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OFFICE COPY
PERMIT
APPLICATION FOR CITY OF CUPERTINO NUMBER
INSPECTION DIVISION PERMIT EXPIRATION
' REROOF PERMIT (408)777-3228 PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 100 DAYS OF PERMIT ISSUANCE OR
100 DAYS FROM LAST CALLED INSPECTION.
BUILDING ADDRESS
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fO I �ry
J L T
RESIDENTIAL COMMERCIAL OTHER
OWNER'S
HAZARDOUS FIRE AREA
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SDU S MA 2.y AN►J
VES ❑. a Dlass A
sessembly
NAME C� (�f+ 1� I hl l:+F� J
too is reGulretli
NO ❑ Ini6I.C.B.O. R
PWLLET"�
EXISTING ROOF COVERING
ADDRESS 10 12 YLACS
f3'
4D�6 -
NUMBER OF EXISTING COVERINGS
PHONE
y.r
CONTRAC OR'S
NAME P RISS AN:.� K—OO� t fJ (e �f� _ IN L,
TO BE REMOVED "� TO BE RETAINED
ADDRESS -
TYPE OF ROOF COVERING
clTYazlP =*Z, L1r�GotA� AJrc c✓$ f 95125`�\
EXISTING G-�
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4�
PHONE `
BUILT-UP RO
19 1§39
,/
LICENSEr�Q
NUMBER 9 �� l --T-5(7
ASPHALT SHIINPLESUG ❑
" UCENSED CONTRACTORS DECLARATION
I hereby affirm mat I am licensed under provisions of Chapter 9lcommenclng with Section
WOOD SHAK Sa �_�
]000) of Division 3 of the Business and Professions Cade, and ary license is in full (am and
y
effect.
C,?Jq
WOOD SHINGLESEl
Llwase Class Lb. Number
y
1215P ri
OTHER (SPECI)FY
Dale ^ ` Coniremar c I
PROPOSED 9/
LDER DECLARATION
OWNorh
the License Lar forme vires following reason.
I hereby affirm that am exempt Iron the e: Any
(Sac. xh, alt, , misho a antl Professions code: Arty cry or county which re, also requires perms to
alter, Improve, d or repeat eny structure, prior to Its Issuance, the
BUILT-UP ROOF
file a si ant met he Is
t for such perms to Ills a shared pursuant to the pro
apps t to t erwal
hcane o
of the Contractors License Law (Chapter 9
of theC r 9 (commencingof the
co a Wath Section ]000) of Division 3 of the
Buelnese P is ex
of Com) or that he Is exempt therefrom and me bests for the
pt t
ASPHALT SHINGLES ❑
. iclati icurnalleged
exemption. Anyf of Section ]031.5 by any epplkant two penult subjects the applicant io
e tiNl penalty, of not more then flue hundred Collars
not more
WOOD SHAKES
01, as owner of the property, on my employees with wages an their sole compensation, will do
❑
the work, antl the structure Is rat intended or offered fur We (Sec. ]Oaa, Business and Profes-
sions Code: The Contractors LioenseLaw does not apply toanowner ofpropeMwhohiildsor
WOOD SHINGLES ElImproves
thereon, and who floes such work hirasell or through his own empichms, provided that
such Improvements are not Intended or offered for sale. If, however, the building or Improvement
/ p/ �.pp���� �Ly
is sold wi one year of completion, the owner -builder will have the harden of proving that he did
OTHER (SPECIFY) 1r II?(5 rI`Cl7 ✓t'
not build or improre for purpose of sele.l.
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to conslrvet
the prolect (Sec. ]Odd, Business and Professions Cade: The Contractors License Law does trot
PROVIDE I.C.B.O. REPORT NO.
apply to an owner of property who builds or hnprovas thereon, and who contracts for such prolects
with a contractogs) licensed pursuantto aha Contractor's Ucense law.
PROVIDE MFGR. INSTALLATION SPECS.
❑ 1 an exempt under Sec. ,B 8 P.6. for this reason
Owner Data
APPLICATION DATE
VALUATION
PERMIT FEE
WORKER'S COMPENSATION DECLARATION
_ _ --t ,� �,
I hereby affirm under pointedly of perjury one of me fallowing declaration:
-11 have and will mentain a Certificate of Consent to salt-Insura for Workers Compensation,
Building L I
as provided for by Section 37W of the Labor Code, for the perbrmerae of the work for which this
perms la leeuetl.
q qQ
p. �/ 7G
1.50
0 1 have end will maintain Workers Companaefion Insurerrco, as raqulretl try Sort. 3]OO of
— I `� V I
g1('4f 7Z5
W r
Seismic
the Lather Code, for the performance of the work for which this Permit Ie Issued. My Workers
ao�',so
Compenearon Insurance carder and Policy number are:
Total
CamerAM61ll At!r6CM M IPSPo1loyN, r7bP_DbZZ%70
PERMIT AUTHORIZATION
DATE
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE N.CL]
(This section need not be completed H the permit Is far one hundred dollars (5 100) or lase.)
I certify that in the performance of the work for which this permit Is fall I shall cot empl ry
my pemon In any manner so as to become subject to the Workers' Compensation Laws of Cels
V 1
All roofs shall be inspected prior to any roofing material being
fan's
installed. If a roof is installed without first obtaining an
Date Applicant
inspection, I agree to remove all new materials for inspection.
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should became
Applicant understands and will comply with all non point
PP P Y P
subject to the Workers' Compensation provisions of the Labor Code, you must forihwrh comply,
with such proviurioos or cols permit shall be deemed revoked.
source r gulathons.
I comtythat I have read W s applkatbn arW slate that me above Information Is correct. I agree
to comply with ell dry and county ordirc rims and state laws relating to bulldlrg construction; and
All to ver gs to be cla s "C" or better.
hereby authorize representatives of this sty to enter upon the ebove-mentbrred property for in-
spection purposes.
,
(We) agree to save, Indemnify and keep harmless the Oty of Cupertino, a inst hiablities,
SI URE OF AP IC NT DATE
judgmental costs and expenses which may In am way accrue against said CGty4n c«reequerne
of Me granting of this pe
peri
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
I
CITY OF CUPERTINO
IL 1 of 1 BUILDING PERMIT RECEIPT OPERATOR: karenb
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:31646043.00
DATE ISSUED.......: 08/19/1999
RECEIPT q......:..: 9853
REFERENCE ID M ...: 99080137
SITE ADDRESS .....: 10312 PARLETT PL
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OWNER ............. CAROTHERS W D JR AND MARY A
ADDRESS ..........:
CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-2017
305 FRAME
601 ROOF TEAR OFF
603 ROOF BATTENS
C+
307 INSULATION
602 ROOF PLYWOOD NAIL
604 ROOF IN -PROGRESS
RECEIVED FROM ....:
TIM
CONTRACTOR .......:
DADDARIO, STEVE LIC N
20739
COMPANY ..........:
RENAISSANCE ROOFING CO
INC
ADDRESS ..........:
2292 LINCOLN AVE
CITY/STATE/ZIP ...:
SAN JOSE, CA 95125
TELEPHONE ........:
(408)448-0697
FEE ID
UNIT QUANTITY
AMOUNT PD -TO -DT
THIS RED NEW
BAL
----------
BPERMFEE
-----------------------
VALUATION 15,000.00
--------------------
207.00 0.00
--------------------
207.00
0.00
HMICRE VALUATION 15,000.00
1.50 0.00
1.50
0.00
IP
'IL. PERMIT
208.50 0.00
208.50
0.00
METHOD OF
PAYMENT AMOUNT
NUMBER
_________________
CHECK
____________
208.50
__________________
15843
TOTAL RECEIPT 20B.50
VOICE ID
OESCRI PTION
VOICE ID
DESCRIPTION
305 FRAME
601 ROOF TEAR OFF
603 ROOF BATTENS
C+
307 INSULATION
602 ROOF PLYWOOD NAIL
604 ROOF IN -PROGRESS