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99090082 DPERMIT R_qw APPLICATION FOR CITY OF CUP RTINODB� NUMBER r, INSPECTION DIVISION PERMIT EXPIRAnON REROOF PERMIT (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 ^ C RESIDENTIAL COMMERCIAL OTHER HAZARDOUS FIRE AREA VES ❑ II yes-I InWeretand that a Claw A NAME llN�(L.//1r roof assemhy is regLdred. NO ❑ lnftW I.C.B.O.# ADDRESS— EXISTING IIS�T EXISTING ROOF COVERING PHONE "Cl/ � NUMBER OF EXISTING COVERINGS / CONTRACT/TO/1R/�' L (n�- yn .Z TO BE REMOVED TO BE RETAINED NAME // ' ( �'/l 4 iCAA//L.I..b ADDRESSq,/S� �� n TYPE OF ROOF COVERING CRY&ZIP O 7 GG EXISTING PHONE 40? 7` ` —3 2-5 y BUILT-UP ROOF ❑ ' CENSE NUMBER 75669 ASPHALT SHINGLES NUMBER ❑ LICE NEED CONTRACTORS DECLARATION - ^ I t hereby affirm that I em licensed under provislons of Chapter 9(commencing with Sechon WOOD SHAKES 7000)of Division 3 of the Business and Professions Code,and my,license is in full force and effect WOOD SHINGLES ❑ License Class �/ Lb.Number 7 / OTHER (SPECIFY�� DateC OWNER-BUILDER OWNER-me Conn OE Contractors Lice ON PROPOSED L hereby affirm in that em exempt from Co Contractors license Law for the Hollowing reason. ��^ (Sec.7031.5, ,improve and olich,or re it any Any city m Couny which requires a permit to SEP `9 construct,ensu,Improve,demolish,or repairany structure,thapoor to a leeuanm,aiso require mo BUILT UP ROO C of me C t for such permit a Lias a signed rftrstatement that he Is licensed Wreuant tome pro ofthe , of the ss and tPro Dsions ode) haptar 9(commencing with Section the70sX)b of Division 3 al the Business and YUatskxls Code) 7the.he b exempt therefrom arm the bests for the alleged ASPHALT SHIN LES ❑ exempPen.Artyf not onof Section]03dr d'shy applicant for a permit subjects the-Pplkant to e civil penally of not more men live hundred driers(5500).): By 01,asawner of the property.or on,emp"s with wages as melrsele compensation,will do WOOD SHAKES ❑ the work,sum tha Vrudure Is not intended or offered for sale(Sec.7044,Buslnae i eM Proles- eldns Code:The Contmclors License Law does not appy to an owner of property who builds or WOOD SHINGLES improves thereon,enol who does such work himself or through his own employees,provided mat El such Improvements are not Intended or offered for sale.If,however,the Gelding or improvement Is sold within one year of completion,the owner-Wllder will have me burden of proving mal he did OTHER(SPECIFY) not Wild or Improve for purpose of sale.). El Elas owner of the property,am exciu-Ively contracting with Iicensad contractors to construct Me project,.see,7044,Buelnese and Professions Code:The Contrsotrs License Law Wes not PROVIDE I.C.B.O. REPORT NO. � S3 ✓ appy to an of.property colo Wlltls or Improves thereon,and who contracts for such projects with a coot-.16s)s)'licensed pursuant to the Contractor§License law. PROVIDE MFGR.INSTALLATION SPECS. ❑ am"exempt under Sec. ,B 8 P.C.for this reason Owner Dale - WORKER'S COMPENSATH)N DECLARATION APPLICATION DATE VALUATION PERMIT FEE ' I hereby affirm under penalty of perjury aro of me toriowing declaration: 1 have and will maintain a Certificate of Consent to sell-insure for Workers Compensation, Building Iting ac provlded for by Section 3700 of the Labor Cade,for the performance of the work for which this pe m)�Lsste°. �3�9 700 Seismic /�^nV have arm will maintain Workers Compensation Insurance,oe,es rout trod ru Section Workers 0l - the La r Coca,for the pedormence of the work for which this permit Is Issuetl.My Workers Co oanswi n Insurance carrier and Policy number are: Tota Carder Pdlcy No. PERMIT AUTHORIZATION DATE CERTIFICATE OF EXEMPnON FROM WORKERS' COMPENSATION INSURANCE N.C[] ' (This section load ml be completed H the permit Is for one hundred donate($100)or lees.) candy,that in the perbrmence of the work for which Ihfs permit is issued.I shall not employ any porson Ina mariner w as to become subject t: erg Compereafion Laws of Cali- All roofs shall 'nspected prior to any roofing material being f°`nla. installed. If a roof is installed without first obtaining an Date.� Applicant inspection,I agree to remove all new materials for inspection. NO TO AP DCANT: If,-Her making this Certlllcete Exemption,you should become A Ilcant understands and will Com I with all non int subject to the Workers'Compensation provisions of the Lab Code,you must forthwith comply PP P Y PO with such provlslons or this permit shall be downed revoked. source regulations. I Cerfify met I have read this apWcafon and state that the above Information is Correct.I agree to Comply wtih all city and county ordinances and state laws relatlrg to building construction,and All roof coverin s to be class"C"Or better. hereby authorize represenmtivee of this city to anter upon ma ebwamentionetl property for m- hbon purposes. (We)agree to aave,indemnify and keep harnesses;the Cly of Cupertino agwron IlabilNlee Z judgments,mets arm expenses which may in any way accrue against send City...anaequsnm of the granting of this Permit. SIGNATURE 9F,APPLICANT DATE L 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 CITY OF CUPERTINO It* 1 of 1 BUILDING PERMIT RECEIPT OPERATOR: nancyc COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot:35613037.00 DATE ISSUED.. ..... : 09/13/1999 RECEIPT q. . . ......: 10058 REFERENCE ID # ...: 99090082 SITE ADDRESS ..... : 10822 WILKINSON AV ' SUBDIVISION ...... . CITY .... . . ....... : CUPERTINO IMPACT AREA ......: OWNER ... ......... : LEARN ARTHUR J AND BETTY J ADDRESS . ......... : CITY/STATE/ZIP .. . : CUPERTINO CA, CA 95014-4732 RECEIVED FROM . . . . : TO CONTRACTOR ....... : MCCARTHY JR, MICHAEL LIC # 21043 COMPANY .......... : MCCARTHY INDUSTRIES INC ADDRESS 845 COMMERCIAL ST CITY/STATE/ZIP ... : SAN JOSE, CA 95112 TELEPHONE ........ : 4084361560 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL __________ _____________ ____ __ _---___--- BPERMFEE VALUATION 15,000.00 207.00 0.00 207.00 0.00 ICRE VALUATION 15,000.00 1.50 0.00 1.50 0.00 PERMIT : 208.50 0.00 208.50 0.00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ ------------------ CHECK 208.50 10243 ------------ TOTAL RECEIPT 208.50 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: nancyc Sec: Twp: Rng: Sub: Elk: LOL:35613037.00 INVOICE DATE... . . . : 09/13/1999 REFERENCE ID # . . . : 99090082 SITE ADDRESS . . . ..: 10822 WILKINSON AV SUBDIVISION ... .... CITY . ......... . . . : CUPERTINO IMPACT AREA . .. . OWNER ........... . : LEARN ARTHUR J AND EETTY J ADDRESS ........ . . : CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4732 CONTRACTOR . . . . . . . : MCCARTHY JR, MICHAEL LIC # 21043 COMPANY ... . . . . . ..: MCCARTHY INDUSTRIES INC ADDRESS ....... . ..: 845 COMMERCIAL ST CITY/STATE/ZIP . . .: SAN JOSE, CA 95112 TELEPHONE . . . . .. ..: 4084361560 FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE --------------- --- --------- ------------ ----------- . BPERMFEE P 207.00 0.00 207.00 BSEISMICRE P 1.50 0.00 1.50 --------- ------------ ----------- 208.50 0.00 208.50 V�..ID =-..-._ DESCRIPTION -.... VOICE ID .-.---. DESCRIPTION ............ ........ .............. 305 FRAME 307 INSULATION 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 603 ROOF BATTENS 604 ROOF IN-PROGRESS