and herehy until representatives of this city rt enter upon
Lti the shovcmenlioncd pmpny for inspection purpose.
y (We)agree at save,indmnnily mW keep hnnnlc,,the City of Cupertino against
tZ) lialublic,,judgmm..is,coot,and expense,which nl:Iy In any way acrrbu a,......,hid
V z City in eon T UNDERSTANDS
of do,TAgranting of this pnnir.
SOURCAM UNIIIiRSTANIIs 's WILL CUMI'.1'WITH ALL NO'}'I'C NT Issued by: Date
SOURCE REGULATIONS S/�!IO�—
signal vol Applimum2optacm- — 1/Ire Re-roofs -
IIA2AR000S n'lERItAIS IIISCLOSUIiB
Will dr,apphr; ar farm nuildingrecupnm oomor handle hwallous materia/ Type of Roof
e detined by the Cupnino Municipal Code Chapter 1.12.and me Health and Safety
Crile.Section 255320)'!
oyes All roofs shall be inspected prior to any rooting material being installed.
will dm:prpintn lir ullor,build'illg neeo ,ion tt,ecgbgomcm mdevi,e,whhlt If a roof is installed without first obtaining an inspection, I agree to remove
."blaln
rnNou,sir oontatninanl,:u'detlne ny th,[toy Amu AirVwlly Mnnugnncnl
Diarl"! all new materials for inspection. Applicant understands and will comply with
h
0Y, all non-point Source regulations.
Itr ' ads h C autumnal, 4 n CI'pt 695 rte, / p
Caleb ' H l IIh ffi, Ir C S sir '25511i 21533ly 1,loo, I a ,tire r]' V�p
illi Id bJ,x,n II>1. •lit tth t't':Iny p .1 C ,aneof 3
c Pam of the rc m t,whh muq M amt poor no nsuanw ora Ccnirc:ec al
(xcr
r Signature of Appli ant Date
s/3��/
1Twlt,r...natlmr cd:Ig—til D t, All roof coverings to be Class "B" or better
OFFICE