The URL can be used to link to this page

99100092 2- APPLICATION APPLICATION FOR CITY OF CUPERTINO INSPECTION DIVISION PERMIT EXPIRATION REROOF PERMIT (408) 777-3228 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN IW DAYS OF PERMIT ISSUANCE OR 189 DAYS FROM LAST CALLED INSPECTION, BUILDING ADDRESS .f 209aU �-formes- � RESIDENTIAL._COMMERCIAL OTHER OWNERS HAZARDOUS FIRE AREA bare!" 2 �` YES 0 It —assembly understand that a Class A NAME IJ essembly'rs required. [f ��+-� NO IrNW I.C.B.O.d ADDRESS I U bo Ned V,e S� iW �V ,1y EXISTING ROOF COVERING PHONE �$ — `12 Z/ NUMBER OF EXISTING COVERINGS I CONTRACTOR'S / - / TO BE REMOVED TO BE RETAINED NAME C , �x TYPE OF ROOF COVERING cr,zIP /�3 S 0'- 7 .Q5, ..S3• Y5112 5//2 EXISTI NG PHONE �L "'' — BUILT-UP ROOF ❑ LICENSE NUMBER yS ZO io - ASPHALT SHINGLES Ky�� UCENSED CONTRACTORS DECLARATION I ndretry,affirm that I am licensed under provisions of Chapter 9(commencing with Section WOOD SHAKES ]099)of Division 3 of the Business and Professions Cade,and my license Is In full force and elfect. C3 9 Lo.Number rblU WOOD SHINGLES ❑ License Class D Z L 9 0-0 — d/ OTHER(SPECIFY) ❑ Data SU IUDE D OWNmthe DER DECLARATION D QCT 1 9 hereby ,Bu that am exempt Iron the e: Any city License Lew for the brewing reason. 999 (Sec. d,alt,Business acrd cusli ebnp Code: Any city p county whichIssuance,realso a permit to �7A cronsirud,alter.Improve,tome a si or repeat eny nt mat he prior to Ile pursuant also requires the BUI ROOF QJx\ applicant for such pecan a Iib aChapt r 9(commencing mat he U Ilc nsadactio pursuant to me rt 3 of the of the ss 8nd!Pro sines Lew,(Chaplet 9(commencing whir Section fine b si Dfor me 3 of the Business entl Professions Code)or that he is exempt therefrom and Ne bests for ap ice t to ASPHAL GLES exemption.ArtyN of oneof Section huf1.5 byany s($50( bra Permit subjects Na applicant to a civil per,alry of not more then flue hundretl dollars(5500).): ❑I,as owner of the property,or my employees with wages as their We compensation,will WOOD SHAKES ❑ Ne work and the structure is net Intended or offered for sole(Sec.7044,Business and Proles. Mons Cade:The Contractors License Law does not appy to an owner of Property who Wilds or WOOD SHINGLES ❑ Improves thereon,and who does such work himself or through his own employees,provided that such Improvements era not Intended or offered for sale.If,however,the building or Improvement is sold within We year of completion,the owner-tWilder will have the Wden of provig that he did OTHER (SPECIFY) ❑ not Wulld or Improve for purpose of sale.). I,as owner of me property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:The Contractors License Law does not PROVIDE I.C.B.O.REPORT NO. apply to en owner of property wnd W Ilds or Improves thereon,and whocontracts for such pmjecm with a contractors)licensed Wrsuant to the Contractors License law. PROVIDE MFGR: INSTALLATION SPECS. 1 am exempt under Sec. ,B 8 P.C.for this reason Owner Data APPLICATION DATE VALUATION PERMIT FEE WORKER'S COMPENSATION DECLARATION I hereby affirm under penally of penury one W the IolluMng declension: I]1 hexa ard MII malnbin a Certificate of Consent to sef-i sure for Workers Compensation, (vl it �� Building 00 as provided for by Section 37of thbo e Lar Code,far r performance of the worx far which this P m 4lesuetl. have and will mormin Workers Compensation Insurance,as required by Section 3]00 of Seismic thLa Code,or the Performance of the work for which this permit Is Issued.My Workers Comwnsati n Insureante carder and Polley number are: Total Carrier �`/'r�V�Z whey No.y"�/ PERMIT AUTHORIZATION DATE CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE N.C.[] (This section need not be completed II the permit Is for one hundred dollars(51 00)or Wes.) I coruty that in the performance of the work for which this permit H issued,I shall not employ any person In airy mannerso as to become subject tot"Workers'Compensation Lewis of Cell- All roofs Shall be Inspected prior l0 any roofing material being b,nla. - installed. If a roof is installed without first obtaining an Dale Applicant inspection,I agree to remove all new materials for inspection. NOTICE TO APPUCANT: II,after making me Couf cats of Exemption,you should become Applicant understands and will comply with all non point Subject to the Workers'ComPensetion provisions of Vee Labor Code,you moat fori vi comply with such provisions or ruts permit shall be deemed revoked. source regulations. I cordty mat I haw,read this eppllcadon and state that the above Information Is correct.I agree to comply with all city and county ordinances and slate laws relating to Wilding construction,and All roof Coverings to/b�e'Dcl/ass�or better. hereby aPurpo a representatives of this city to enter upon the above-mentioned property for In- coercion We)agreeses. (We)ts,agree to save,Indemnity and keep harmless the City of st Culperfino Ci against Ilebilillae, Judgments,costs this expenses which may In any way accrue against said City In coneaquence 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 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: uaucyc i Sec: Twp: Rug: Sub: Blk: Lot:32609029.00 INVOICE DATE...... : 10/19/1999 REFERENCE ID q ... : 99100092 SITE ADDRESS . .... : 20900 HOMESTEAD RD SUBDIVISION . . . . ..: CITY ...... . . . . . ..: CUPERTINO IMPACT AREA . . . . . . . OWNER ... . . . . . . . . . : 20900 HOMESTEAD PARTNERSHIP ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014 CONTRACTOR . . . . . . . : STEVENSON, MIKE LIC # 20774 COMPANY .... . . . . . . : TAYLOR ROOFING INC ADDRESS ..... . . . . .: 1853 S 7TH ST CITY/STATE/ZIP ...: SAN JOSE, CA 95112 TELEPHONE . . . . . . ..: (400)971-7500 FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE _______________ ___ _________ ____________ ___________ BPERMFRE P 257.00 0.00 257.00 BSEISMICRE P 2.00 0.00 2.00 _________ ____________ ___________ 259.00 0.00 259.00 YID DSCRIPTION VOICE ID __---- DESCRIPTION ............................ ........ .............. 305 FRAME 307 INSULATION 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 603 ROOF BATTENS 604 ROOF IN-PROGRESS CITY OF CUPERTINO 1 of 1 BUILDING PERMIT RECEIPT OPERATOR: nencyc COPY # 1 Ser Twp: Rng: Sub: Blk: Lot:32609029.00 - DATE ISSUED.. . . . . . : 10/19/1999 RECEIPT #... .. . . . . : 10369 REFERENCE ID # . . . : 99100092 SITE ADDRESS ... . . : 20900 HOMESTEAD RD SUBDIVISION ..... . . CITY . . ......... . . : CUPERTINO IMPACT AREA .. . . . . . OWNER . ....... . . . . : 20900 HOMESTEAD PARTNERSHIP ADDRESS ........ . . : , CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014 RECEIVED FROM . . . . : TIM CONTRACTOR . . . . . . . : STEVENSON, MIKE LIC # 20774 COMPANY ....... . . . : TAYLOR ROOFING INC ADDRESS ...... . . . . : 1853 S 7TH ST CITY/STATE/ZIP . . . : SAN JOSE, CA 95112 TELEPHONE ... . . . . . : (408)9]1-]500 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS RIC NEW BAL __ __________ __________ 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 T'pPERMIT : 259.00 0.00 259.00 0.00 ME. D OF PAYMENT AMOUNT NUMBER _________________ ____________ __________________ CHECK 259.00 53164 ------------ TOTAL RECEIPT 259.00 VOICE IO DESCRIPTION VOICE ID DESCRIPTION 305 FRAME 307 INSULATION 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 603 ROOF BATTENS 604 ROOF IN-PROGRESS •