99090178 A? 95 -,1
-d3 �OI '7
APPLICATION FOR CITY OF CUPERTINO [NPE,,R,,%rErg R"
INSPECTION DIVISION PERMIT EXPIRATION
REROOF PERMIT (408)777-.3228 PERMIT EXPIRES IF WORKS NOT STARTED
W!"IN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
49 BUILDING ADDRESS '
10 5'4 1(Oy) 'JIXiiii RESIDENTIAL—_L/—COMMERCIAL— OTHER
OWNER'S ,�f '�� HAZARDOUS FIRE AREA
.Y/�A4'4RJ4 r� YES U- If yea-I understand that a CIM A
NAME O -T c n n roof assembly is required.
NO jg-. . Irdfial I.C.B.O.0
ADDRESs &0 - EXISTING ROOF COVERING
PHONE JT. " �6C017 NUMBER OF EXISTING COVERINGS /
CONTRACTOR'S - �//7 (`
NAME ova IgSahCle /LOO 1"1ClgJ TO BE REMOVED TO BE RETAINED_
ADDRESS a�b�O� I TYPE F ROOF ERIN
CITY&ZIP 7 �(s,yI7 CU n -/�I/ �� gri�y�
EXISTING
PHONEwyLC!�Q YNS'06,Q yT BUILT-UP ROOF
LICENSE S�y 3(p ASPHALT SHINGLES l
NUMBER ❑
LICENSED CONTRACTORS DECLARATION
I hereby affirm that I am Ikensed under provisions of Chapter 9(commencing with Swam ,WOOD SHAKES 36
]000)of Division 3 of the BUSlness end Profnesbrm Code,and try,ficense in In fun force and
effect CI
n SSC 7 34 cru 13 -3/-°G WOOD SHINGLES n � E]
Lienee Gass L l 1 A Lk.Numoor/n� 7 T
oats q - -9�/ Contractor /C219q�ivtrP OTHER (SPI�CIFY)� �❑ I�+1f
OWNER-theConRDtorsLcTION PROPOSED SEP 2 g 1999 1
hereby affirm that am exempt from the e: Any cry Umnae Lew for the brewing reason. ❑ I0 1
(Sec.7031.5,Business ere Professions Cade: Arty city or county which re, lso e uirmlt to U
construct,ever,Improve,demolish,or repair any swcmre,poor to nor Issuance,also requires the BUILT-UPR F
applicant for such permit to file a signed statement that he Is license!pursuant to the provisions
of the Contractors License Law(Chapter 9(tormenting with Section]000)of Dlvlsan 3 of the I p V
Business and Professions Code)or that he Is exempt Therefrom and the basis for the alleged ASPHALT+SHINGL-ES—�❑�
exemption.Ary violation of Sedan 7031.5 by any applicant for a permit xUtlmte the applkont to
a dull penalty of not more than five hundred tlo0ere(15500).):
❑I,as owner of the property,or my employees with wages as thetr sole compensation,will do WOOD SHAKES L A 1
Ito work,and the Mi tura Is not Intended or offered for sale(Sac.7044,Business and Protons. - C"x V y GIrLS
Mans Code:The Correctors License Law does not appy to an owner of property who building or WOOD SHINGLES ❑
improves that.,and wnd dose such work himself or through his owe employees,proAded that
Much Improvements are not Intended or offered for Mels.11,however,the buliding m Improvement
Is told wlihln one year of cornpliion,the owner-bulker will have Ne burden of proving Met he did OTHER(SPECIFY) E]not bola or Improve era.). E]
purpose of e -
1,as owner d the propend,am exclusively mnVectingg wlih licensed contractors to construct
Me project(Sec.7044,Business and Professions Code:Tine Contractors License Law now not PROVIDE I.C.B.O.REPORT NO.
apply to an owner of property who bulbs or Improves thereon,and who contracts for such projects
with a contractor(s)licensed pursuant to the contractors License Law. - PROVIDE MFGR. INSTALLATION SPECS. -
1 am exempt under Sec: ,S 8 P.C.for this reason
owner _ Date.
WORKER'S COMPENSATION DECLARATION APPLICATION DATE VALUATION PERMIT FEE
'
I hereby affirm under penalty of perjury one of the following declaration:
❑I have and wig maintain a Certificate of Consent to sen-insure for Workers Compensatlon, Building
as provul for by Section 3700 of Ne Labor Cade,for the perlormence of Me work ar which this f(/� g
pouring
v� ore and wmaintain Worker's CompensaTa
n Insurance,as required by Section 3700 of T j �G .Seismic
the Labe it Code,lour the pedorranpa of the wank lor which thing pemtlt is issued,My Workers �
Compensation Insurer"carrier and Policy number are: � Total 2-L
,��/_
Canner AYY10ric.an 94 0"tor, Mli PoIbyNo.58Roo�3 � PERMIT AUTHORIZATION DATE
C.ilj' CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE N.C.
(Thin sectkm need not be complete!if the permit Is forme hundred dollar M(15100)or lose.) �7— 8
1 parity Met In the performance of the work for which this permit Is issued,1 shall not em Try
any person In any manner m as to become subject to the orkers' mpansetion Laws of L�su. All roofs shall be inspected prior to any roofing material being
forma. installed. If a roof is Installed without first obtaining an
Date / fl'99 ApMloant inspection,I agree to remove all new materials for inspection.
NOTICE TO APPILCANT: If,after making this Gentili namptlon,yo Mab become Applicant understands and will comply with all non tot
subject to the Workers'Compensatan provabna of th or Code,you m Iorthwllh campy pP P Y PD
with such proAeans or this permit shall be document revoked. source regulations.
I candy that I have read the application and sate that the above information is correct.I agree
to comply with all dry and munry edirnences end state laws relating to building cauwcTlon,and All roof coverings t Bclass,00r better.
hereby autndrize repres ur ativea of this my to enter upon the ato v mentonetl property for In-
spection
n �/e
sp purposes.
two)
(We)apse to save,eases wi ice keep harmless the Gry i st si no epelrnet YaNllUee,
Iutlgmana,coal and expanses which may In any way accrue epalna sob City In mnsequeroe SI I�JR PLIC AT
r the grentlrp of this permit.
PRE-INSPECTION: PLYWOOD: IN-PROGRESS: e ,
INSP. DATE INSP. DATE INSP. DATE �C
TEAR OFF INSPECTION: ^ BATTENS FINAL: A '
INSP. DATE - INSP. DATE INSP. DATE p(
NOTE: OSHA APPROVED ACCESSTO ROOF SHALL BE PROVIDED FOR INSPECTION
OFFICE COPY
CITY OF CUPERTINO
Is 1 of 1 BUILDING PERMIT RECEIPT OPERATOR: yvonnek
COPY 0 1
Sec: Twp: Rn9: Sub: Blk: Lot:359028039.00
DATE ISSUED. . . . . . . : 09/28/1999
RECEIPT q.. . . . . . . . : 10175
REFERENCE ID # . . . : 99090178
SITE ADDRESS . . . . . : 1054 COLONY HILL LANE
SUBDIVISION . . . . . . .
CITY . . ... . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER .. . . . . . . . . . . : ALAN JOHNSON
ADDRESS . . . . . . . . .. : 1054 COLONY HILL LANE
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : TIM
CONTRACTOR .. . . . . . : DADDARIO, STEVE LIC ft 20739
COMPANY . .. . . . . . . . : RENAISSANCE ROOFING CO INC
ADDRESS .... . . . . . . : 2292 LINCOLN AVE
CITY/STATE/ZIP . . . : SAN JOSE, CA 95125
TELEPHONE . . . . . . . . : (408)448-0697
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW SAL
BPERMFEE VALUATION 20,000 00 257.00 0.00 257.00 0.00
BSEISMICRE VALUATION 20,000.00 2.00 0.00 2.00 0.00
i PERMIT 259.00 0.00 259.00 0.00
METHOD OF PAYMENT AMOUNT NUMBER
CHECK 259.00 16182
TOTAL RECEIPT 259.00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
........ ........ ............................
305 FRAME 307 INSULATION
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
6D3 ROOF BATTENS 604 ROOF IN-PROGRESS
•
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO
• BUILDING PERMIT INVOICE OPERATOR: yvoonek
Sec: Tp: Rng: Sub: Blk: Lot:395028039.00
INVOICE DATE. . . . . . : 09/28/1999
REFERENCE ID 4 . . . : 99090178
SITE ADDRESS . . . . . : 1054 COLONY HILL LANE
SUBDIVISION . . . . . . .
CITY . . .. . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER ..... . . . . . . . : JOHNSON
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
CONTRACTOR . . . . .. . : DADDARIO, STEVE LIC 0 20"!39
COMPANY . . . . . . . . . . : RENAISSANCE ROOFING CO INC
ADDRESS . . . ... . . . . : 2292 LINCOLN AVE
CITY/STATE/ZIP . . . : SAN JOSE, CA 95125
TELEPHONE . ... . . . . : (408)448-0697
NOTE: THE FEES LISTED ARE ONLY THOSE DUE BEFORE PERMIT PRINTING
FEE DESCRIPTION CHK TOTAL FEE PAID-'IO-DATE BALANCE DUE
--------------- --- --------- ------------ -----------
BPERMFEE P 257.00 0.00 257.00
BSEISMICRE P 2.00 0.00 2.00
--------- ------------ -----------
259.00 0.00 259.00
VID DESCRIPTION VOICE ID DESCRIPTION
........ ............................ ........ ............................
305 FRAME 307 INSULATION
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
603 ROOF BATTENS 604 ROOF IN-PROGRESS
•