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99090018 PERMIT R_ APPLICATION FOR CITY OF CUPERTINO NUMBER INSPECTION DIVISION PERMIT EXPIRATION REROOF PERMIT (408)777-3228 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 1W DAYS FROM LAST CALLED INSPECTION. BUILDING ADDRESS L 1 RESIDENTIAL COMMERCIAL OTHER OWNER'S A� HAZARDOUS FIRE AREA NAME �'` • " C ALD W e"LL, YES Cl II yes–I molar, N tltat a Class A roof assemOty is reglrireQ Q f\ NO Initial LC.B.O.tl t I(] -Ref �-LL 'PL • �U�. t�l EXISTING ROOF COVERING ADDRESS—)�((( / f - PHONE I�Q — 2_ 3 4 3 NUMBER OF EXISTING COVERINGS CONTRACTOR'S GI NAME V �U0 r-IN �� TO BE REMOVED l TO BE RETAINED ADDRESS Q ,(SAN LAWO �L• 1. -L • , 3 z TYPE OF ROOF COVERING CITY&ZIP o0 111 r- `� _l7U _ EXISTING PHONE BUILT-UP ROOF LICENSE 7 Z L511 P I ' NUMBER ( E I ASPHALT SHINGLES - 1 1999 IIUii DCENS licensed under RACTORS DECLARATION h.f D affirm het em usinsantler pmmlemar of Chapter rl(commencing with Section WOOD SHAKES ]000)of D'rvisian 3 0l the Business entl Proleesbrm Code,and my license Is In lull lone enol effect. ^ l WOOD SHINGLE License ea ` Lbmbe .Nur '72l �� 1 S El Date Of) . Contactor U I OTHER (SPECIFY) OWNER-BUILDER DECLARATION PROPOSED /^� hereby affirm that an exempt from the Code: Any pr's License Law for r e Blowing reason. (/J ^.�/ (Sec.]031.6,Business entl Profeoish,or ref ranAny dry or county whbh requires a uirmd to / 4'_G/ applicant,or sr,Improve,demolish, n rdstar any statement ffiatstructure,Iden d Its Issuance,also requires the BUILT-UP ROOF of the o for such permit a Ills a signed r 9(corent that he Is Ilconaed Wrsuant to he prwLslone (✓� al the Conireaore License law(Chapter 8(cam.4trg with Section]000)of DMedn 3 of the AIM Business eM Prolaesions Code)or Met he Is exarrpt therefrom and Me basis br the alleged ASPHALT SHINGLES ❑ exemption.Any viafetion of Section 7031.5 by any applicant for a permit subjects the applicant to a cbll penalty of not mare than five hundred dollars(5500).1: WOOD SHAKES [:]I,as owner of the property,or my empbyaes with wages as their sole compensation,wall do ❑ the work.and are structure Ia not intendetl or offered for sale(Sec.7044,Buslneas and Profes- sionsCode. The Contractors License Law deals rot apply to an owner of property who builds or WOOD SHINGLES ❑ Improves thereon,and who does such work himself or through has own employees,proAded that such improvements are not Iatentletl or offered for sale.If,however,the building or Improvement is said within one year of completion,Me owner-bullder will have the burden of proving Mat he aid OTHER(SPECIFY) rat held or Improve br purpose of sale.). I,as owner of the property,am exclusivey uantmding with licensed contractors to eoraffect the project(Sec.]0 ,Business and Prolesabns Code:The Contmctor's Ucenae Law does not PROVIDE LC.B.O.REPORT NO. y 44 apply to an owner of property who builds or Improves thereon,and who contracts for such projects with a contractors)licensed pursuant o he Concadors License Law. PROVIDE MFGR.INSTALLATION SPECS. 1 am exempt and.Sec. ,B&P.C.for ties reason Owner Date APPLICATION DATE VALUATION PERMIT FEE WORKER'S COMPENSATION DECLARATION I hereby affirm under lateral of perjury one of he following declarallon: ❑1 have antl will maintain a Certlflcete of Consent to"ITinsure for Worker's Compensation, � Building as provided for by Section 3700 of the Labor Code,for Me perfprm.ao of the work for which this I o v parmXy issuetl. b)dl theca arW MII maintain Worker's Compensetlm Insurance,as required try Section 3]00 0l (_AI zl I yt I 11 • seismic Le r Code,far Me performance of the work for whfch data permit Is Issued.My Workers /� l '%7 r/ -7./'n Compenaatlon Insurance dealer antl Policy number ere: C 1 I v TOtal (�«L Cerner_Sr'AltrA PdidyNo. 7� l' I�VTd-�0 PER ORIZATION DATE CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE N.00 mns section need rat be completed d the permit is for one hundred dollars($100)or lass.) I cerdfy that In he performance of Me work for which this permit is issued,I shall not employ any person In any manner be as to become subject to Me Workers'Compensatlon Lasa of Cell-. All roofs s I be inspected prior to any roofing material being Poria. install . If a roof is installed without first obtaining an Date Apgl ant insp tion,I agree to remove all new materials for inspection. Not to EToAPPes'Compe atio khgmboftheLab r Eve you ays,fonnwIthco py Applicant understands and will comply with all non point subject to the Workers'Com ,after provisions this C the Lebon Code, with such provisions or this pamYt shall be deemed revoked. source regulations. I cedity that I heye reed this application entl state that the above Informallon Is conect.I agree ' to comply with an sty and county ominancus and state laws relating to bulling conslratlon. %eringS to be class"C"or better. hereby authorize representatives of this dry to enter upon the above-mentioned property r In- specibn purposes. /–]1 (We)agree to save,indemnity and keep harmless the City of Concrtbw against Iil ll 1 judgments,costa and egresses which may In any way scares egedet said City in call q 'APPLICANT DATE AdIIIIJ of the granfirg of this permit. 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 ACCESS TO ROOF SHALL BE PROVIDED FOR INSPECTION OFFICEIll CITY OF CUPERTINO 1� 1 of 1 BUILDING PERMIT RECEIPT OPERATOR: chrietya COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot:36230046.00 DATE ISSUED..... . . : 09/02/1999 RECEIPT #.... . . . .. : 9970 REFERENCE ID # . . . : 99090018 SITE ADDRESS .....: 1190 RUPPELL PL SUBDIVISION ....... CITY .... . . . . .. ...: CUPERTINO IMPACT AREA ....... OWNER . . . ......... : CALDWELL DAVID F AND SUZANNE E ADDRESS . . . .......: CITY/STATE/ZIP ...: CUPERTINO CA, 95014-5049 RECEIVED FROM .... : JOB S CONTRACTOR ....... : PROCTOR, PAUL LIC # 19698 COMPANY ......... . : R E ROOFING ADDRESS ..... . . . ..: 108 OAKLAND PL CITY/STATE/ZIP ...: LOS GAMS, CA 95032 TELEPHONE ... . . . ..: (408)925-9995 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL __________ __________ __________ __________ __________ __________ BPERMPEE VALUATION 12,000.00 177.00 0.00 177.00 0.00 B. MI CRE VALUATION 12,000.00 1.20 0.00 1.20 0.00 0 PERMIT ____178 20 0.00 178.20 0.00 MFCHOD OF PAYMENT AMOUNT NUMBER ____ CHECK 178.20 3047 ------------ TOTAL RECEIPT 178.20 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 INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE CITY OF CUPERTINO BUILDING PERMIT INVOICE OPERATOR: christya Sec: Twp: Rug: Sub: Blk: Lot:36230046.00 INVOICE DATE......: 09/02/1999 REFERENCE 'ID k ...: 99090018 SITE ADDRESS ..... : 1190 RUPPELL PL SUBDIVISION ...... . CITY . ............ : CUPERTINO IMPACT AREA ..... OWNER ............ : CALDWELL DAVID F AND SUZANNE E ADDRESS .......... : CITY/STATE/ZIP ... : CUPERTINO CA, 95014-5049 CONTRACTOR .... . . . : PROCTOR, PAUL LIC M 19698 COMPANY ..... . . . . . : R E ROOFING ADDRESS .... . . . . . . : 108 OAKLAND PL CITY/STATE/ZIP . ..: LOS GATOS, CA 95032 TELEPHONE . . . .....: (408)925-9995 FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE --------------- _-- --------- ------------ ----------- BPERMFEE P 177.00 0.00 177.00 BSEISMICRE P 1.20 0.00 1.20 --------- ------------ ----------- 178.20 0.00 178.20 ID _--.DESCRIPTION _..-- VOICE ID - DESCRIPTION ---- ......... ..--- ------ ................ ' FRAME 307 INSULATION 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 603 ROOF BATTENS 604 ROOF IN-PROGRESS '