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99090180 �9PN3 z = 5�8 '3Dg0 D PERMIT R_ APPLICATION FOR CITY OF CUPERTINO NUMBER INSPECTION DIVISION noN REROOF PERMIT (408)]]]-9228 PERMIT EXPIRES IF WORK IS NOT STMTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. BUILDING ADDRESS RESIDENTIAL COMMERCIAL OTHER OWNER'S HAZARDOUS FIRE AREA YES ❑ If yes—I understand that a Class A NAME S CA n sync roof essemdy is required. NO `( Initial - I.C.B.O.41 ADDRESS EXISTING ROOF COVERING PHONE lose 3 NUMBER OF EXISTING COVERINGS / CONTRACTOR'S YlCA 1 S501rvC 2, �DC)�1_Yl� TO BE REMOVED TO BE RETAINED NAME )?e ADDRESS 2Gn / TYPE G CITY&ZIP r_2" �"/rX �/Hrnb AV � 95ia�•5 EXISTING PHONEG1X)`/`/940697 BUILT-UP ROOF LICENSE / NUMBER SS 9/7 3Co ASPHALT SHINGLES UCENSED CONTRACTORS DECLARATION I hereby mourn Nat I am licensed under provisions,of Chapter 9(commencing with Section WOOD SHAKES ]000)of Division 3 of the Business and Professional Code,and my license Is In lull force and effect. WOOD SHINGLES 0_. Ucene Class Luc.Number Irl /, rt l Date— Contractor �Piw-.F �p-�_ o-i Cr'..� OT �HER(SPECIFY) OWNER-BUILDER DECLARATION IJ PRoF!aaSEP 8 1SS9 I �,I ty I hereby affirm that I am exempt from the Contractors License Law for the folknwing reason. 1 II-f (Sac.7031.5, Business and Protractors Code: Any city a counwhich requires a permit to construct.after,improve,demolish,or repair any structure,pier to its issuance,also requlreal the BUILT IJP ROOF J] �1e� applicant for such permit to file a signed statement that he Is licensed pursuant to fie provisions . of the Contractor's 11come Law(Chapter 9(cammemcl Mth Section]000)of DivsOn 3 N the Business al Profession Coda)or that he Is exempt Therefrom and the bash,for Thr alleged ASPHALTySHINGL-ES�_❑J M O/ avMMIDn.Any videlion of Sechon]031.5 by any applicant for a permit subfecls the epplcart to ��' LrI6 a civil perelty of not more then five hundred dollars($500).): e_ 1 ❑1,as oesler of ftproperty,or my employees with wages es their able compeneatbn.will do WOOD SHAKES EJ _T`71,e_ UJ/056-T the work,and the son c urs Is M Intended or offered for sale(Sec.]044,Business and Proles- I/hY I (rW./(f—/_ sions Code:The Contractors License Law does not apply to an o vner of properly who bulbs on WOOD SHINGLES _ Improves thereon,and who does such work hlmeelf or through his own employees,provided that ❑ �� 15 auch Improvements are not intandod or offered for able,ll,however,the boding or improvement k Is sod within one year of completion,the ownervbulder will have the burden of proving that he did OTHER(SPECIFY) not build or improve for purpose of sale.). ❑1,as owner of the property,em exclusively contracting with licensed contractors to Wrrstrutt the project(Sec.7(1 Business and Professions Code:The Contractors ucense Law does net PROVIDE I.C.B.O.REPORT NO. A09 3 apply to an owner of property who builds or Improves thereon,and who contracts for such projects - »;tb a contractor(s)licensed pursuant to the Contractor's License Lew. PROVIDE MFGR.INSTALLATION SPECS. ❑1 am exempt under Sac. ,B 8 P.C.for this real owner Date WORKER'S COMPENSATION DECLARATION APPLICATION DATE VALUATION PERMIT FEE I hereby affirm under penally of perjury one of the folli declaration: ❑I have and will maintain a Certificate of Consent to self-Insure for Worker's Compensation, Building as provided for by Section 3]00 of the Labor Code,fw the Performance of the work for which this q nrmit is ve anIssued. 5/5/� Oce Seismic have end wl r maintainprt Workers Compensation Insurance,Me,es required by Section Worker's of ®0 1 r Code,for the p came Ince of the work for which Title permit re Issued.My Workers - mpensAagon Inurerlce tendo ntl//P�olicy nrmbar are: Total Cerrfor LtYY12.Y'C�LLVI "'9kZ LI12 r405ollby No. S�RLYJo234jt00 PERMIT AUTHORIZATION DATE C-lu CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE NCO (This section need not be completed it the permit is for orla hundred dollars($100)or less.) I cortify that In the performance of the work for 's permit Is issued,I shall n t employ any perebn In any manner an as to become subject kwe'Comp sa on L of Cal. All roots shall be inspected prior to any roofing material being - fwnia. installed. If a roof is installed without first obtaining an Date L / rwplmant inspection,I agree to remove all new materials for inspection. NOt to Me APPLICANT: msefiD v king.f Cenitkate of Exem p hwth�pN Applicant understands and will comply with all non point Subject to Na Workers'Com tion r of the Leber Code, with such pnniebry or Mi.pwrNt shall .med rewil ed. source regulations. I ceriity that l have reed this top lkat and stale Nat the above information is correct.)agree to comply will,s,0 city antl county ordinances and state lower relatng to blldig corumuctfon,ard All roof cc ri t e class 16 or better. hereby authorize representatives of this city to enter upon the,bare-rnniloned property for In. spechon purposes. (We)agree to save,Indemnity and keep harmless the City of Cupertino against Ilabi1111as, Judgments,costs and expenaleal which may In any way accme against said City in consequence of the granting of this permit. SIG AT, granting of permit. SIG ATU APPLICfC DATE • PRE-INSPECTION: - PLYWOOD: X IN-PROGRESS: K INSP. DATE INSP. DATE INSP. DATE TEAR OFF INSPECTION: �( BATTENS: FINAL: k INSP. DATE INSP DATE INSP. DATE NOTE: OSHA APPROVED ACCESSTO ROOF SHALL BE PROVIDED FOR INSPECTION OFFICEICOPY CITY OF CUPERTINO 1 of 1 BUILDING PERMIT RECEIPT OPERATOR: y onnek COPY 0 1 Sec: Twp: Rng: Sub: Blk: LOL:392D48007.00 DATE ISSUED.. . .... : 09/2B/1999 RECEIPT b. . . . .... . : 10176 REFERENCE ID 9 — : 99090180 SITE ADDRESS . . . . . : 22662 DAKCREST CT SUBDIVISION . . . . . . . CITY . . . . ..... . . . . : CUPERTINO IMPACT AREA .. . . . . . OWNER . . . .... . . . . . : SUSIE YOUNG ADDRESS . .. . . . . . . . : 22662 OAKCREST CT CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . —. : TIM CONTRACTOR . . . . ... : DADDARIO, STEVE LIC # 20739 COMPANY . . . . . .. — RENAISSANCE ROOFING CO INC ADDRESS . . . .. ..... : 2292 LINCOLN AVE CITY/STATE/ZIP ... : SAN JOSE, CA 95125 TELEPHONE . . . ...— : (908)998-0697 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW DAL -------- ---------- ---------- ---------- ---------- -_____---- BPERMFEE VALUATION 16,000.00 217.00 0.00 217.00 0.00 BSF:I SMICRE VALUATION 1G,000.00 1.60 0.00 1.G0 0.00 PERMIT 218 60 0.00 218 60 0.00 METHOD OF PAYMENT AMOUNT NUMBER ____ ------------ ------------------ CHECK 218.60 16183 TOTAL RECEIPT 210.60 VOICE ID DESCRIPTION V010E ID DESCRIPTION ........ ............................ ........ ...................... 305 FRAME 307 INSULATION 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 603 ROOF BATTENS 609 ROOF IN-PROGRESS INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE • CITY OF CUPERTINO . BUILDING PERMIT INVOICE OPERATOR: yvonnek Sec: Twp: RnH: Sub: Blk: Lot:342048007.00 INVOICE DATE. .. .. . : 09/28/1999 REFERENCE ID H ... : 99090180 SITE ADDRESS ..... : 22662 OAKCREST CT SUBDIVISION .... . . . CITY . . . . . . . ... . . . : CUPERTINO IMPACT AREA .. . . . . . OWNER . . . . . .. . . . . . : MS. YOUNG ADDRESS . . . . . . . . . . : 22662 OAKCREST CT CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 CONTRACTOR . . . . . . . : DADDARIO, STEVE LIC 0 20739 COMPANY . . . . . . . . .. : RENAISSANCE ROOFING CO INC ADDRESS . . . . . . . ... : 2292 LINCOLN AVE CITY/STATE/ZIP ... : SAN JOSE, CA 95125 TELEPHONE . . . ..... : (408)448-0697 NOTE: THE FEES LISTED ARE ONLY THOSE DUE BEFORE PERMIT PRINTING FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE --------------- _-- --------- ------------ ----------- BPERMFEE P 217.00 0.00 217.00. BSEISMICRE P 1.60 0.00 1.60 --------- ------------ ----------- 218 6D ---------- 218.60 0.00 218.60 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 •