99090172 -3
PERMIT
APPLICATION FOR CITY OF CUPERTINO NUMBER
RER FPERMIT INSPECTION DIVISION PERMIT EXPIRATION
(408)]]/-32'28 PERMIT EXPIRES IF WORK IS NOT STARTED
- WITHIN IN DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LASTCALLED INSPECTION.
BUILDING ADDRESS � {/�X
� �/ ' r�`� O / wDuk) 7—C/t��O4V RESIDENTIAL f/ COMMERCIAL OTHER
OWNER'S _ HAZARDOUS FIRE AREA
YES`� ❑ �y nde land that a Class A
NAME
ary' required.
NO ❑ Initial I.C.B.O.41
ADDRESS 7a UAJ/yenRSI VLS LOS EXISTING ROOF COVERING
PHONE Z 09 q NUMBER OF EXISTING COVERINGS
CONTRACTOR'xi.n
NAME TO BE REMOVED TO BE RETAINED
ADDRESS // 0 TYPE OF ROOF COVERING
CITU 8 ZIPS �'y�qV
PHONE (4D0 G/ / .. Z.3�Z SS
El
LICENSE - I �
NUMBER
LICENSED CONTRACTORS DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9(commending wi ❑
7000)of Division 3 of Ne Business and Profeeslons Code,and my,license Is In lull force and
effect.
C'-39 �6iiSf , o-- ----
License 91Lk.Number
CI
Date Comrecmr -- UU OVVNER-BUILDER DECLAR TION ED , /
I hereby etllrm that I am exempt from the Contractors License Law for the following reason. - v E CV rD �j 91999
(Sec.7031.5,Business and Professions Cade: Any cty or conty which requires a permit to
construct,alter,improve,demollsh,or repair any structure,prior to Its Issuance,also requires the BUILT- ROOFapplicant for such perm)to file a signed statement that he Is licensed pursuant to the provisiore \of the Cantradors Ucanse Law(Chapter 9(commencing with Section 7000)of Dlvlslon 3 of theBusiness end Professions Code)or that he U exempt therefrom and the basis for the aleged ASPHALT HINGLES
axemplan.Any vidabon d Section 7031.5 by arty applicant for a permit subjects the applicant to e chill penalty of not more then fine hundred dollars($500).):❑I,es owner of the property,or my employees with wages es their sole compensation,will do WOOD SHA Sthework,antl the structure Is not intended or offered for sale(Sec.7044,Business and Proles.
dons Cade:The Contractors License Lew deep not appy to en owner of property who bulds or WOODS I SImproves thereon,and wine tloes puctr work himself or through his own employe ,provided that
such Imorovomeras are not intended or offered for side.It,however,the building or Improvement
is add within one year of completion,the owner-bulicer will neve the burden d proving mat he did OTHER SPECI
not build or Improve for purpose of sole.).
❑1,as owner of the property,am excluslvey contracting with licensed contractors to construct
the project(Sec.7044,Business and Professions Code:The Contractor's License Lew does not PROVIDE I.C.B.O. PORT NO.
apply to an owner of property who builds or Improve.;thereon,and who contracts kn such pra)ecia
with a conVadd(s)licensed pursuant to the Contredor's Ucenee law. PROVIDE MFGR.IN ELATION SPECS.
❑I em exempt antler Sec. ,B&P.C.kr this reason
ownerDECLARATION Data
WORKER'S COMPENSATIONAPPLICATION DATE VA L ATION PERMIT FEE
etllrm under Nasty of perjury one of the fdlowing tleclanetlon: 7 '
kava and win maintain a Conifid a of Consent to salt asure for Workers Compensation, BUilding2o " -
as provided for by Section 3700 of the Labor Cade,for the performance d the work for whlM but )/ _
pu`mt ed. /� Seismic J0
end will mountain Worker's Compensation Insurance,as required by Section 3700 d
the Lobar Code,for the performance of the work for which Ibis permit Is Issued.My Workers �Q
CompensVn Insurance carrier an Polayynumber are �T�• Total
Carrier!_�FHOVT ,tq,f Pallcy No `YIs��O PERMIT AUTHORIZATION DATE
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE Nco y
(This section need net be completed!If the permit Is for one hundred dellen($100)or leas.) � 7 r 2;-'?
� —Q /
1 certify that M the performance of the work for which this permit Is issued,I shall not employ (/� 1
any person In any manner so as to become subj o he workers Compensaoon Layne of Call. All roofs shall be inspected prior to an roofing material being
brnia. ^ installed. If a roof is installedwitht first obtaining an
Date O 9 Applicant -r inspection,I agree to remove all new m erials for inspection.
Subject tothe ICE ake If,alter making this Candidate of Exemption,ypdn,you ehwkt baccame
apply Applicant understands and will comply with all non point
pen it she Prwiebnv d the Labor Code,you must forthwith can ply p Y P
with each provisions r this perms shall application deemed that the SOUfCe fagUlatIODS.
ceply, that have readthis aunordinnc and State that theebovd Information Iscorrect.lagree
to hereby ywith
orize rcity oprosdcounyordihiscesard state laws relatingowe-melon ed propertlon,and All roof coverings to be class' or better.
yn purposes.representatives of this city to enter upon the above-mentioned property for Ins
specikn gangosas. .
tl(We)agree to save,kdemdly ord keep harmless the City of Cupertino against liabilities,
of the granting 1 this ppaanna which may In any cosy accrue epelrst said Gry In consequence SIGNATURE OF APPLICANT DATE
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: chrletya
Sec: Twp: Rng: Sub: B1k: Lot:31638034.00
INVOICE DATE.. . ...: 09/28/1999
REFERENCE IO $ . ..: 99090172
SITE ADDRESS . ....: 10880 NORTHPOINT WY
SUBDIVISION . ......
CITY ....... ......: CUPERTINO
IMPACT AREA .. .....
OWNER .... . . . .....: CMS
ADDRESS .. . . . .....:
CITY/STATE/ZIP ... : CUPERTINO CA, CA 95014-0534
CONTRACTOR ....... : XARIEL, ANTHONY J LIC # 20806
COMPANY . . . .......: ROYAL SERVICES
ADDRESS . . . . ......: 4398 NICKER CI
CITY/STATE/ZIP ...: SOQUEL, CA 95073
TELEPHONE . ....... : (831)462-0539
FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE
--------------- --- --------- ------------ -----------
BPERMFEE P 207.00 0.00 207.00
BSEISMICRE P 1.50 0.00 1.50
--------- ------------ -----------
208.50 0.00 206.50
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
FRAME 307 INSULATION
6 1 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: christya
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:31638034.00
DATE ISSUED...... . : 09/28/1999
RECEIPT q...... . . . : 10167
REFERENCE ID N . . . : 99090172
SITE ADDRESS . . . . .: 10880 NORMPOINT WY
SUBDIVISION . . . . ...
CITY .......... . . .: CUPERTINO
IMPACT AREA . . . . . . .
OWNER ........ . ...: CMS
ADDRESS ........ . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-0534
RECEIVED FROM . . .. : TIM
CONTRACTOR ... . . . . : KARIEL, ANTHONY J LIC k 20806
COMPANY ... . . . ....: ROYAL SERVICES
ADDRESS .. . . . .....: 4398 NICKER CT
CITY/STATE/ZIP ...: SOQUEL, CA 95073
TELEPHONE . . . .....: (831)462-0539
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ------__--
BPERMFEE VALUATION 15,000.00 207.00 0.00 207.00 0.00
BSEISMICRE VALUATION 15,000.00 1.50 0.00 1.50 0.00
---------- ---------- ---------- ----------
TPERMIT 208.50 0.00 208.50 0.00
rMLD DOF PAYMENT AMOUNT NUMBER
--- ------------ -------
CHECK 208.50 5883
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
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