10100068 CITY OF CUPERTIP O BUILDING PERMIT
BUILDING ADDRESS: 21391 MILFORD DR CONTRACTOR:SUNGATE ENERGY PERMIT NO: 10100068
SOLUTIONS
s"AINER'S NAME:
r r
C2 / p BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic.# BD6SOv�
MECH RESIDENTIAL COMMERCIAL r
ContractookUkE-16 MPY3 Date (019L,(
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: RE-ROOF REMOVE EXISTING ROOF.INSTALL 1/2"OSB
(commencing with Section 7000)of Division 3 of the Business&Professions SOLID
Code and that my license is in full force and effect. SHEETING&INSTALL 30YR COMPOSITION SHINGLE CLASS
A 22SQ
I hereby affirm under penalty of perjury one of the following two declarations:
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
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
permit is issued. Sq.Ft Floor Area: Valuation:$12000
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is APN Number:32641104.00 Occupancy Type:
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
indemnify and keep harmless the City of Cupertino against liabilities,judgments, PERMIT EXPIRES IF WORK IS NOT STARTED
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally he applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR
with all non- the Cupertino Municipal Code,Section180 DAYS FROM LAST CALLED INSPECTION.
9.18.
S+anatu Date Issued b3 Date: lceA--?— eG
❑ WN -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS:
the following two reasons: All roofs shall be inspected prio any roofing material being installed.If a roof is
I,as owner of the property,or my employees with wages as their sole compensation, installed without first inspecti a to remove all new materials for
will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection.
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applican. Date:
construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three ALL ROOF COV INGS TO BE CLASS"A"OR BETTER
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE
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 read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
Section 3700 of the Labor Code,for the performance of the work for which this compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Safety Code,Section 25532(a)should I store or handle hazardous material.
permit is issued. Additionally,should I use equipment or devices which emit hazardous air
I certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I will
not employ any person in any manner so as to become subject to the Worker's maintain co phance with the Cupertino Municipal Code,Chapter 9.12 and the
Compensation laws of California. If,after making this certificate of exemption,I Health
l
Date:
APPLICANT CERTIFICATION CONSTRUCTION LEN ING AGENCY
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 I here a that there is a construction lending agency for the performance of work's
to building construction,and hereby authorize representatives of this city to enter for whrc this permit is issued(Sec.3097,Civ C.)
r the above mentioned property for inspection purposes.(We)agree to save Lender's Name
nify and keep harmless the City of Cupertino against liabilities,judgments,
and expenses which may accrue against said City in consequence of the Lender's Address
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION
9.18.
I understand my plans shall be used as public records.
Signature Date
Licensed Professional
CITY OF CUPERTINO
FEE ESTIMATOR-- BUILDING DIVISION
ADDRESS: DATE: REVIEWED BY:
APN: BP#: *VALUATION: 1$12,000
;PERMIT TYPE: Minor Building Permit PLA N CHECK TYPE: Re-roof
PRIMARY �>1 #i, PENTAMATION
SFD or Duplex t t�c�t t 1 SFDWLROOF
USE: PERMIT TYPE:
WORK
SCOPE
FEE ID ROOF AREA
s.f.
1REROOFFRES 2,200
C t,-, h,
1'jc�"!`7. I��Yflt I t'Li. I:� c,.. 1'.cC. f t"t1,•Lf:t:y,�.
Li01,/i,,-),!0 Imp,
NOTE. Thesefees are based on the preliminary information t vailable and are only an estimate. Contact the De t or addn 7 info.
FEE ITEMS (Fee Resolution 09-051 Ef'. 7;'1!10) FEE QTY/FEE MISC ITEMS
I'r'ult C'Itt'c:k I e�c�:
.5uppl. PC Ft'c
P/1//n _1`,1,c,c/1. ' c'c:f lai1
Permit Fee: $28E.00
S1rpp/, his!l=ee
P/rrr1d).1lcc°h,111cc: (`Trt F,%,.
I'/ltrstf7.i:11t�c"'1.:'Llcc P0,1111It 1-"CC
t.`c77slr°IIC'fTf)f1 7"n,
,'1<:rttesficctl I�'c�r���c�11�f�°c�.
Work Without Permit? 0 Yes (F) No $C.00
-Fr��i�eel f)t�c�trll�e�fattllir>n l�`res_
I
Strong Motion Fee: IBSEISMICR $1.20 Select an Administrative Item
Bldp-Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $28E,.201 $0.00 TOTAL FEE: $288.20
Revised: 9/29/2010