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R-6540 0 PERMIT R_ 6540 APPLICATION FOR CITY of CUPERTINO NUMBER INSPECTION DIVISION . .PERMIT EXPIRATION - REROOFPERMIT (408) 777-3228PERMIT EXPIRES IFWORK IS NOT STARTED WITRIN DAYS S PERMIT ISSUANCE O 180 DAYSS FROM LAST CALLED INSPECTION.. BUILDING ADDRESS 'C1 eVD--T- "bQwvVIac6 U RESIDENTIAL_"�CCOMMERCIAL OTHER OWNER'S HAZARDOUS FIRE AREA , YES ❑ B yes—I understand that B Crass A NAME - AM /✓"� f!�}�1'� roof li4serrlby is required. ADDRESS � � ' EXISTING ROOF COVERING �j II ' PHONE (��✓— �` �, NUMBER OF EXISTING COVERINGS - CONT C R'S�� NAME �Ty W V ` Cr•. l TO BE REMOVED SO BE RETAINED ADDRESS •17 ' 0 F ROOF COVE CITY 3 ZIP' 1 (/,V/I PW n,�G, 'Ateyl ��V�Lij q00 Ln�IL PHONE BUILT-UP ROOF ❑// LICENSENUMBER pp O7 ❑ NUMBER I (. ASPHALT SHINGLES LICENSED CONTRACTORS DECLARATION y� I hereby affirm met I am uceneed under provlslons at Chapter B(commencing with Section WOOD SHAKES - 7W0)of dNslon 3 of the Buelnaae erW Professions Code,end my license fe In full force and ems' WOOD SHINGLES License C La.Number - El Date CantreciaOTHER(SPECIFY) C3__ OWNER-BUILDER DECIARATION I hereby affirm that I am exempt from the Contractor's License Law for the allowing racoon. PROPOSED (Sec.7031.5,Suelnese and Prelemlons Code: Any city or county wNch requires a permit to ),! construct,after,Improve,demolish,or repairany structure,prior to Its Ideuerae,also requires me BUILT UP ROOF DEC �^�� ,�� . applicant for such permit to file a signed statement that he b licensed pursuant to the provisions 2 9''y I]]] of the Conbectors Ucense Lew(Chapter B(commenalng wih Section 7000)of DIvi5en 3 of the l Businms and Professions Cade)or that he Is exempt rllerefran end the bou le for the eilegad ASPHALT,SHINGLES ❑ rUul exemption.Any vlaletion d Section 7031.5 by any applicant far a permit subjects me applicant to e civil penalty of not more than five huntlred dallary($500),): WOOD SHAKES By I,as owner of the Property,❑ pap rn or to dedl see redo wages as their Bole compessa and will s- the work,and the structure Is not intended do offered for eels n ow er of Business end idol e0 sbne Code:The,shelve to desLicensesuch Lewtlimnot apply toenowner ofproperty whoicedtor WOOD SHINGLES Improves hereon,and who does deco work himself or through ste own employees,pr pro e r met ❑ such improvements eye ere not Intended or offered far sale.q hoverer,IM bei of pr vi Improvement n sold tWIWorImpr the OTHER(SPECIFY) ❑ not build or Improve for purpose pl eels.). ❑I,as owner el are property,and exclusively contracting with licensed contractors to construct, the project(Sec.7044,Business anti Professions Code:The Contractor's License Lax does not PROVIDE I.C.B.O.REPORT NO. apply to an owner of property who builds w improves thereon,and who contracts for such projects with a co tractods)licensed purauant to me Contractor's Ulcerate Law. PROVIDE MFGR.INSTALLATION SPECS. ❑I em exempt under Sec. ,B a P.C.far tithe reason Owner Data APPLICATION DATE VALUATION PERMIT FEE WORKER'S COMPENSATION DECIARATION I hereby affirm under penalty of perjury one of the following declaration: ❑I heed entl will 3na Cf the Labor Consent toeperformafw Workerswork Companselbn, /) Building as provided for by 9ecUm 3700 o1 the Labor Code,for the perlormence of mei for which ole 1 1 q rml fe Issued. l� entl will maintain Workers Compensation Insurance,as required Search 3700 of Seismic the Lobar Cafe,for the performance of the work or whbh his permit b Isal My Workers - —T Compensation Insurance unler an Pdiry numb ere: Total r r o Center �LF0; policy Nn PERMIT AUTHORIZATION- DATE CERTIFICATE OF EXEMP7IbN FROM WORKERS' COMPENSATION INSURANCE N.CL] ' (This motion need hot be completed If he permit Is for one hundred dollars($100)or leas.) - 1IlZQ. I"dirty that In me performence of me work for which this permit le Issued,I shell not employ any pereoh In any manner co as to become subject to me Workers'Companmtan Laws of Calf All roofs Shall be inspected Prior toany roofing material being fonds. installed. If-a roof is installed without first obtaining an Date Applicant inspection,I agree to remove all new materials for inspection. NOTICE TO APPLICANT: It,after making the Certlkcate of Exemption,you should become Applicant understands and will comply with all non point subjact to the Workers'Compensation provfslond of the Labor Code,you must forthwith comply with stah provisions or this permit Mall be deemed revoked. sot roe r UtatiOym I certify that leve rmtl thin appiketlgn and erste that the ebaye Information k correct.l epee to campy win all shy end county ordinances and erste lewd retailing Int Witting conadect I a and All ro cos ringclass`C'o e' r. hereby authorize repreeentetivae at this city to enter upon the above-mentioned property for In. epection purpoam. (We)agree to save,Indemnity and keep harmiem the CIry of Cupertino against Ilabllftles, ' judgments,costa and expenses which may In any way accrue against said City In consequence of the granting of this persalt. NATURE OF APPLICANT DAT PRE-INSPECTION: PLYWOOD: IN-PROGRESS: INSP. DATE - INSP. DATE INSP. DATE TEAR OFF INSPECTION: - BATTENS: FINAL: INSP, DATE INSP. DATE - INSP. DATE NOTE: OSHA APPROVED ACCESSTO ROOF.SHALL BE PROVIDED FOR INSPECTION OFFICE COPY INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE CITY OF CUPERTINO • BUILDING PERMIT INVOICE OPERATOR: chrietya Sec: Twp: Rng: Sub: Blk: Lot:31630131.00 - INVOICE DATE...... : 12/29/1999 REFERENCE ID p .. : 99120147 SITE ADDRESS .. . . .: 19857 BEEKMAN PL SUBDIVISION ........ CITY ..... . .......: CUPERTINO IMPACT AREA ....... OWNER . . . ......... : SHANKAR MAGAJI G AND KATHRYN A ADDRESS . ......... : CITY/STATE/ZIP ... : CUPERTINO CA, CA 95016 CONTRACTOR ....... : KAHN, RUSSELL LIC k 17999 COMPANY ......... . : CROWN ROOFING INC ADDRESS ......... . : 214 CRISTICH LN CITY/STATE/ZIP . . .: CAMPBELL, CA 95008 TELEPHONE .... . . ..: (408)369-7444 FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE --------------- --- --------- ------------ ----------- BPERMFEE P 147.00 0.00 147.00 BSEISMICRE P 0.90 0.00 0.90 --------- ------------ ----------- 147.90 0.00 147.90 V�ID --------OESCRI PTION-------__ VOICE ID ------- DESCRIPTION 305 FRAME 307 INSULATION 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 603 ROOF BATTENS 604 ROOF IN-PROGRESS •