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99100003 C1 tobco-f) PERMIT APPLICATION FOR CITY OF CUPERTINO NUMBS REROOF PERMIT INSPECTION PERMITEXPIRA N (408)777-3228 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CPLLED INSPECTION. BUILDING ADDRESS - 1 S v/ RESIDENTIAL COMMERCIAL OTHER O'WNER'S ..v1 I,, HAZARDOUS FIRE AREA NAME L�{t I ✓Q'\ /� � YES ❑ If I understand thate ClawA a ssambly required NO . [� / 1y ❑ Initlel I.C.B.O.tl ADDRESS —o 19 L l C.•(1CT - EXISTING ROOF COVERING PHONE -7 QYV NUMBER OF EXISTING COVERINGS CONTRACTTOOR'$ NAME 1— �1) \� I�ub`'t IJ�C\ VG. 70 BE REMOVED TO BE RETAINED ADDREss1YPE OF ROOF COVERING crrvazlP 322, TvulYar,7" +r� , S•S. 9S'13r-1 EXISTING . / PHONE d Ot�— !1 1' l BUILT-UP ROOF El �/ - NE UMBE3 6 3 6 NUMBER ASPHALT SHINGLES LICENSED CONTRACTORS DECLARATION I hereby affirm that I em licensed under provisions of Chapter B(commencing with Sol WOOD SHAKESLBy 7000)of Division 3 of the Buseraw entl Professkns Code,entl my license is In full force arkaffect. '{� �,., '• WOOD SHINGLESLear.Close ` J Lk.Number "r1 nin Data 1 (5I ( � �C. Contractor ✓ xr OTHER(SPECIFY)--VOMER-BUILDER DECLARATION I hereby affirm Net I am exempt from the Contractor's License Lew for the following reason, PROPOSED(Sec.7031.5,Business and I'mfoesiora Code: Any city or cgmy which requires a porrNl to construct,alter,Improve,demditu,or repair any structure,prior to lis issuance,oleo requires the BUILT-UP ROOF opplioent for such permh to file a signed statement that he is licensed pursuant to Ne provisions of the Correctors Dcense Lew(Chapter 8(commencing with Section 7000)of Division 3 of the Burmese and Professions Code)or mat he is exempt therefrom and the basis for the alleged ASPHALT SHINGLES I�f exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil Penalty of not mere Man live hundred dollars(S5W).): ❑l,esownerol the properly,ormyemployees.M.gnwthelrnolecompennUw,willtlo WOOD SHAKES El the work,and the structure Is not Intended or offeretl for sale(Sec.7064,Burmese and Profen- Nods Code:The Contractors License Law does not appy to an owner of property who police or WOOD SHINGLES El Improves thereon,and who toes such work himself or through his own mfoloyees,provided Nat such Improvements are not Intended or offered for sale.If,however,the building or improvement is add within one year of comple0on,the owner-buider will have the burden of proving that he da OTHER(SPECIFY) rat bulk rove or Impfor purpose of sale.). 01,as owl ol the property,am exclusively contracti with lioensi correctors to mast the project(Sec.7064,BuNneva and Profess one Codi a Contractors Ucerae Law does net PROVIDE LC.B.O.REPORT NO. apply to an owner of property whro bullds or Impri thereon,and who contracts kr such projects with a crunlractor(s)licensed pursuant to the Contractor's License Lew, PROVIDE MFGR.INSTALLATION SPECS. ❑1 am exempt under Sec. ,B&P.C.to, as r this reon owrer Dale WORKER'S COMPENSATION DECUFiATION APPLICATION DATE VALUATION PERMIT FEE I hereby affirm under penalty of perjury ore of the Ialkwlrg declamtim: [D I have and w111 maintain a Certificate of Consent to seg-Insure for Worker's Compensation, i L/I C Building I as provided for by Section 3700 of the Labor Code,for the pedon name of the work for which this J �v 1� Permit is issued. L96b /� tv ❑1 have and will maintain Workers Compensation Insurance,as required by Section 3]00 d U6 SKIS �c r Ne Labor Code,for the pedormance of the work kr which this permit Is issued.My Workees 1 h Compensation Ineu carrlar send Poli'j'number ere: t_ Tot L t 111 ��JJ/ Carder S`FQTc �U1�0( Policy No. -7- PERMITAUTHORIZATION DATE CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE N.00 (This section meed not be completed It the permit Is for one hundred dollars($1(X0 or bsa.) f0// I caddy that In the Performance of the work for which this permit Is Issued,I shall not employ any person 1n any manner no an to bawme subject to the Workers'Compensation Laws of Cali. All roofs shall be inspected prior to any roofing material being'. Erma. Installed. If a roof is installed without first obtaining an Date Appgcanl inspection,I agree to remove all new materials for inspection. NOTICE TO APPLICANT: H,after mekrg this Certgfcate of Exemption,you Shedd becarne Applicant understands and will comply with all non point subject to me Workers'Compensation pmvlsk tar of the Labor Cotle,you must forthwith comply pP P Y P with such pro4slons v this permit shall be deemed revoked. source regulations. I codify that I have read this application and state that the above Informal is correct.I agree to comply with all city and county ordnences ark state laws relating to bulking construction,aM All roof coverings to be class°C"or better., hereby authorize representatives of this dry to enter upon the above-nrenlioned property for k- spectbn purposes. . l (WM agree to Move,incentrdy and!keep harmless the City of Cupomno against liebllltiee, 1._) �nnr�J jutlgme nk,costs entl expenses which may in any way accrue against read City In consequence 1 oft ggranting of this permit. SIGNATURE OF APP ICANT DATEI— 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'CIII - CITY OF CUPERTINO 1 of 1 BUILDING PERMIT RECEIPT OPERATOR: katenb COPY 0 1 Ser. Twp: RnS: Sub: Elk: Lot:36919018.00 DATE ISSUED.... . . . : 10/01/1999 RECEIPT p. . . . . . . ..: 10228 REFERENCE ID # . ..: 99100003 SITE ADDRESS . .... : 956 CANDLEWOOD DR SUBDIVISION ...... . CITY .. . . . . .. ..... : CUPERTINO IMPACT AREA .... . . . OWNER . . . .... .. . . . : JOHNSTON JOAN V AND LAWRENCE L ADDRESS ........ . . : CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4018 RECEIVED FROM ....: ALAN CONTRACTOR . . . . ...: MONROE, DUANE LIC N 20613 COMPANY . . . . . . .... : PIONEER ROOFING CO ADDRESS .. . . ......: 1520 HERVEY LN CITY/STATE/ZIP ... : SAN JOSE, CA 95125 TELEPHONE ........ : (408)294-4071 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL __________ _____________ __________ __________ __________ __________ BPERMFEE VALUATION 5,000.00 107.00 0.00 107.00 0.00 13; SMICRE VALUATION 4,600.00 0.50 0.00 0.50 0.00 ____ ---------- 1PERMIT 107.50 0.00 1107.50 0.00 METHOD OF PAYMENT AMOUNT NUMBER _________________ ____________ __________________ CHECK 107.50 6418 TOTAL RECEIPT ------ 107 50 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 INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE CITY OF CUPERTINO • BUILDING PERMIT INVOICE OPERATOR: karenb Sec: Twp: Rng: Sub: Blk: Lot:36919018.00 INVOICE DATE. . ....: 10/01/1999 REFERENCE ID # ...: 99100003 SITE ADDRESS ..... : 956 CANDLEWOOD DR SUBDIVISION ...... . CITY .... . . . ...... : CUPERTINO IMPACT AREA ...... . OWNER .. . . . . . .... . : JOHNSTON JOAN V AND LAWRENCE L ADDRESS . ......... : CITY/STATE/ZIP ... : CUPERTINO CA, CA 95014-4018 CONTRACTOR ....... : MONROE, DUANE LIC 4 20613 COMPANY . . . ....... : PIONEER ROOFING CO ADDRESS . ......... : 1520 HERVEY LN CITY/STATE/ZIP ... : SAN JOSE, CA 95125 TELEPHONE ........ : (408)294-4071 FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE --------------- --- --------- ------------ ----------- BP ERM FEE P 107.00 0.00 107.00 BSEISMICRE P 0.50 0.00 0.50 --------- ------------ ----------- 107.50 0.00 107.50 ID __-__---DESCRIPTION__-_-____ VOICE ID --DESCRIPTION .. ......... ........ ............................ FRAME 307 INSULATION 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 603 ROOF BATTENS 604 ROOF IN-PROGRESS •