99090068 s - 26 02i 5 go0fl�8
PERMIT
APPLICATION FOR CITY OF CUPERTINO NUMBER
INSPECTION DIVISION PERMIT EXPIRATION
REROOF PERM O 777.3228 PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN RHIN 100 OAYS OF PERMIT ISSUANCE OR
DANS FROM LAST CALLINSPECTION.
INSPEECTION.
BUILDING ADDRESS
RESIDENTIAL—)C COMMERCIAL OTHER
OWNER'S HAZARDOUS FIRE AREA
/--' VES ❑ Ryes—Indar5a
ClassA
NAMEroof aserMly is required. _
NO ❑
Initial I.C.B.O.Y
ADORES G ZZ EXISTING ROOF COVERING
PHONE p L 0 NUMBER OF EXISTING COVERINGS /
' CONITRACTO - /
TO BE REMOVED ` TO BE RETAINED /
NAME
ADDRESS p TMP
clTv a zl 7
Qc EXISTING
PHONE 7 C I - BUILT-UP ROOF
LICENSE
NUMBER `Lra, lO / ASPHALT SHINGLES
LICENSED CONTRACTORS DECLARATION
I hereby affirm that I em licensed under pdWsfors of Chapter 8(commencing with Sedlon WOOD SHAKES '
7000)of Division 3 G the Business and Professions Cade,and my license Is In lull lone and
effect. WOOD SHINGLES
License Clan Lk.Number !� • r�`�� ❑ n "
7 / Q/ _ OTHER(SPECIFY) [� I f
Oats pkyryER8UILOER DECLARATIO I a.LP 9 ,r�,('[Y' ,
I hereby affirm Chet I am exempt from the Con"Orces License Lew for the following reason. PROPOSED J
(Sec.7031.5,Business and Prolepsiors Code: Any city or county which requires a permit to I tr y
construct,sitar,Improve,demolish,or repair any structure,prior to Its Issuance,sell requires the BUILT-UP ROOF -�--
applicant for each permit to file a signed statement that he Is licensors pursuant to the provisions
of the Contractor's License Lew(Chapter 0(commencing with Section 7000)of DlyLston 3 of the
Business and Professions Code)or Chet he Is exempt memfrom and the basis for Me alleged ASPHALT SHINGLES
exemption.Any vfoietlon of Section 7031.5 by any applicant for a permit subjects the applicant to
e ddI penalty of not more than five hundred dollars(S500).):
❑I,as Owner of the property,or my employees with wages as their We compensation,will do WOOD SHAKES
Me work,and the structure Is not Intended or offered for sale(Sec.70/4,Business end Profen.
slons Code:The Contractor's Ucense Lew close no appy to an owner of property who bullus or WOOD.SHINGLES
Improves thereon,and who does such work himself or through his own ampordies,provided that
such Improvements are not Intended or offered for sale.II,however,the bulkMg or Improvement
Is sold within one year of conpletlon,the owner.bullder will he"the burden of proving that he did OTHER(SPECIFY) Q
not build or Improve for purpose of pale.),
❑I,ss owner of the property,em exdu°Heiy contrading with licensed contracture to construct
the protect(Sec.7044,Business and Profes°lane Code:The Contractors License Lew does not PROVIDE I.C.B.O.REPORT NO.
appy to an owner of property who bulks or Improves thereon,and who cmtrwW for such project°
with a contractor(B)Ilcenned pursuant to the Contractors Ucanse Law. PROVIDE MFGR.INSTALLATION SPECS.
❑1 am exempt unser Sec. ,B&P.C.for this reason
Owner Date APPLICATION DATE VALUATION PERMIT FEE
WORKER'S COMPENSATION DECIARATION
I hereby affirm under Penalty of perjury one of the following dedaretlorc CPO
❑I have and will maintain a Certificate of Consent to seMlneura for Worker.Cis a ensatfon, / / Building 7�. —
as provided for by Section 3700 of the Labor Cod°,for the performance of Me work for which this L/// r///
perm souse. 4 I 1Z S� - Seismic .S0
eve end will maintain Workers Compensatlon Insurance,as required by Section 3700 of R
Ih abor Cod°,for the performance of the work tic which this permit le Issued.My Workers
mpena till °carder end Polity mbar are: Total i
Cerner �IDJ :P, -MZ PERMIT AUTHORIZATION DATE
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATIONINSURANCE N.C{] ._
(This section need not be completed If Me permit le for one hundred dollen($ 'I
or less.)
I certly that In the performance of the work for which this permit Is Issued, shell not employ
any person In manner so m to Demme subject to the W cera'Compensation Law°of all- All roof.^.shall be inspected priocto any roofing material being
lornle. installed. If a roof is installed without first obtaining an
Dole Applicant inspection,I agree to remove all new materials for inspection.
Nonc TO APPuc�e�san«�rko dslo me a me LLaborr Coicati of odde,you you°hour Dome Applicant understands and will comply with all non point
suoted to the Workers' you moat brihwlM campy
with each proWelme or Mlp parse.hal&be aeemae revoked. source regulations. -
IcertaythatIhavereadthisap plication and state that the above Information is corred.I agree
to campy,with all city and county ordt'nencns and state issue relating to building Wrstructlon,end All roofcove Ings t eclas" "or better.
hereby authorize representatives of this city to enter upon Me ab mentioned property for In.
apeatrpoeee.
(Weo))agree to save,Indemnify and keep harrrseas MNlr
e City of Cupew against Ilablllllas,
judgment%costs entl expenses which may,in pry way accrue against sold Cly In consequence
of the granting of thus permit. SIGNATURE OF PLICANT ' ANTE
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: christye
Sec: Twp: Rng: Sub: Blk: Lot:37526025.00
INVOICE DATE...... : 09/09/1999
REFERENCE ID H ... : 99090068
SITE ADDRESS .. . . . : 18650 STARRETT COURT
SUBDIVISION .. . . . . .
CITY ........ . . . . . : CUPERTINO
IMPACT AREA .. . . . . .
OWNER .......... . . : DAVIS PROPERTY MGMT
ADDRESS ....... ... :
CITY/STATE/ZIP . . .: CUPERTINO, CA 95014
CONTRACTOR .. . . . . . : WRAY, RICHARD LIC k 20755
COMPANY ..... . . . . .: SHELTON ROOFING
ADDRESS ...... . ...: 1988 LEGHORN ST
CITY/STATE/ZIP ...: MI VIEW, CA 94043
TELEPHONE . . ......: (650)961-7699
FEE DESCRIPTION CHR TOTAL FEE PAID-TO-DATE BALANCE DUE
--------------- --- --------- ------------ -----------
BPERMFEE P 77.00 0.00 77.00
BSEISMICRE P 0.50 0.00 0.50
--------- ------------ -----------
77.50 0.00 77.50
ID -------DESCRIPTION__.---.-- VOICE ID ---___ DESCRIPTION
305 FRAME 307 INSULATION
601 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: chrietya
COPY # 1
Sec: Tp: Rng: Sub: Blk: Lot:37526025.00
DATE ISSUED....... : 09/09/1999
RECEIPT #......... : 10030
REFERENCE ID # ... : 99090068
SITE ADDRESS ..... : 18650 STARRETT COURT
SUBDIVISION ...... .
CITY . . . . ......... : CUPERTINO
IMPACT AREA ...... .
OWNER . . .......... : DAVIS PROPERTY MGMT
ADDRESS .......... :
CITY/STATE/ZIP ... : CUPERTINO, CA 95014
RECEIVED FROM ....: TIM
CONTRACTOR .......: WRAY, RICHARD LIC # 20755
COMPANY . . ........: SHELTON ROOFING
ADDRESS . .........: 1988 LEGHORN ST _
CITY/STATE/ZIP ...: MI VIEW, CA 94043
TELEPHONE ........: (650)961-]699
FEE IO UNIT QUANTITY AMOUNT PD-TO-DT MIS REC NEW SAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 2,000.00 ]].00 0.00 ]].00
BE 11CRE VALUATION 1,751.00 0.50 0.00 0.50 _ 0.00 ,
T. PERMIT 77.50 0.00 77.SD 0.00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ---------
CHECK ]].50 10230
------------
TOTAL RECEIPT 77.50
VOICE IO DESCRIPTION VOICE ID DESCRIPTION
305 FRAME 307 INSULATION
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
603 ROOF BATTENS 604 ROOF IN-PROGRESS
•