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09090189 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7733 LILAC WAY CONTRACTOR:KNIGHT ROOFING PERMIT NO:09090189 SERVICES 'r"VNER'S NAME: CONLAN ROBERT L AND HELEN M 42035 OSGOOD RD DATE ISSUED:09/25/2009 4NER'S PHONE: 4082523933 FREMONT,CA 94539 PHONE NO:(510)438-9077 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT f— PLUMB r License Class Lic.#_I_ y�Ut� MECH r– RESIDENTIAL r COMMERCIAL Contractor i?1;1/�/ OF G JOB DESCRIPTION:RE-ROOF TEAR OFF SHAKE ROOFING. INSTALL I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business&Professions SHEATHING Code and that my license is in full force and effect. INSTALL CLASS A COMPOSITION SHINGLE 31 SQ I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance,as provided for by Sq,Ft Floor Area: Valuation:$11780 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:35904004.00 Occupancy Type: APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize representatives of this city to enter PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Issued Date: c`-*nature Date �G ❑ OWNER-BUILDER DECLARATION RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for the following two reasons: inspection. 1,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044, Signa re of Applicant: y Date: Business&Professions Code) av I,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.70441 Business&Professions Code). I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: 1 have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should 1 store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534. not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If,after making this certificate of exemption,I Ow r or au or ed agent: G become subject to the Worker's Compensation provisions of the Labor Code,I must Z Date: forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.) correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name to building construction,and hereby authorize representatives of this city to enter the above mentioned property for inspection purposes.(We)agree to save Lender's Address .mify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. Licensed Professional Signature Date CITY OF CUPERTINO 3 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 35904004 .00 DATE ISSUED. . . . . . . : 09/25/2009 RECEIPT ##. . . . . . . . . : BS000008769 REFERENCE ID # • • . : 09090189 SITE ADDRESS . . . . . : 7733 LILAC WAY SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : CONLAN ROBERT L AND HELEN M ADDRESS . . . . . . . . . . : 7733 LILAC WAY CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4208 RECEIVED FROM . . . . : KNIGHT ROOFING SVCS CONTRACTOR . . . . . . . : DAVID RICE LIC # 27646 COMPANY . . . . . . . . . . : KNIGHT ROOFING SERVICES ADDRESS . . . . . . . . . . : 42035 OSGOOD RD CITY/STATE/ZIP . . . : FREMONT, CA 94539 TELEPHONE . . . . . . . . : (510) 438-9077 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 11, 780. 00 1 .00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 11, 780. 00 1.20 0 . 00 1 .20 0 . 00 1REROOFRES SQ FEET 31. 00 403 . 00 0 . 00 403 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 405 .20 0 . 00 405 .20 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 823 .30 #11000 --------------- TOTAL RECEIPT 823 .30 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF v�� 9Ui �� CITY OF CUPERTINO REROOF CUPEkTINO PERMIT APPLICATION APN# ��v Date: 9-9-09 Building Address: 7733 Lilac Way Owner's Name: Helen Conlan Phone #: 408 252 3933 Contractor: Knight Roofing Services Phone #: 510 438 9077 Fax #: Cupertino Business License #: 27646 Contractor License #: Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles 9 Asphalt Shingles vi Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other(Specify) ❑ Other(Specify) Number of existing coverings 1 Q Provide I.C.B.O. Report # 0 To be Removed ❑ Provide Mfgr. Installation Specs. Job Description: Tear off shake roofing . INstall sheathing . Install Class A Composition Shingle . 31 Sq . Residential ® Commercial Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if there are any restrictions: ❑ Valuation: $ 11 780 I Have Read, derstand and Will ply with Cupertino's Tear-Off Policy: Signature