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99070047 G PERMIT R_ APPLICATION FOR CITY of CUPERTINO NUMBER INSPECTION DIVISION PERMIT EXPIRATION REROOF PERMIT (408)777-3228 PERMIT EXPIRES IF WORK IS NOT STARTED . DA MF VS PERMIT ISSUANCE O 180 190 DAYS FROM LAST CALLED INSPECTION.. BUILDING'ADDRESS 00 v RESIDENTIAL COMMERCIAL OTHER OWNER'S HAZARDOUS FIRE AREA 'l / Ad u L YES ❑ Hyes—I understand that a ClassA NAME_ L 15?ell �� 7 %,_/z rod assembly is required. NO ❑ Initial 'I.C.B.O.A ADDRESS e�pt�"Tof��J EXISTING ROOF COVERING .PHONE DO q — NUMBER OF EXISTING COVERINGS CONTRAC OR'S�D J NAME V // D TO BE REMOVED TO BE RETAINED ADDRESS VTYPE OF RO OF RI CITY&ZIPZAIA-11AVe �NG ' o (�/ S,q PHGNE>T In/ZOSY BUILT-UP ROOF. LICENSE NUMBER /r,}'� _ ASPHALT SHINGLES. ' . 1 LICENSED CONTRACTORS DECLARATION )of D W rm slut em hcansed he Pr provolone of Chapter y(commencing PIN os and WOOD SHAKES ]1100)of D offir 3 e the ficerse and under Cade,apt r 9 Icomm ts In tut lorceand ' eH8t1' _ dQnt WOOD SHINGLES Llcenm Cleve Uc.Number �/ `� Data OG contractor OTHER(SPECIF�`+). OWNER-BUILDER DECLARATION PROPOSED li . Q I hereby affirm that l am exempt from the Contractors Ucense Law for the following reason. � (Sec.7031.5,Business amd Professions Code; Any dry or county which requires a permit to I` caratruct,after,Improve,candller,or repair any structure,prior to Its Issuance.also regolree tits BUILT-UP ROOF I''I epplkant for each permit to Ills a signed statement that fro Is Ikensed purouent to the proNebne r- JULO Q��nn^ ' of the Contractors Ucenee Lew(Chapter a(commencing whh Section]000)of.DIAslan 3 of the I J 2 [1(7�.' 999 ' Business and Professions Code)or that he Is exempt therefrom and Me basis for the alleged ASPHALT SHINGLES exemption.Any violation of Secdon]031,5 by any applicant for a permit subjects the applicant to e cMl penalty of not more then five hundred dollars(5500).): 01,as owner of the property,or my employees with wegas as their sols compensation,ensat ,wit do WOOD SHAKES Sy ❑ Ne wed:and the structure U rot Intended or offered for sale(Sec.7044,Business entl Proles- slons Cade: The Centractor's Lkenm Law does not apply to an owner of property who tunics or WOOD SHINGLES ❑ Improves thereon,end who dose such work himself or through his own employees,provided that such Improvements are not Intended or offered for sale.If,however,the bullding or I provement a+ d within ona year of compleeon,the owner-bulkier will have me burden of proving that he did OTHER(SPECIFY) ❑ not build or Improve for purpose of sale.). 01,as owner of the property,am excluslvely contracting with Ifoensed contractors to construct the project(Sec.7044,Business and Professons Code:The Contractors UcensB Lew dam rot PROVIDE I.C.B.O,REPORT NO. apply to an owner of property who builds or lmpmm thereon,and who contracts for such projects with a conbactor(s)licensed pursuant to the Contractors Ocanae Law. PROVIDE MFGR.INSTALLATION SPECS. ❑I am exempt under Sec. ,B&P,C.for this reason Owner - Data WORKER'S COMPENSATION DECLARATION. APPLICATION DATE VALUATION - PERMIT FEE I hereby affirm under penalty of perjury one of the following declaration: eap❑rwW o for by nd Mil ection 3700 o1 the LalborfCo�de,ant to for Me erfo�rer�of the won for pwnhich this Building�� Permit is leaned. _ �`^"D Q SEISMIC lave aM will maintain Workers Compenmtion Inautence,as required by Becton 3700 of [/. v Mp LSDor Code,for the pedormence of the wok far wnicn Ince permit u Issued.My Workers 7^�v 9 p enrol In rence rarrbr en Icy number /'e/rf • / Total/O Cenler�l_;" V Lir Pdlq No.f S Q� PERMIT AUTHORIZATION DATE CERTIFICATE OF EXEMPTION FROM WORK RS' COMPENSATION INSURANCE N.C.0 (This evoke need rot be completed I the permit la for one hundred belles($100)or less.) - I cordly that In the performance of the work for which this pormt Is Issued,I shall not employ arty person m am manner so as to become at 91 the worker,con ge.aabon Laws of Call- All roofs shall be inspected prior to any roofing material being torrid. CC. I installed. If a roof is installed without first obtaining an Date 2-06- / / Applicant inspection,I agree to remove all new materials for inspection. NOTICE TO APPLICANT: It,after making this Canpbate of Exemption,yot show "tome Applicant understands and will comply with all non point Subject to Me Workers'Compensauce provtslons of the Labor Cada,you must IoM comply PP P Y with sten aoAslerm or this parent Mat be deemed revoked. source regulations. I certify that I have reed this eppkabon end state that fire aboro Informadan Is correct.I agree to comply went an city entl county ordinances and state laws relating to bulaing construction.and All eroofvenngs to be class or better. hereby authorize representatives of this city to enter upon the above-mentioned property for In-spectlon purposes.(We)agree to save,Indemnity end keep harmless the City of Cupertino agn con Iequebs, juments,costs ane expenses wnlcn may In am way ecaue epelnst mid City In consequence IG NAP OF APPLICA DATE 41 e prentlnp of tole 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 ACCESS TO ROOF SHALL BE PROVIDED FOR INSPECTION OFFICE COPY INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE ' CITY OF CUPERTINO BUILDING PERMIT INVOICE OPERATOR: nancyc . Sec: Twp: Rng: Sub: Elk: Lot:35711022.00 INVOICE DATE...... : 07/26/1999 t{ REFERENCE ID k ... : 99070047 SITE ADDRESS .....: 10015 BYRNE AV SUBDIVISION ...... . 3 CITY .............: CUPERTINO IMPACT AREA ...... . OWNER ............ : HERTEL TERRY J ADDRESS ..........: " { CITY/STATE/ZIP .... , CONTRACTOR .......: CURRY; GROVER LIC q 19977 t4 COMPANY ..........: C G ROOFING ADDRESS ...... ....: 3637 SNELL AVE CITY/STATE/ZIP ...: SAN JOSE, CA 95136 TELEPHONE ........: (408)224-6208 .� FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE --------------- --- --------- ------------ ------_--__ ... BPERMFEE P 107.00 107.00 0.00 �p BSEISMICRE P 0.50 0.50 0.00 --------- ------------ ----------- 107.50 107.50 0.00 ID DESCRIPTIONVOICE ID DESCRIPTION..--------------- -------- --------------- fir, FRAME 307 INSULATION jt 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL pfd 603 ROOF BATTENS 604 ROOF IN-PROGRESS '1 t� M `4 �i r f� l iI F `i Building Permit Fee Code Checklist ` ` v7 D O V 7 Qty. if Applicable Fee ID Fee Description Fee Group PPERMITFEE PLUMBNG PERMIT ISSUE PLUMBING BAPPLOTHER OTHER APPLIANCES BUILDING BBOILERI BOILER <= 100,000 BTU BUILDING BBOILER2 BOILER >100KTO500K BTU BUILDING BBOILER3 BOILER >500K TO 1M BTU BUILDING BBOILER4 BOILER>1M TO 1.75M BTU BUILDING BBOILER5 BOILER > 1.75M BTU BUILDING BCONSTAX CONSTRUCTION TAX BUILDING BCONSTAX CONSTRUCTION TAX BUILDING BELEC1000 ELEC 600V <=1000A BUILDING BELEC1001 ELEC 600V >1000A BUILDING BELEC200 ELECT SVCS 600V <=200A BUILDING BENERGY ENERGY BUILDING BENERGYADD ENERGY ADD MULTI BUILDING BNEWMULTI MULTIFAMILY RES BUILDING BNUMULTI NEW MULIFAMILY RES BUILDING BNUSFD,. NEW SINGLEFAMILY RES BUILDING BOVERTIME INSPECTION OVERTIME BUILDING BPBACKFLOW ATMOSPHERIC VACUUM BUILDING BPCESSPOOL CESSPOOL BUILDING BPERMFEE BLDG PERMIT FEES BUILDING BPERMIT HOUSING MITIGATION FEEBUILDING BPFIXTURE PBLG FIXTURE BUILDING BPGAS GAS PIPING SYSTEM FEE BUILDING BPINTERCEP IND WASTE INTERCEPTOR BUILDING BPLANCHK PLAN CHECK FEE BUILDING BPLANCKADD PLAN CHECK ADD MULTI BUILDING BPLANCKREP PLAN CHECK REPEAT FEE BUILDING BPREPIPE REPIPE OF FIXTURES BUILDING BPSEWAGE SEWAGE DISPOSAL BUILDING BPSEWER SEWERS BUILDING BPSPRINK LAWN SPRINKLER/BACKFLO BUILDING BPSTORM STORM/RAIN WATER BUILDING BPTRAP KITCHEN TRAP BUILDING BPVENT ALT OF DRAIN &VENT BUILDING BPWATER INSTALUALTER WATERPIP BUILDING BPWHEATER WATER HEATERNENT BUILDING BPWSVCS MAIN WATER SERVICE BUILDING BREINSPECT REINSPECTION FEE BUILDING BREMACOVER AC UNIT>10000CFM BUILDING BREMAPPLI APPLIANCE INSTALL BUILDING BREMBUSWAY REMODEL BUSWAYS BUILDING BREMFIXT LIGHTING FIXTURES BUILDING BREMHEAT HEATER INSTALLATION BUILDING BREMMISC MISC APPARATUS BUILDING • BREMNRAPP REM NON-RES APPLIANCE BUILDING BREMPOLE POLE/PLATFORM FIXTURE BUILDING BREMPOWER POWER DEVICE/APPARATUS BUILDING l Building Permit Fee Cade Checklist BREMRECEPT RCPTL, SWITCH &OUTLETS BUILDING BREMRESAPP REMODEL RES APPLIANCE BUILDING BREMSIGNAD RMDL SIGNS ADD BRANCH BUILDING BREMSIGNS REMODEL SIGNS, MARQUEE BUILDING BREMTHEATR THEATRICAL LGHTNG FIX BUILDING BREMVENFAN VENT FAN SINGLE DUCT BUILDING BSCBLVD SCB SPECIFIC PLAN BUILDING BSEISMICOM SEISMIC COMMERCIAL BUILDING BSEISMICRE SEISMIC FEE RES BUILDING BSF&2FAM SINGLE & 2 FAMILY BUILDING BSPECIAL SPECIAL INSPECTION BUILDING BSWIM SWIMMING POOL BUILDING BTEMP TEMPORARY POWER BUILDING BTEMPSVCS TEMP DIST SVCS BUILDING ZADDCHG ADDRESS CHANGE BUILDING EPERMITFEE ELEC PERMIT ISSUANCE ELECTRICAL BMNEWMULTI NEW MULTI-FAMILY RES MECHANICAL BMNEWSF&2F NEW SF&2F RES BLDGS MECHANICAL BREMAI HAN A/C UNITS <= 10,000CFM MECHANICAL BREMFURN RELOCATION OF FURNACE MECHANICAL BREMFURNOV RELO FURNACE > 10K BTU MECHANICAL BREMINHOOD INSTALLATION OF HOOD MECHANICAL BREMRELOCA RELOCATION OF HOOD MECHANICAL BREMREPALT REPAIR/ALTER HEATING MECHANICAL BREMVENSYS VENTILATION SYSTEMS MECHANICAL MPERMITFEE MECH PERMIT ISSUANCE MECHANICAL ZDEVAGREE DEVELOPMENT AGREEMENT PLANNING ZDIRTM DIR TENT MAP PLANNING ZFULLHR FULL APPL BASE + HR PLANNING ZFULLTM FULL APPL TENT MAP PLANNING ZFULLUP FULL APPL USE PERMIT PLANNING ZFULLZONE FULL APPL ZONING PLANNING ZGPAMEND GENERAL PLAN AMEND PLANNING ZLIMAMEND LIMITED AMEND PLANNING ZLIMTM LIMITED TENT MAP PLANNING ZLIMUP LIMITED APPL USE PERMI PLANNING ZMATEMPUP MIN AMEND TEMP USEPERM PLANNING ZMINHILLEX MINOR APPL HILL EXC PLANNING ZMINSIGNEX MISC SIGN EXCEPTION PLANNING ZMINTM MINOR APP TENT MAP PLANNING ZMINUP MINOR APPL USE PERMIT PLANNING ZMISCASA MISC ARCH SITE PLANNING ZMISCEXT MISC TM AND UP EXT PLANNING ZMISCFENCE MISC FENCE EXCEPTION PLANNING ZMISCGEN MISCELL APPL GENERAL PLANNING ZMISCPCINT MISC PC INTERPRETATION PLANNING ZSIGN SIGN PERMI PLANNING ZTEMPSIGN TEMPORARY SIGN PLANNING • ZVARIANCE . DIRECTOR VARIANCE IPLANNING