99090179 APA) # 366
PERMIT
APPLICATION FOR CITY OF CUPERTINO NUMBER
REROOF PERMIT INSPECTION DIWSION PERMIT EXPIRATION
(408)777-3228 PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
BUILDING ADDRESS ',�'"� I � CSI SO/y,
-7,540 02Rnl V e' ; L0S56 M )ill RESIDENTIAL COMMERCIAL OTHER
OWNER'S L HAZARDOUS FIRE AREA
M / ' ` U M!T YES ❑ If yes-1 understand that a Chess A
NAME roof assembly Is required.
NO �� IrMial I.C.B.O.C
ADDRESS
5�,4. EXISTING ROOF COVERING
c
PHONE - 1itJ NUMBER OF EXISTING COVERINGS
CONT
RACT,,QQR'S //�� //��r
NAME Ze'/LI A/5 4aJc e / (3c /A �.V ,I,uL- TO BE REMOVED / TO BE RETAINED
ADDRESS �j ,/ 5 7 9`S/L r` -E OF ROOF I
CITY&ZIP -13— � 1 of c o� Ave EXISTING I1�
PHONE /� 8 ' y y(] �— O 61�- BUILT-UP ROOLICENSE
F � �Oy 'Ili
NUMBER SS ,3 ASPHALT SHINII LES �[� /
UCENSED CONTRACTORS DECLARATION gybes
liner affirm that I am licensed wrier provisions of Chapter 9(commentng with Section WOOD SHAKES
]000)of Division 3 of the Business end Professions Code,and arty license b In IuII t«ce�n f
effect. /
License Gla "^� Oc.Number .5 3 3/J/�� WOOD SHINGLES ❑
,1 �6 OTHER(SPECIFY) El Curial
OWNER-BUILDER DECIARATION PROPOSED 30 LB Fpt,T
I hereby affirm that I em exempt from the Commodes License Law for the following reason. ,y
(Sec.7031.5.Business and Professions Code: Arty city or county which requires a permit to
construct,after,Improve,demolish,or repair any stnoture,prior to its issuance,also requires the BUILT-UP ROOF ❑ ( 9
applicant for l u M permit to file a signed statement that he Is licensed pursuant to the provlslons /Z
of me Contractors License Law(Chapter 0(cammooci g with Sectlon 7000)of Diviti n 3 of the / ,/^ �/pR•
Business and Professions Cade)or that hbe
e le exempt therefrom and the was for the alleged #6 ASPHALT SHINGLES �' / �flkeSl
exemption.Any violation of Section 7031.5 by any applicant for a permit sublets the applicant to
a civil away of not more than five hundred dollars($500).1:
❑I,as owner of the property,or my employees with wages as their sole compensation,will do WOOD SHAKES ❑ CON� .Q�F
slap
the work,and the structure Is not Intended or offered 04
for sale(Sec.74,Business and Proles- _ t
' s Cade:The Contractors License law does not apply to an owner of property who bulks or WOOD SHINGLES
Improves thereon,and who coal such work hlarso f or through his own employees,proAdetl that E) C.C.rF1S A f
such Improvements are not Intended or ollered for split.If,however,the building or Improvement
Is sad within one year of completion,the comer-buiker will have the burden of proving that he did OTHER(SPECIFY) ❑
not build or Improve for purpose a sale.).
O I,as other of the property,em exclushely contracting will kcensed COMMUom to construct
Ne project(Sec.701 Business end Proksslone Code:The Contractor's License Law does not PROVIDE I.C.B.O.REPORT NO.
apply to an Amer of property who bulbs or improves thereon,and who contracts for such projects
with a contractors)licensed pur uant to the Contractor's Lkanse Law.
❑I am exempt under Sec. — .69 P.C.for this reason PROVIDE MFGR.INSTALLATION SPECS.
Owner Date APPLICATION DATE VALUATION PERMIT FEE
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following dederatlon: I/ -�I vn,Yv
I have and will maintain a CerWicate of Consent to Ball-Insure for Workers Compensation, Building IYO V rVl
as provided for by Section 37W of the Labor Code,for the performance of the work for which this /�
X
no" slsauetl. 8 310 '� seismic 1 IU
eve end will malntaln Worker's Compensation Insurance,as required by Section 3]00 of U ns D
I Code,for the Performance of the walk for which this permit is issued.My Workers "11
ompensAetlon Insurance canter nd Policy number ere: Total 1109, 10
_ _
Cara�t¢¢��r AM P-QI C 4AJ I�Rv recnavu policy Ne. 5132 2' _2__' d PERMIT AUTHORIZATION DATE
/AK>. C O. CERTIRCATE OF EXEMPTION FRAM WORKERS
COMPENSATION INSURANCE N.CQ T_
(This section need rot be completed H Ne permit is for one hundred dollere($100)or less.) n q
I cal ly that M the performance of the work for w riffs permit B uetl,I shaft rot artpby )f T
any pawn k any rearms so as to baaama 'at a t e w«ke s one u e f cal All roofs shall be inspected prior to any roofing material being
fornia. - installed. If a roof is installed without first obtaining an
Date A Applicant inspection,I agree to remove all new materials for inspection.
euq no the APP re OM If,after meking Certilkate of Exemption,you isouk became Applicant understands and will comply with all non int
with such provisions or this perm tehelP teamed the Labor
Cade'you must lorthwfth compty, Source r ations. p y
I certify that I have read this apoicad n and state that the above Information is correct.I agree [/
to campy with all city.and county ordinances sari state laws relating to buikYng construction,and All r COV rings to bP la S r
hereby summers representedves of this city to enter upon the above-mentioned properly for In
specoon purposes. a8
(We)agree to save,indemnity and keep hermleas the City of Cupertino against IIabllliles,
Judgments,costs and expenses which may In any way accrue egainat said Gy In conaequeroe
of the fing of this permit TURE"OFAPPLICANT DATE
PRE-INSPECTION: PLYWOOD: 'C IN-PROGRESS: x
INSP. DATE INSP. D E INSP. DATE
TEAR OFF INSPECTION: Y BATTENS: FINAL:x
INSP. DATE /- INSP. DATE INSP. DATE
NOTE: OSHA APPROVED ACCESS TO ROOF SHALL BE PROVIDED FOR INSPECTION
OFFICE'COPY
CITY OF CUPERTINO
1 of 1 BUILDING PERMIT RECEIPT OPERATOR: yvonnek
COPY 4 1
Sec: 1Wp: Rug: Sub. Blk: Loc:36611065.00
DATE ISSUED. . . . . . . : 09/28/1999
RECEIPT q... . . . . . . : 10174
REFERENCE ID N . . . : 99090179
SITE ADDRESS . . . . . . 7540 ORANGE BLOSSOM DR
SUBDIVISION . . . . . . .
CITY . .... . . . . .. . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . .. . : SMITH STEVEN A AND BARBARA S
ADDRESS . . . . . . . .. . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-5225
RECEIVED FROM .. . . : TIM
CONTRACTOR ... . . . . : DADDARIO, STEVE LIC 4 20739
COMPANY . .... . . . . . : RENAISSANCE ROOFING CO INC
ADDRESS .... . . . . . . : 2292 LINCOLN AVE
CITY/STATE/ZIP . . . : SAN JOSE, CA 95125
TELEPHONE . . . . . . . . : (408)448-069]
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW DAL
---------- ------------- ---------- -------"" ---------- ---------- ----------
BPERMFEE VALUATION 11,000.00 167.00 0.00 169.00 0.00
BSEISMICRE VALUATION 11,000.00 1.10 0.00 1.10 0.00
--------- ---------- ---------- ----------
REMIT 168.10 0.00 168.10 0.00
METHOD OF PAYMENT AMOUNT NUMBER
-----------"----- ------------ ------------------
CHECK 168.10 16182
TOTAL RECEIPT c 168.10
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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INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO
. BUILDING PERMIT INVOICE OPERATOR: karenb
Sec: Twp: Rng: Sub: Hlk: Lot:36611065.00
INVOICE DATE. . . . .. : 09/28/1999
REFERENCE ID 4 ... : 99090179
SITE ADDRESS . . . ... 7540 ORANGE BLOSSOM DR
SUBDIVISION . . . . ...
CITY . . ..... . . . ...: CUPERTINO
IMPACT AREA . . . ...:
OWNER ....... . ....: SMITH STEVEN A AND BARBARA S
ADDRESS .... . . .... :
CITY/STATE/ZIP ... : CUPERTINO CA, CA 95014-5225
CONTRACTOR .. . . . ..: DADDARIO, STEVE LIC # 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 167.00 0.00 167.00
BSEISMICRE P 1.10 0.00 1.10
--------- ------------ -----------
168.10 0.00 168.10
VO E ID ..--..- DESCRIPTION-----_--- VOICE ID --DESCRIPTION
.. ........ ........ ...... ...............
FRAME 307 INSULATION
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
603 ROOF BATTENS 604 ROOF IN-PROGRESS
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