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12010006 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7543 NORMANDY WAY CONTRACTOR:TBD-'1'0 BE Df IT"RMINED PERMIT NO: 12010006 OWNER'S NAME: SOI IN JEFFREY 13 AND AVRIL DATE ISSUED:01/03/2012 OWNER'S PHONE: 4082559582 PHONE NO: I LICENSED CONTRACTOR'S DECLARATION /f BUILDING PERMIT INFO: BLDG ELECT ' PLUMB License Class 613 Lic.N P-.7-f�p / I- MECH RESIDENTIAL . COMMERCIAL Contractor /w/g-4/tate hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION: R1 ROOF REMOVE WOOD SHINGLES REPLACE wl'tI i (commencing with Section 7000 of Division 3 of the Business&Professions COME SHINGLES 25 SQIJARP.S Code and that my license is in full force and effect. 1 hereby affirm under penalty of perjury one of the following two declarations: 1 have and will maintain a certificate of consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Arca: Valuation:$6200 permit is issued. APPLICANT CERTIFICATION APN Number:3661 1 152.00 Occupancy"Type: I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments. costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additirn,ally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point sour e regulatio , upertino Municipal Code.Section 9 18. Date: Issued by. Signa re Date OWNER-BUILDER DECLARATION RE-ROOFS: I_ eby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed. 11'a roof is the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for I,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Signature of Applicant: Date: 1,as owner of the property,am exclusively contracting with licensed contractors to — construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINCS TO BE CLASS"A"OR BE"T"TER 1 hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE: I have and will maintain a Certificate of Consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the 1 have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California llealth&Safety Code,Sections 25505,25533,and 25534. I will maintain II have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Safety Code,Section 25532(x)should 1 store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area.Air Quality Management District 1 will I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Workers llealth&Safety Code,Sectio 5505,25533,and 25534. Compensation Taws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must 0., e t r'" forthwith comply with such provisions or this permit shall be deemed revoked. Date: CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereby affirm I certify that I have read this application and state that the above information is firm that there is a construction lending agency for the performance of work's correct. I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address costs,and expenses which may accrue against said City in consequence of the ng of this permit.Additionally,the applicant understands and will comply pRC11I"1'EC"1''S DECLARATION .11 non-point source regulations per the Cupertino Municipal Code,Section 9.18. 1 understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 7543 normandy way DATE: 01/03/2012 REVIEWED BY: bobs. APN: r I BP#: 0/" "VALUATION: 1$6,200 rPERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof PRIMARY SFD or Du lex PENTAMATION 1 SFDWLROOF USE: P PERMIT TYPE: WORK remove wood shingles replace with comp shingles. SCOPE FEE ID ROOF AREA s.f. 1REROOFFRES 2,500 F-1 Li Lj NOTE: This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . Theseees are based on therelin ina information available and are only an estimate Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution II-053 FEE QTY/FEE MISC ITEMS Permit Fee: $350.00 Work Without Permit? 0 Yes No $0.00 Strong Motion Fee: IBSEISNIICR $0.62 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $351.62 $0.00 TOTAL FEE: $351.62 Revised: 12/04/2011 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 U P E RTI N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: 3nq 11Lje&7dn0W �/a PERMIT# OWNER'S NAME: �a/ / ' PHONE# GENERAL CONTRACTOR: ry /C'/r A&m S LICENSE# ADDRESSCl CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONT34CTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. ' I am not using any subcontractors: /A?/ Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring/ Carpeting Linoleum /Wood Glass/ Glazing Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date CITY OF CUPERTINO f- 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: suew COPY 4 1 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 36611152 . 00 DATE ISSUED. . . . . . . : 01/03/2012 RECEIPT 4 . . . . . . . . . : BS000015642 REFERENCE ID # . . . : 12010006 SITE ADDRESS . . . . . : 7543 NORMANDY WAY SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : SOHN JEFFREY B AND AVRIL ADDRESS . . . . . . . . . . : 7543 NORMANDY WAY CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5222 RECEIVED FROM . . . . : ANTHONY RAINIERI CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096 COMPANY . . . . . . . . . . : TBD - TO BE DETERMINED ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : , TELEPHONE . . . . . . . . : rs� FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 6, 200 . 00 1 . 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 6, 200 . 00 0 . 62 0 . 00 0 . 62 0 . 00 1BUSLIC FLAT RATE 1 . 00 119 . 00 0 . 00 119 . 00 0 . 00 1REROOFRES SQ FEET 25 . 00 350 . 00 0 . 00 350 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 470 . 62 0 . 00 470 . 62 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 470 . 62 VISA --------------- TOTAL RECEIPT 470 . 62 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 309 EXTERIOR LATH 311 SCRATCH COAT 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF