99080158 0 �
PERMIT
APPLICATION FOR CIN OF cuPERTwO NUMBER
REROOF PERMIT INSPECTION DIVISION PERMIT EXPIRArOh1
(408)777-3228 PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 100 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
BUILDING ADDRESS
rr
`
bO LpER_(,Y)Ov Q C;—k RESIDENTIAL COMMERCIAL OTHER
OWNER'S - HAZARDOUS FIRE AREA
^M`s.� t� t YES ❑ It yes—I understand that a Class A
J
NAME ` a� r—C>V root assembly Is required.
NO ❑ Initial I.C.B.O.N
ADDRESS//7`3O I, �-nW '�'Q C-( t EXISTING ROOF COVERING
PHONE k•A L7 •" LJ (�— (� 4 NUMBER OF EXISTING COVERINGS U1•/13
CONTRACTORS p A TO BE REMOVED b� TO BE RETAINED
NAME J . 9, f—C7��'I NG , r�
ADDRESS TYPE OF ROOF COVERING
CITY B ZIP �g►JN V K- 101S j l «
O EXISTING
PHONE 4 �� �• 25•L- a1 "�2�� BUILT-UP ROOF ❑
LICENSE
NUMBER -+. _ �. p l ` - ASPHALT SHINGLE S
LICENSED CONTRACTORS DECLARATION
I hereby affirm that I em licerwed under provislaae of Chapter 9(commere,ing with Section WOOD SHAKES
7000)of Division 3 of Me Business and Prolessom Code,and my license is in lull brco and U
cited.
Vit
C _^� 4 M1 $.}^ WOOD SHINGLES AUG �� 1999
License Class Ld.Number—
Date ate• `+ t'3 `J' Contractor OTHER(SPECI ❑
OWNER-BUILDER DECIARATION
I hereby affirm that I am exempt from the Contractors License Law for the following reason. PROPOSEDB f
(Sec.71 Business and Prolessbrvs Code: Arty city or county which requires a permit to
construct,alter,improve.demoUeh,or rel any structure.prior to its bsuence,else requires Me BUILT-UP R ❑
applicant for such permh to file a signed statement Met he Is licensed pursuant to the pmOsIci
of me Contractors License Lew(Chapter 9(commendog w8h Section 70D0)of Division 3 of the
Business entl Prdeselone Code)or that he is exempt therefrom and me subjects the
tforhe the scantalleged ASPHALT SHINGL 4� `� G �'fL
exemption.Any violation of Code)
7031.5 by any applicant for a permit he Mats
Me leant to 1
e clvll,penalty of not more than five hundred dollars($500):): O
1.as owner of the property,or or,ehnpbyeee with wages as their sole compensation,will do WOOD SHAKES
the work.and the stmcture Is not intended or offered for sale(Sec.7044,Business entl Prolm-
Mone Cade:The Commctora Lienee law does net apply to an owner of property who bulks or WOOD SHINGLES
unwan,es thereon,and word does such work himself or through his own employees,provided that ❑
such krprovemenLs are not Intended or offered for safe.If,however,the building or improvement
Is sold wIMIn one year of Wnpletlon•the owner-Wilder will have the burden of proving met he did OTHER (SPECIFY) _
not build or Improve for purpose of sale.).
[:11,es comer of the property,em exClusioely contracting with licensed contractors to construct
Me project(Sec.70x4,Business and Professions Code:The Contractors License Lew does not PROVIDE I.C.B.O. REPORT NO.
apPty to an owner of property,wine,WOMB or lmprmee thereon,are,who contracts for such projects
with a contrectoffs)licensetl pursuant to the Co tractora Dcense Lew.
❑I am exempt under Sea ,B s P.C.for this reason PROVIDE MFGR.INSTALLATION SPECS.
owner. Date APPLICATION DATE VALUATION - PERMIT FEE
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declaration:
I have arta will maintain a Cennkate of Consent to self-insure for Workers Compensation, Building
as provided for by Section 3700 of the Labor Code,for the performwork for of the wofor whish tale '�OO g
Permit is IseuV
od. G Q I
1} have and Mil maen
maintain Workers Canpsetlon Insurance,as required Sectio 37M Se3700 of f Seismic
the Labor Code,for she Performance of the work for whish this permit Is Issued.My Workers
Comperwatlon Insumoce carrier and Policy number are: _ Total
Carl 3'+ ryrt 'Ft„jPJI(J PdicyNnlS G 2.�'-9� P AUTHORIZATIONf DATE
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE N.C{]
(This sedlon react net be completed H the pomp Is for one hundred dollen(5 100)or;.)
I certify that n the performance of me work for which tab permit Is Issued,I shell not ty '
any person In any manner so,as to became wgect to the Workers'
Component! Laws aIF All r e Inspe prior to any roofing material ing
fornix. ` installed. a roof is installed without first obtaining an
Do. R_23 — 14 `I A;ol inspect) •I agree to remove all new materials for Inspection.
_.NOTICE TO APPLICANT: If,after rmhed this Certificate of E mpwn,((y�ou sh uld become A Ile t understands and will comply with all non Dint
subject to the Workers'Corncom atbn pr {one of the Lobar .you mks '^„, th comply PP P Y p
with such provielons or this,permit shell be deemed reveled. Sour regulations.
I certify that I have reed cols application and state that me above Informetien Is correct I agree
to comply with all dry and county ordinances and state laws relating to Wilding construction,and AI roof coverings to be clasl or better.
hereby authorize representatives of this city to enter upon the ebave-mentbned property for in-
spection purposes. '.
(Wo)agree andcover Indemnity and keep h any
wa a the City of Cupertino against Ilebllltlae. Ji
41L3—'Ty
oftlpmarts,coats and expenses whish may In arty way accrue against said City in cansequerwre
of fore granting of cols permit. qIGNATURE OF A PLICA DATE
• PRE-INSPECTION: PLYWOOD: IN' ROGRESS:
INSP. DATE INSP. DATE INSP. DATE
TEAR OFF INSPECTION: BATTENS: FINAL:
ll 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: nancyc
Sec: Twp: Rug: Sub: Blk: Lot:35929025.00
INVOICE DATE...... : 08/23/1999
REFERENCE ID h ... : 99080158 '
SITE ADDRESS . . ... : 7630 ELDERWOOD CT
SUBDIVISION . . . ... .
CITY ... . . . . . .. ... : CUPERTINO
IMPACT AREA . ..... .
OWNER . . . ........ . : KOU YEONG-SUN ET AL
ADDRESS .......... :
CITY/STATE/ZIP ... : CUPERTINO CA, CA 95014-4327
CONTRACTOR ....... : LIC 4
COMPANY . ......... : -
ADDRESS .......... :
CITY/STATE/ZIP . .. . ,
TELEPHONE ..... .. . :
FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE
--------------- --- --------- ------------ -----------
BP£RMFEE P 157.00 0.00 157.00
BSEISMICRE P 1.00 0.00 1.00
--------- ------------ -----------
158.00 0.00 158.00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
FRAME 307 INSULATION
ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
603 ROOF BATTENS 604 ROOF IN-PROGRESS