99080132 7 5- 2.5 3
PERMIT
.APPLICATION FOR CITY of CUPERTINO NUMBER
INSPECTION DIVISION PERMITEXPIRATION
REROOF PERMIT (408)777-3228 PERMIT EXPIRES IF WORK IS NOT STARTED
. . WITHIN 180 DAYS OF PERMIT ISSUANCE OR
BUILDING ADDRESS
180 DAYS FROM LAST CALLED INSPECTION.
/n� •
LO)2ceVe, l ll f�r>O RESIDENTIAL COMMERCIAL OTHER
OWNER'S HAZARDOUS FIRE AREA
/+� YES ❑ "yes–I understand Btat a Class A
NAME_l=.t�-)Yr I"7"r 1 root assembly is required.
NO ❑ Initial I.C.B.O.11
ADDRESS ° JAX OS �>J SWYIA - EXISTING ROOF COVERING
PHONE NUMBER OF EXISTING COVERINGS
CONTRACTOR'S �..�r�v� I TO BE RETAINED
Ss-d
NAME U_ >2-�Xl• l � 'G-e I C-<' TYPE OF ROO ING
T BE REMOVED
ADDRESS
CIN 6 ZIP 2x040 - .)6 111
EXISTING
PHONE gDS01—Ia44e6 BUILT-UP ROOF "ink
LICENSE
NUMBER t I A r75 1 ASPHALT SHINGLES LJ
LICENSED CON TRACTORS DECI-ARATION
1 hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section WOOD SHAKES ❑
9000)of Dlvlslon 3 of the Business and Profeaslons Code,and my license b In full forte and
affect.
WOOD SHINGLES
License sa�cL� Uc.Number1 ���/� ❑
Dale 2R!/� Contractor �l�1 FL.IJI.JVI OTHER(SPECI � vaavrl
OWNER-BUILDER DEGLARAT10NPROPOSED u
I hereby affirm Met I am exempt from the Contradore License Lew for U ng reason. D
(Sec.7031.5,Business and Professions Code: Any city or county which nyWIres a permit to AUG 19 X99
construct,alter,Improve,demollah,or repair any structure,prior to Its Issuance,also requires the BUI LT-UP R00II
applicant or each permit to file a signed statement that he Is licensed pursuant to the provlelons
• of the Contractors License Lew(Chapter 9(command rgg with Section 7000)of Division 3 of the
nd
Busmom aProfessions Code)or that he Is exempt Merefrom and the basis for me alleged ASPHALT SHINGLES ❑
exemption.Any Aoletlon of Section 7031.5 by any applicant for a permit subjects the applicant to I RY
e cNll penalty of not more Man five hundred dollars($50D).):
01,as owner of the property,or my employees with wages as their sole compensation,will do WOOD SHAKES— — _n
the work,and the structure Is not Intended or offered for We(Sac.7044,Business and Profits.
sionu Code:The Contractors License Lew does not apply to an owner of property who builds or WOOD SHINGLES ElImpro ova Menson,and who does sthrough such work himself or hs own employees,provided Chet
such Imprwemens are no;Inlarote i or offered for We.If,however,the Wilding or Improvement
Is stud within one year of completion,me owner4,ulMer will have the Whiten of proNng oat he did OTHER(SPECIFY)
SPECIFY
not Wild or Improve far purpose of agile.). ( /
❑I,as owner of Me property,am exclusively contract ng with licensed contractors to construct
Me project(Sac.70,14,Business and Professions Code:The Contractors License Law does rot PROVIDE I.C.B.O.REPORT NO. 4B
apply to an owner of property who bullds or Improve,thereon,and who contracts or such project
with a contractor(s)licensed pursuant to the Contractors Ucense Law. PROVIDE MFGR.INSTALLATION SPECS.
O 1 am exempt under Sec. ,B&P.C.for thio reason
Owner Data
WORKER'S COMPENSATION OECLARAnQY APPLICATION DATE VALUATION PERMIT FEE
I hereby affirm under penelry of perjury oro of the fallowing decsretlon: I O •O D
I he"al maintain a Cer"ficate of Consent to aelfansurs for Workers Carnpeneetlon, Building
nd M
as provided for by Section 3700 of the Labor Code,or the performance of the work for which tub f--�/� (� �0
perht}it b Issued. i i:/ / G�-?Ip2'� Seism'
X have and will maintain Workers Compensation Insurance,as repaired by Section 37W of
Me Labor Code,for the perfohmerKe of the wolf for which this permit s slued.My Workers 1n
Compo` �j�'�Insummce carriergird Policy number ars: Total
caMarV7ia^ 1 �" Pali N0\b 2��14 PERMIT AUTHORIZATION DATE
- CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSAnON INSURANCE N.C{]
(This section road not be completed 1 the permit Is for one hundred dollars($100)or lees.)
I certify that In the performance of the wwk for which this permit Is Issued,I shall not employ
any person In any manner so as to become,subject to the Workers'Compensation Laws of Cell- All roofs Shall be Inspected prior to any roofing material being
forme. installed. If a roof is installed without first obtaining an
Data Applicant inspection,I agree to remove all new materials for inspection.
NOTICE TO eugect to the WorkenL 'APPLICANT:
eation pro dslwrs 0 ft Certificateof mYou you should become Applicant understands and will comply with all non point
You moat farthwilh corrlpty
with such prwslone or this Permit shall the deemed revoked. SOUTCe regulations.
I certify that I have read IN,appllcallon and state that Me above Information is correct.I agree
to comply with all city and county ordnencee and slate laws relating to bulking construction,and All roof coverings to be class'C'or better.
hereby authorize reprmentallves of this city to enter upon the above-mentlmotl property for In-
epeWepurposes.
(We)agnea to,eve,Indemnity and keep harmless the City ai Cupertino Ci against Idbllltiea,
. l�dpmgran toss and expenses wTkh may In arty way accrue apelnal ealtl City In coneequaroe
of Urs gmnWg of this Permit, S ATURE OF I ANT DATE
PRE-INSPECTION: PLYWOOD: IN- ROGRESS:
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 _
CITY OF CUPERTINO
I• 1 of 1 BUILDING PERMIT RECEIPT OPERATOR: karenb
COPY 4 1
Sec: Twp: Rug: Sub: Blk: Lot:37525069.00
DATE ISSUED. . . . ...: 08/19/1999
RECEIPT H.. . . . . ...: 9847
REFERENCE ID # ...: 99080132
SITE ADDRESS . . . ... 18654 LOREE AVE
SUBDIVISION . . . ...:
CITY . .... . . . . . . . .: CUPERTINO
IMPACT AREA . . . . .. .
OWNER ... . . . . . . ... : GRIFFITH
ADDRESS . . . . . . .... :
CITY/STATE/ZIP ... : CUPERTINO, CA 95014
RECEIVED FROM ... . : TIM
CONTRACTOR ..... . . : UNKNOWN LIC N 9856
COMPANY ....... . . . : ALL SEASONS ROOFING INC
ADDRESS ....... . . . : 2640 PACER LN
CITY/STATE/ZIP . ..: SAN JOSE, CA 95111
TELEPHONE . . . . . . . .: (408)972-4455
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
BSEISMICRE VALUATION 4,262.00 0.50 0.00 0.50 0.00
---------- ---------- ---------- ----------
Ile PERMIT 107.50 0.00 107.50 0.00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 107.50 10491
•• •
TOTAL RECEIPT 107.50
VOICE ID I DESCRIPTION VOICE ID DESCRIPTION
........ ............................ ........ ............................
305 FRAME 307 INSULATION
601 ROOF PEAR OFF 602 ROOF PLYWOOD NAIL ,
603 ROOF BATTENS 604 ROOF IN-PROGRESS
•