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99090017 ©rte- gg09001 PERMIT-- rR— APPLICATION FOR CITY OF CUPERTINO NUMBER INSPECTION DIVISION PERMIT EXPIRATION REROOF PERMIT (408)7n-3228 PERMIT EXPIRES IF WOW S\NOT STARTED WITHIN 160 DAYS OF PERMIT ISSUANCE OR 160 DAYS FROM LAST CALLED INSPECTION. BUILDING ADDRESS `��J` I VhRL/, I u ` I 11 �Rt�" RESIDENTIALCOMMERCIAL - OTHER OWNER'S //y' 'my� HAZARDOUS FIRE AREA NAME l /�B1_ B"I� YES ❑ tlyeasImbly isandina . GassA rood assembly is requireA. /� C ,t NO IrtiCal I.C.B.O.A ADDRESS 1i C�.J ��ZI 1 ( .UP• 1 Vl EXISTING ROOF COVERING A`� PHONE . Z / t NUMBER OF EXISTING COVERINGS CONTRACTOR'S Tj �� K iV(1G(,I TO BE REMOVED TO BE RETAINED NAME' /` ,t l/ f�w r r`\ �{ ] ADDRESS I v K9y TL. L Cc 9�f U J Z TYPE OF ROOF COVERING1� CRY a ZIP EXISTING D PHONE "'0`- IgZy – I I 1 7 BUILT-UP ROOFLICENSE ❑ u NUMBER -7 2- 5 1 ASPHALT SHINGLE SEP o 1 1999 LICENSED CONTRACTORS DECLARATION 0 I hereby affirm Mat I am licensed under provfelonu of Chapter B(commencing with Section WOOD SHAKES 7000)of Dons on 3 of the Sushi and Professions Code,auto my license Is In full Iwoo and By elLic.Number �21511 WOOD SHINGLES License Claes .� + I-1 Date Caroectort� r±��^+r('1= OTHER(SPECIFY) OWNER-the C ER DEC's ON PROPOSED 1� / -hereby 7031. ,Bu that l em exempt from the e: Any oc License Lew ion the following reason. ❑< /_� (Sec.703 aft r,impr ,e eM Professions rep Code: Any urs p county which requires requires permit d Z /J coostrmelleuimprove,tomolaSsinrepeatenynt thate.priorto Its issuance,alsoProvthe BUILT-UP ROOF 7 applicant for such permit a Ills a Signed statement that he Is n licensed pursuant to the prod el ons of the ss and License Law(Chapter 0 Is exempt t with Sec.kn 7000)of Divider 3 of the Business end violatekne Cade)or thet he le exempt antforom"oM the je is for the alleged ASPHALT SHINGLES exemption.Any violation of SeNon 7031.5 by olry applicant for a permit subjects Me applicant to e ova penalty of not more then iWa hundred dollars ❑I,as owner of the property,or my employees with wages as I We compensation,will do WOOD SHAKES ❑ Me work,entl Ne structure is not Intended or offered for sale(See.7044,Burton"and Pmfe t- eknsCode: The ContractorsUcerueLaw does not apply toanowner ofpropertywho bulltlsor WOOD SHINGLES Improves thereon,and whe tlwe such work hlmseH or through his own employees,provided Ihet ❑ such Improvements are not intended or offered for sale.If,however,the building or Improvement Is Said within one year of completion,the owner bulkier will have the burden of proving that he did OTHER(SPECIFY)SPECIFY) not build or Improve for purpose of Sale.). ❑ ❑1,as owner of the property,em exclusively contracting with licensed contractors to construct Me Project(Sao 7044,Business and Professions Code:The Contractors_Kwse Lew does rot PROVIDE I.C.B.O.REPORT NO. appy to an owner of Property who builds or Improves thereon,and who contracts for such projects wHh a contrscton(s)licensed pursuant to the Contractors L cen us Law. PROVIDE MFGR.INSTALLATION SPECS. ❑I am exempt under Sec. ,B&P.C.for INS reason OwnerDate WORKER'S COMPENSATION DECLARATION APPLICATION DATE VALUATION PERMIT FEE I herstry affirm under penally d perjury one of the following declaration: rj 1 have and will mountain a Cerdfi ate of Consent to self insure for Workers Comperualbn, Building 177 as provlded for by Section 3700 of the Labor Code,for the petlormanxa of the work for which this pe, Iseuetl. q a e $eISfT11C �. W l ve and will melndln Workers Campensatlon Insurance,es required by Section 3700 of l I (( l/`/—/CJS!` a r Code,lot the performance of the work for which this permit Is Issued.My Workers Compensation Insurance carrier and Policy number are: c Total Carrier— PaicyNo. 2' i P IT UTHORIZA N� DATE CERTIFlCATE F EXEMPTION FROM WORKERS' COMPENSATION INSURANCE N.C.0 (This settlor need not be completed If the permit is for one hundred tlollars($100)or less.) I certify that in the performance of the work for which thus permit Is issued.I shall not employ soy person In any manner so as to become subject to the Workers'Compensation Laws of Cali- All roofs all be inspected prior to any roofing material bei g home. install If a roof Is installed without first obtaining an Date Applicant ins ion,I agree to remove all new materials for inspection. NOTICE TO APPLICANT: If,after making this Certlllcate of Exemption,you should becorne Applicant understands and will comply with all non I sil to the Workers'Compensation provbuons of the Labor Code,you most forthwith comply PP P Y point with such provlefons or INs Permit shall be deemed revoked. source regulations.. I certify that I have rued thle applkatlon and stale that the above Information Is comac..I agree to comply with all d y azul County ordinances and state laws relating to building construcl'ron,and All roof coverings to be Class"C"or better. hereby authohze representatives of MIs city to enter upon the to o bramonetl property fo spechant purposes. (We)agree to Sova,Indemnity and keep notorious the CIy of CUpergro eget labiMee. L Judgments.wets and expenses which may In any way accrue egaMst said City In ' sequence NATO APPLICANT T Alai of the grendng of this petit. 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 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: yvonnek Ser. Twp: Rng: Sub: Blk: LOC:31635012.00 INVOICE DATE..... . : 09/02/1999 REFERENCE ID p .. . : 99090017 SITE ADDRESS ..... : 19781 MERRITT DR SUBDIVISION ...... . CITY . . . . . ........ : CUPERTINO IMPACT AREA ......: OWNER . . . . . . . ..... : BONN CAROL H ADDRESS . . . . . .. ... : CITY/STATE/ZIP ... : CUPERTINO CA, CA 95014-2406 CONTRACTOR .......: PROCTOR, PAUL LIC k 19698 COMPANY . . . . ...... : R E ROOFING ADDRESS . . ........ : 108 OAKLAND PL CITY/STATE/ZIP ...: LOS GAME, CA 95032 TELEPHONE . .......: (408)925-9995 NOTE: THE FEES LISTED ARE ONLY THOSE DOE BEFORE PERMIT PRINTING FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE BPERMFEE P 177.00 0.00 177.00 IMID ICRE P 1.20 0.00 1.20 178.20 0.00 178.20 DESCRIPTION VOICE ID DESCRIPTION ........ ............................ ........ ............................ 305 PRAM 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: yvonnek COPY # 1 Sec: Twp: Rn9: Sub: Blk: Lot:31635012.00 DATE ISSUED....... : 09/09/1999 RECEIPT #.. . ...... : 10014 REFERENCE ID # ... : 99090017 SITE ADDRESS ..... : 19781 MERRITT DR SUBDIVISION ....... CITY . . . . . . .. ..... : CUPERTINO IMPACT AREA ...... . OWNER ............ : BUNN CAROL H ADDRESS ........:. : CITY/STATE/ZIP ... : CUPERTINO CA, CA 95014-2406 -1 RECEIVED FROM . . . . : JOE SI' CONTRACTOR . . . . . . . : PROCTOR, PAUL LIC # 19698 COMPANY ... . . . . . . . : R E ROOFING ADDRESS .... .. . .. . : 108 OAKLAND PL CITY/STATE/ZIP . . . : IAS GATOS, CA 95032 TELEPHONE . . . . . . . . : (408)925-9995 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- --------' BPERMEEE VALUATION 12,000.00 177.00 0.00 177.00 0.00 BSEISMICRE VALUATION 12,000.00 1.20 0.D0 1.20 0.00 ---------- ---------- ---------- ---------- '� PERMIT 178.20 0.00 178.20 0.00 OD OF PAYMENT AMOUNT NUMBER ----------------- ------------ ------------------ CHECK 178.20 3047 ------------ TOTAL RECEIPT - 178.20 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