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9909194 PERMIT APPLICATION FOR CITY OF CUPERTINO TN INSPECTION DIVISION PERMIT EXPIRATION REROOF PERMIT (406)777-3228 PERMIT EXPIRES IF WORK IS NOT STARTED _ WITHIN 100 DAYS OF PERMIT ISSUANCE OR 100 DAYS FROM LAST CALLED INSPECTION. - BUILDING ADDRESS RESIDENTIAL COMMERCIAL OTHER - E:? HAZARDOUS FIRE AREA s' ��• YES ❑ If yes-1 understand that a Class A NAME llll__��••�� "`""' u�� roof assemdy Is required. - / NO ❑ Initlaj I.C.B.O.N ,S• ��/y/ �� EXISTING ROOF COVERING ADDRESS /7.2� cll�� PHONE NUMBER OF EXISTING COVERINGS I CONTRACTOR'S TO BE REMOVED ' TO BE RETAINED NAME ADDRESS�C553 TYPE OF ROOF COVERING CITY&ZIP 'J EXISTING PHONE �7 �_ BUILT-UP ROOF LICENSE NUMBER � �U�`� 7 ASPHALT SHINGLES ` ❑ LICENSED CONTRACTORS DECLARATION I hereby affirm that I em licensed under Provisions of Chapter B(camrnem"Olig with Seth WOOD SHAKES 7000)of Division 3 of the Business and Professions Cade,and my license is in full force �R r M M effect. - L� L U Dcerwe Clea Lk.Number ZG�� W D SHINGLES Date d� Contractor r O ER(SPECIFY) SEP OWNER-BUILDER OECLARAT N PROPOSED I hm ereby affirm that I aWorrell from the Contracts.Lklrp anse Law for the forawreason. (Sac.7031.5,Buslnees and Profession Code: Any city or county which requires a permit to corretruct,alter,improve,demolish,or repair any elruoture,prior to its Issuance,also requires the BUILT-UP ROOF By applicant for Such permit to file a signed statement Net he Is licensed pursuant to the provisions ' of the Contractor's License Law(Chapter 9(commendrg with Section 7000)of DMsbn 3 of the Business and Professions Code)or that he is exempt therefrom and the basis for the alleged ASPHALT SHINGLES ❑ exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the appicant to a civil penally of not more than five hundred clothes($500).1: ❑I,as owner of Me property,or my employees with wages as their sole compensatlon,mu do WOOD SHAKES ❑ the work,entl the structure t not Intended or offered for sale(Sec.7044,Business and Freres- slam;Code: The Contractee License Lew does rot apply to an owner of property wlro bullas or WOOD SHINGLES ❑ Improves Verson,add who does cern work himself o through his own employees,provided that such Improvements are not intended or offered ler sale.If.however,Ne bulling or improvement S sold within one year of completion,her owner-talker will have the burden of fuming Net he did OTHER(SPECIFY) ❑ not build or Improve for purpose of sale.). ❑I,as owner of the property,am exciusbety,connocting wild licensed co tractors to construct he project fSec.7o44,Business ark PmfesSlon Code:The Conbactoss License Lew does not PROVIDE I.C.B.O.REPORT NO. apply to an Avner of property who bulks or Improves th loom,antl who contracts for Such projects with a contrectods)licensed pursuant to the Contractor's Dcense Law. PROVIDE MFGR.INSTALLATION SPECS. [II am exempt under Sec. ,B&P.C.for NIS reason owner Date APPLICATION DATE VALUATION PERMIT FEE WORKER'S COMPENSATION DECLARATION' I hereby affirm under Ninety of perjury one of Its following declaration: /M/D/. ❑I neve and will maintain a Corticate of Consent to set-insure for Workers Compensation, BUIClIn Dt•s/" es provided for by Section 37W of Me Labor Code,ler the performance of the worc far which this perm t Issued. G 9 Seismic nay •k/ I have end cele maintain Worker's Compensetlen Insurance,m required by Section 37W o1 4 .O 1 �—�C th bar Code,for the performance of the work lar which NIS permit a bsuec.My Worker's y ComigfIrmshtion Inurarnce cenler arta Polity number ere: Total Carder�l/��A-�•� Z Policy No.�/r/3�7y�I PERMIT AUTHORIZATION DATE ' CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE N.OQ (This section need not be completed it the permit Is ler one hundred dollas($1 W)o Ion I' I ovary that In the performance of the work for which this permit is issued,I shell not employ any person in any manner so m to become subject to the Workers'Compensation Laws d Cali- All roofs shall be inspected prior to any roofing material being Io`n's. 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: If,after making this Certificate of Exemption,you should become subject to the Worker Compensation provisions of the Labor Code,you must forthwith comfy Applicant pPhcant understands and will comply with all non point with such provisions or this permit shell be deemed revoked, source regulations. coldly that I have read this application and state that the above Inlormabon Is correct.)agree to can ply with all city and county ordinances and state laws relating to bulking construction,and All roof coverings to be class"C"or better. hereby authorize repreeenttivae of his city to enter ngon the above-mentioned property ler in- ( teras spooffon purposes. -7/y I (We)agree to save,Indemnity and keep herrNess to City of Cupertino against ficial judgment,cents and!expenses which may In eery way accrue against Sold City In consequence NATURE OF APPLICANT DATE of the granting of this permit. - 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: karenb Sec: Twp: Rug: Sub: Blk: Lot:35923018.00 INVOICE DATE...... : 09/30/1999 REFERENCE ID # ... : 99090194 SITE ADDRESS .....: 7335 BOLLINGER RD SUBDIVISION ...... . CITY ... . . . ....... : CUPERTINO IMPACT AREA ...... . OWNER .. . . . ....... : COATES 4 SEWARDS ADDRESS . . . ....... : CITY/STATE/ZIP ... : FREEDOM CA, CA 95019- CONTRACTOR ....... : STEVENSON, MIKE LIC 4 20774 COMPANY . . ........ : TAYLOR ROOFING INC ADDRESS . ......... : 1853 S 7TH ST CITY/STATE/ZIP ... : SAN JOSE, CA 95112 TELEPHONE . ....... : (408)971-7500 FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE --------------- --- _________ ------------ BPERMFEE P 340.00 0.00 340.00 BSEISMICRE P 3.00 0.00 3.00 _________ ____________ ___________ 343.00 0.00 343.00 V ID DESCRIPTION VOICE ID DESCRIPTION .. ......��a................... �....... ............................ FRAME 307 INSULATION 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 603 ROOF BATTENS 604 ROOF IN-PROGRESS • CITY OF CUPERTINO I! 1 of 1 BUILDING PERMIT RECEIPT OPERATOR: karenb COPY # 1 Sec: Tp: Rvg: Sub: Blk: Lot:35923018.00 DATE ISSUED. . . . . .. : 09/30/1999 RECEIPT #. . . . . . ... : 10209 REFERENCE ID # . .. : 99090194 SITE ADDRESS . .... : 7335 BOLLINGER RD SUBDIVISION . . . ... . CITY .... . . . . . . ...: CUPERTINO IMPACT AREA . . .... . OWNER .. . . . . . ..... : COATES & SEWARDS ADDRESS . . . . . ..... : CITY/STATE/ZIP ... : FREEDOM CA, CA 95019- RECEIVED FROM ... . : TIM _ CONTRACTOR ...... . : STEVENSON, MIRE LIC # 20774 COMPANY . . ........ : TAYLOR ROOFING INC ADDRESS . ....... . . : 1853 S 7TH ST CITY/STATE/ZIP .. . : SAN JOSE, CA 95112 TELEPHONE ....... . : (408)971-7500 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW HAL BPERMFEE VALUATION 30,000.00 340.00 0.00 340.00 0.00 BSEISMICRE VALUATION 30,000.00 3.00 0.00 3.00 0.00 PERMIT 343.00 0.00 343.00 0.00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ ------------------ CHECK 343.00 53105 ------------ TOTAL RECEIPT 343.00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 305 FRAME 307 INSULATION 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 603 ROOF BATTENS 604 ROOF IN-PROGRESS