Loading...
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 •