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99110058 S O7 d -APPLICATION FOR _ CITY OF CUPERTINO INSPECTION DIVISION q4w REROOF PERMIT (408)777-3228 PERMREXPIRESIFWORK S�NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. BUILDING ADDRESS 6/p C RESIDENTIAL COMMERCIAL OTHER - OWNERS HAZARDOUS FIRE AREA NAME //�-7�y /�'I711�.5 VES ❑ ��IS rr equirthatae Class A NO ❑ Inifial I.C.B.O. ADDRESS/—" % 1114640?7 C'y1 EXISTING ROOF COVERING PHONE NUMBER OF EXISTING COVERINGS CONTRACT ' NAME ARS TO BE REMOVED TO BE RETAINED ADDRESSTYPE OF ROOF RIN CITY 8 ZIP EXISTING PHONEC,bV ) ZYY'069-t7 BUILT-UP ROOF LICENSE NUMBER 55" � ASPHALT SHINGLES �� LICENSED CONTRACTORS DECLARATION C hereby dofflamsion that em Business ssunder fiessi ons of Chapter B(comms is in with Sectionand WOOD SHAKES / ]000)of Division 3 of me Business entl Professions Coca,and my Ikons¢Is In WII lone entl erect. Q WOOD SHINGLES ❑ License Class ��r Lk.Number ' Date IZ �G- Cornractor OTHER(SPECIFY) El OWNER-BUILDER DECI-ARA116PROPOSED I hereby affirm Net I am exonpt from the Contractors License Law for the fallowing reason. (Sec.7031.5,Business and Profoseions Code: Any city or county which requires a permit toEP;LES construct,alter,Improve,demolish,or repair any structure,prior to Its Issuance,also requires the BUILT-UP applicant for such permit to rile a stgned statement that he Is licensed pursuant to the provisions1 at the Cantmctors License Law(Cheptor 9(commenclrg with Semlon]000)of DNarcer 3 of the .Business,and Professions Code)or that he Is exempt ht erefrom and the basis for me alleged ASPHALTexemption.My violation of Section]0 31.5 by any applicant for a permit subjects the applicant toa civil Penalty of not more than fiva hundred dollars(SSW).): ❑I,as matter of the property,or my employees with wages as their sole compensation,will do WOODSHthe work,antl the stmclum Is rot Intended or offered for sale(Sec.7044,Business antl Profnse- $ionsCode:The Contractor a Lknsnse Law does rat apply to an purer of p operty who build,or W1DOD SHImproves tereon,and who does such work himself or through his own emplo ees,provided Natsuch improvements are not Intended or offered for sale.II,however,the building or improvement is sdd within one year of competlon,the owner-Wilder win have the burden of proving Met he d c! OTHER(Sp-+ D not Wild or improve for purpose of vele.). ❑I,as owner of the property,am exclusively connecting with licensed contractors to coruti uct the Project(Sec.7044,Business end Professions Code:The Contractors Ucerwns Lew does rat PROVIDE I.C.B.O.REPORT NO. appy to an owner of property who Wilds or improves thereon,and who contracts for such projects with a contractors)licensed pursuant to the Contractors License Law. PROVIDE MFGR.INSTALLATION SPECS. C]1 am exempt under Sec. ,B&P.C.far this reason Owner Date APPLICATION DATE VALUATION PERMIT FEE WORKER'S COMPENSATION DECIIJiATION I hereby arum under penalty of perjury ane of the following doctorallon: ❑I neve entl will Mora In a Certificate of Consent to sen-insure for Workers Compensation, Buildln ' po as provided for by Section 37M of the Lobar Code,for Me performance of urns work for which Nis g permit L,vued. 116 have and will maintain Workers Conmeneetbn Insurance,as required by Ssctbn 37M of Seismic Cfo ma Labor Code,for ire performance of the work for which Mile permit s Issued.My Workers / vG�,sr� Compensation Innsurancecanier tl ky umber are: /�r _ ` JOV Total Carrier f}► y�'�n � 4 inn PdkyNo. 5.4AQA2_3'6 PERMIT AUTHORIZATION DATE CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE N.CQ GJ This essence need not W completed 0 Ne permh Is for one hundred ddiara($100)or less.) / I cavity that in the performance of Me,work for which bus Pernd Issued,I shall not employ any person In arty manner so as to become wblect to Ne Workers' pensation Less of call- All roofs shall be inspected prior to any ro fing material being ferns. installed. If a roof is installed without first obtaining an owe �1- .b"9i:? Applicant inspection,I agree to remove all new materials for inspection. NOTICE TO APPLICANT: If,after making lh s nun o emplbn,you yl become subject to the Workers'Compenso8on provisions of the r code,you meat forthwith comply - Applicant understands and will comply with all non point with such provisions or this permit short he deemed revoked. source regulations. I cerilly,that I have read this application entl state Nal the above Information le correct.I epee to comply with all city and county ordinances and state laws relating to Wlding construction,and All roof COVerin7sto eclass" rbetter. hereby eugtodze re rosentat"s of this city to enter upon the ahovermantloned property far In- /y spoctlon purposes. ix 9 (We)agree to esus,Indemnify end keep harmless the City of Cupenlno against liabilities. Judgments,costs and expenses which may in any way accrue again it said City In consequence SIGN ATO RE APPNT DATE of the Granting opermit. PRE-INSPECTION:f in PLYWOOD: IN-PROGRESS: INSP. DATE INSP. DATE INSP. DATE TEAR OFF INSPECTION: BATTENS: FINAL: I NSP. DATE INSP. DATE INSP DATE NOTE: OSHA APPROVED ACCESS TO ROOF SHALL BE PROVIDED FOR INSPECTION OFFICE,11COPY INVOICE INVOI(�' INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE CITY OF CUPERTINO • BUILDING PERMIT INVOICE OPERATOR: kerenb Sec: Twp: R g: Sub: Blk: Lo[:35719072.00 INVOICE DATE. . . ...: 11/10/1999 REFERENCE ID H . ..: 99110058 SITE ADDRESS .. . . . : 21696 NOONAN CT SUBDIVISION . .. . . . . CITY . . ..... . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . .... .. . . . . . : HOLP[ES DAVID M ADDRESS .... . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-5912 CONTRACTOR ....... : DADDARIO, STEVE LIC H 20739 COMPANY . ......... . RENAISSANCE ROOFING CO INC ADDRESS . . ........ : 2292 LINCOLN AVE CITY/STATE/ZIP ... : SAN JOSE, CA 95125 TELEPHONE ...... . . : (408)448-0697 FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE _______________ --- --------- ------------ _ BPERMFEE P 147.00 0.00 147.00 BSEISMICRE P 0.90 0.00 0.90 --------- ------------ -- 147.90 0.00 147.90 V ID ___DESCRIPTION.--.-.-.. VOICE ID DESCRIPTION ----- -- 5 FRAME 307 INSULATION 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 603 ROOF BATTENS 604 ROOF IN-PROGRESS �D