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99090070 3�G oo oo O P:ERM IT R_ APPLICATION FOR CITY of CUPERTINO NMBER INSPECTION DIVISION PERM EXPIRATI N REROOF PERMIT (408) 777-3228 - PERMIT EXPIRES IF WORK IS NOT STARTED �• WITHIN DAYS PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. BUILDING ADDRESS 1107 6 AX 7"�J CJ I'll RESIDENTIAL COMMERCIAL OTHER OWNER'S HAZARDOUS FIRE AREA VES ❑ II yerod s—I understand that a Class A al.,,( ' NAME O r'� al.,,( a, assarMYy is required. NO ❑. Initial I.C.B.O.Y ADDRESS S 0. V%% . EXISTING ROOF COVERING PHONE - .NUMBER OF EXISTING COVERINGS CONTRACTOR'S .,—' .TO BE REMOVEDTO BE RETAINED NAME Lill (77 006S IiLc R(iiii ADDRESSE Po.,9 RING CITY&ZIP Ill C& EXISTING / PHONE �'7 3BUILT-UP ROOF LICENSE NUMBER l 7 ASPHALT SHINGLES �1 LICENSED CONTRACTORS DECLARATION / I hereby affirm mel I am licensed under provisions of Chapter 0(commencing with Section WOOD SHAKES 7000)of DNLdon 3 of the Business and Professions Code,and my license Is In Tuft force and ems' WOOD SHINGLES License Class� Uc.Number � ❑ Date Contractor OTHER(SPECIFY) 14Ill OWNER-BUILDER DECLARATION41 PROPOSED 1 hereby affirm that I am exempt from the Contractor's Ucenee Law for the following reason. (Sac.7031.5,Business and Professions Code: Any cl y or county which requires a permit to construct,after,Improve,demollsh,or repair any structure,pprior to he Issuance,also requires ma BUILT-UP ROOF applicant for such permlt to lila a signed statement that be ie Ikensed pursuant 10 the pr0vtaions El of the ConUegar's License Law(Chapter g(commencingp with Section 71X 0)of dNsion 3 of the BuslMas end Profaesbne Cade)or that W ts exempt Iherelram and the balls roi the alleged ASPHALT$HINGE $ exemption.Any Notation of Section 7031.5 by any applicant for a permit subjects the applicant to �_ a cMI penalty of not more man five hundred dollars(3500).): WOOD SHAK �� El 1,an owner of the oneperty,or my employees wbm wages as their sale compensatlon,will do /Z QI� the work,ark the structure ta not Intended or offered for Bele(Bac.7044,Business and Prolae- Z� I siona Code:The Contractors LJcense Law does not apply t0 an owner of property who bunds or WOOD SHIN S Imprwea thereon,and who does such work himself or through his own employees,provided that FIN such Improvements ere not Intended or offered for sale.It,howe r,me building or Improvementle a pa within one year of comphtbn the owner-bulmer win have me burden of prWng that he did OTHER SP IFYSEP ' 9 1(� not Wild or Improve for purpose of al ( I V p 1,as owner of the property,am exclusively contractingp with licensed contractors to construct Ne project(Sec.7044,Business and Professions Cma:'fhe Contractors Lldense Lew does not PROVIDE L Sul REPORT NO. at to an owrwr of property who builds or lmprines thereon,ant who contracts for such projects — Men a contimer(s)licensed pursuant to the Contrectore License Law. ❑1 am exempt under Sec. ,e&P.C.for rola realPROVIDE MI INS IOFkSpEC r. Owner Date APPLICATION DATE VALUATION PERMIT FEE WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of me following declension: [:11 havldetl ve and will malntaln a Cerinlcate of Consent to sell-Insure for Workers Compensation, BUlldinF,�..� as profor by Section 3700 of the Labor Coal for the performance of the work for which this permit is Issued. ❑1 hoentl will maintain Worker's Compensation Insurance,as required by See loft 3700 of //LL Seismic / J `� ve the Labor Code,for me performance of the work for which this permit Is Issued.My Workars conpan�4rh If�''mnca carrier entl Pot ural^are: 7/ /n� v '� Total carrier �l/f r►a 110 , J.,x /n Policy No((�C d0 37.3, PERMIT AUTHORIZATION DATE t CERTIFICATE OF EXEMPT10N FROM WORKERS' + COMPENSATION INSURANCE N.CQ (Thta section need not be completed If the permit is for one hundred dollars($1 W)or foes.) I certify that In the performance of the work for which this permit Is issued,I shell not empfoy any personIn any manner so as to become subject to the workers Compenaeifon Laws of Cell- All roofs shall.be inspected prior to any roofing material being tome. installed. If a roof is installed without first obtaining an Date I Applicant inspection,I agree to remove all new materials for inspection. NOTICE TO APPLICANT: If,atter making this Certificate of Exemption,you till become Applicant understands and will comply with all non point subjed to Me with suucth provisions or We permitshallbe deemed rons of hew4u d.Labor Code,you must ronMvlm canpry source regulations. - I cerilty that I have rand rota epplfoaiion ark state mat the all Information Is coned I agree to comply with ell dry and county ordlnancesand stale laws relating to Wilding construcllonend All roof coverings to be class"C°or better. ' hereby authorize representatives of role dry to enter upon the above-mentloned property for In. speciepurposes. (We) )agree to 9eve,Indemnity ant keep harmless me City of Cupertino safe C against IlelNllllae, ��,.fff//7L/•. (/lC7_�yf1`/ O ' of the guts,coats and expanses which they In any way accrue against seta Gry In consequence SIGNATURE OF APPL ANT 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 ' J INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE CITY OF CUPERTINO • BUILDING PERMIT INVOICE OPERATOR: christya Sec: Twp: Rng: Sub: Blk: Lot:35624006.00 INVOICE DATE......: 09/09/1999 REFERENCE ID N ...: 99090070 SITE ADDRESS . . . . . : 11497 LINDY PL SUBDIVISION ... .. . . CITY ............. : CUPERTINO - IMPACT AREA ...... . OWNER ............ : OHARA HENRY M AND LINDA L ADDRESS .......... : CITY/STATE/ZIP ... : CUPERTINO CA, CA 95014-4814 CONTRACTOR ....... : RADONICH, GARY LIC N 17814 COMPANY .......... : LOS GATOS ROOFING ADDRESS .......... : 1771 SMITH AVE CITY/STATE/ZIP ... : IAS GATOS, CA 95030 TELEPHONE ........ : (408)358-1233 FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE --------------- --- --------- ------------ ----------- BP ERM FEE P 207.00 0.00 207.00 BSEISMICRE P 1.50 0.00 1.50 _________ ____________ ___________ 208.50 0.00 208.50 ID .__-DESCRIPTION-----___. VOICE ID ..----- D..CRI PTION ..z _z.. ..... ........ ................. 305 FRAME 307 INSULATION 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 603 ROOF BATTENS 604 ROOF IN-PROGRESS • CITY OF CUPERTINO I� 1 of 1 BUILDING PERMIT RECEIPT OPERATOR: chriatya COPY # 1 Sec: Twp: RnB: Sub: Blk: LOL:35624006.00 DATE ISSUED.. . . ...: 09/09/1999 RECEIPT q... . . . . ..: 10031 REFERENCE ID N ...: 99090070 SITE ADDRESS . . . ..: 11497 LINDY PL SUBDIVISION ... . . . . CITY ......... . . . . : CUPERTINO IMPACT AREA . . . . .. . OWNER .... .. . . ....: OHARA HENRY M AND LINDA L ADDRESS ..... . . ...: CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-4914 RECEIVED FROM ....: TIM CONTRACTOR . ... . . . : RADONICH, GARY LIC # 17814 COMPANY ....... . . . : LOS GATOS ROOFING ADDRESS ... ... . . . . : 1771 SMITH AVE CITY/STATE/ZIP . . . : LOS GATOS, CA 95030 TELEPHONE .... .. . . : (408)358-1233 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW RAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BPERMFEE VALUATION 15,000.00 207.00 0.00 207.00 0.00 VMICRE VALUATION 15,000.00 1.50 0.00 1.50 0.00 PERMIT 208.50 0.00 208.50 0.00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ ------------------ CHECK 208.50 6207 ------------ TOTAL RECEIPT 208.50 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 •