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99090120 3La Qqp � PERMIT APPLICATION FOR CITY OF CUPERTINO NUMBER INSPECTION DIVISION PERMITEXPIRATICN REROOF PERMIT (408)777-3228 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 1M DAYS OF PERMIT ISSUANCE OR .n 180 DAYS FROM LAST CALLED INSPECTION. , BUILDING ADDRESS I I�V II ` �L-Q— RESIDENTIAL COMMERCIAL OTHER OWNER'S HAZARDOUS FIRE AREA YES ❑ It yes—I Undourstand that a Clens A NAME - roof asselMly,is requited. //�� 7 e_1446 NO ❑ Irl I.C.B.O.N ADDRESS)- O 1 0 e'`�-- 16 P i l �— EXISTING ROOF COVERING PHONE &P 6 -19 NUMBER OF EXISTING COVERINGS CONTRACTOR'S NAME FJC..i �l�r 1/�, rn 9. TO BE REMOVED TO BE RETAINED ADDRESS (e ��• TYPE OF ROOF COVERING CITY a ZIP .U s IL` EXISTING G q ' lS PHONE — if IT / - LILT-UP ROOF ❑LICENSE 4 NUMBER72371� _3 \ ES LICENSED CONTRACTORS DECLARATION hereby aphm that em Ikereetl antler i provisions of Chapter B(carnseII. g life O ]000)of Division 3 of ttna Business and smear provi ays Code,and rrry Icomirro s In full for tl .Ilett. T QQ 11% Ucernse Close� Uc.Number / OT �- Date �( �'� 9'y COntreetor Opt hwh the UDERContractor DECLARATION for s hereby .Bu Net I am exempt ham rho e: Any ote Llconue Lew for the requires rg reason. (Sec.]031.5,Business and Profeaslone Code: Aay city or-county which re,also a uirmk to construct,alter,Improve,to file asigned repeat eny nt Mal e,ptlor to Ice 1pursuant also requires tree BUILT- O applicant for such permit to III. lChapter 9 orsom enet he with pursuant of 10 the provisionsothe of no ss and Prof License Law(Chapter h Is exempt t vdth therefrom the th si Dior Me 3 d1 the Baseness and Professions Code)or that he le ezempl therefrom end the heals for the alleged- ASPHALT SHINGLES I exemption.Any violation of Section 7031.5 by any applicant for a Permit subjects the applicant to a civil penalty of not mare than five hundred dollars($500).): WOODSHAKES�I ❑I,as owner of the property,or my employees with wages as their sole compensation,will do I �� F1999the work,and the structure a spit Intended or offered for able(Sec.7040,Briefness and Profen- y.7 cions Code:The Contractors License law does rel apply to an owner of property who builds a WOOD SHINGLES improves thereon,and who sees such work Nmsea or through his own employees,provided that 1 such Improvements are not Intended or offered for safe.II,however,the bulldIng or improvement Is void within one year of completion,the owner4oulber will have the burden of proving that he did OTHER(SPECI not build or Improve for wrpo.l of sale.). Py I,an owner of the property,em ezdueivey contractsrrqq with lkerssetl contractors to codetruct lJ the Project(Sec.7044,Business aro Profeeakns Code:Th9 Contractor's ucenue law deep 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 epi oral licensed pursuant to the Contractors License Law. PROVIDE MFGR.INSTALLATION SPECS. ii exempt under Sec. ,B 6 P.C.for thee r acon moo, Date APPLICATION DATE VALUATION PERMIT FEE WORKER'S COMPENSATION DECI-ARATION I hereby al under penalty of perjury one of the following declaration: 1 have and will maintain a Certificate of Consent to sell-Insure for Workers Ca ensatbn, Building as provided for by Sedlon 3700 of the Labor Code.for the performance of the work for wil this f(/V/A/ � O� Permit is Laeueel. ❑1 have end will mahouts Workers Compensation Insurance,as required by Section 3700 of Seismic the Labor Code,for the performance of the work for whbh 1Ns permit Is Issued.My Workerh I Compensation Insurance carrier and Policy numbs are Total l Carder Policy No. PERMIT AUTHORIZATION DATE _ CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE NJ (This section need not be completed If the permh Is for one hundred dollars($1 W)or leas.) I candy that In the performance of the work for which this permit Is Issued,I shall not employ any person In any manner so as to become subject to the Workers'Compensabon Laws of Cell- All roofs shall be inspected prior to any roofing material being ror"a' ^ - installed. If a roof is installed without first obtaining an Data 9 Applies ✓ 1 �� inspection,I agree to remove all new materials for inspection. NOTICE TO APPLICANT: If,otter ma ie nubata of E tion,you eh.mtl bectme A Ilcant understands and will tom I with all non point subject to the Workers'Compensation pra+lslons of the Lobar Code,you must fodhwith comply PP P Y P with such provisions or this permit al be deemed revoked. SOUTCa regulate Ore S. I earthy Nat I have reed Mus applicatlon aro erste tfnel the above Inforrrnallm b corted.l agree to comply with all city and county ordinencesand state laws relefirg to drlkingcorWruttbnaro All roof coveririgs to be class or better. hereby euddl representatives of thIa city to enter upon fhe above-mentioned property br in- epoWe)agree tos. = O O (We)agree s save,Indemnity and keep harmless the Clty of Cupertino agelnM Ilebllltke, 2- of Me granting costo and permit. s which niay In any way accrue egelnef oak Ciy b mnsaquenca ATU F APPLICANT DATE of gee granting of tiYe 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: karenb AdIL Sec: Tp: Rng: Sub: Elk: Lt:36905024.00 INVOICE DATE. . . . .. : 09/20/1999 REFERENCE ID # ... : 99090120 SITE ADDRESS . . . ..: 10170 MELLO PL SUBDIVISION . . .... . CITY ...... . . . ....: CUPERTINO IMPACT AREA . . ..... OWNER .. . . . . . . .... : YON CHONG ADDRESS . .. ....... : CITY/STATE/ZIP ... : CUPERTINO CA, CA 95014-3336 CONTRACTOR ....... : LIC N COMPANY . . ........ : ADDRESS . . . . . . . ...: CITY/STATE/ZIP .... , TELEPHONE . . . . . ... : FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE --------------- --- --------- ------------ ----------- BPERMFEE P 137.00 0.00 137.00 BSEISMICRE P 0.80 0.00 0.80 13] 80 0.00 137.BO VOICE ID DESCRIPTION VOICE ID DESCRIPTION -*` FRAME 307INSULATION ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 603 ROOF BATTENS 604 ROOF IN-PROGRESS • CITY OF CUPERTINO 1 of 1 BUILDING PERMIT RECEIPT OPERATOR: karenb COPY k 1 Sec: Twp: Rng: Sub: Blk: Lot:36905024.00 DATE ISSUED....... : 09/20/1999 RECEIPT q. ....... . : 10112 REFERENCE ID $ . . . : 99090120 SITE ADDRESS .... . : 10170 MELLO PL SUBDIVISION ...... . CITY . . . .......... : CUPERTINO IMPACT AREA ..... . . OWNER . . ........ . . : YON CHUNG ADDRESS ...... . . . . : CITY/STATE/ZIP . ..: CUPERTINO CA, CA 95014-3336 RECEIVED FROM . . ... TIM CONTRACTOR .. . . . ..: LIC k COMPANY .... . . . . ..: ADDRESS .... . . . . . .: CITY/STATE/ZIP . . . . TELEPHONE .. . . . . ... FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS AEC NEW BAL ---------- ---"'------- ---------- ---------- ---------- ---------- ---------- BPERMFEE VALUATION 8,000.00 137.00 0.00 137.00 0.00 BSEISMICRE VALUATION 8,000.00 0.80 0.00 0.80 0.00 PERMIT 137.80 0.00 137.80 0.00 D OF PAYMENT AMOUNT NUMBER ____________ ____________ __________________ CHECK 137.80 1244 ------------ TOTAL RECEIPT 137.80 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 •