14120137CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10369 NORWICH AVE
CONTRACTOR: DAN ELLIOTT'S
PERMIT NO: 14120137
ROOFING CO
OWNER'S NAME:
SAN JOSE, CA 95159
PHONE NO: (408)559-7327
❑ LICENSED CONTRACTOR'S DECLARATION
f f
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic. #
f-"' F_ f—
MECH RESIDENTIAL COMMERCIAL
Contractor Date
JOB DESCRIPTION REMOVE SHAKES AND FLASHINGS COMPLETE. INSTALL
15/32 27 SQRS
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business & Professions
Code and that my license is in full force and effect.
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
Sq. Ft Floor Area: 0
Valuation: $9507
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.
APN Number: 31629080.00
Occupancy Type:
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
PERMIT EXPIRES IF WORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
180 DAYS FROM LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
Issued by: Date:
with all non -point source regulations per the Cupertino Municipal Code, Section
9 18.
RE -ROOFS:
Signature Date
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
F1 OWNER -BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
I, as owner of the property, or my employees with wages as their sole compensation,
will do the work, and the structure is not intended or offered for sale (Sec.7044,
Business & Professions Code)
1, as owner of the property, am exclusively contracting with licensed contractors to
HAZARDOUS MATERIALS DISCLOSURE
construct the project (Sec.7044, Business & Professions Code).
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
I hereby affirm under penalty of perjury one of the following three
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
declarations:
Health & Safety Code, Section 25532(a) should I store or handle hazardous
I have and will maintain a Certificate of Consent to self -insure for Worker's
material. Additionally, should I use equipment or devices which emit hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the
air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued.
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sections 25505, 25533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
Owner or authorized agent: Date:
I certify that in the performance of the work for which this permit is issued, I shall
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California. If, after making this certificate of exemption, I
CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code, I must
I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked.
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
APPLICANT CERTIFICATION
Lender's Address
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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
ARCHITECT'S DECLARATION
costs, and expenses which may accrue against said City in consequence of the
I understand my plans shall be used as public records.
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
Licensed Professional
918,
Signature Date
BUILDING ADDRESS:
CITY OF CUPERTINO BUILDING PERMIT INSPECTION CARD
ONORWICIIAVE CormAcTOR;DAN IELI,IOTT.'S rERmITNo-14120137
ROOFING CO
owNEws NAmw, F'
SAN 10M CA 95159 PHONE NO; (403)559-7327
FMMATIONrn1SR5/H•o.s• BUILDING PERMIT INFO. )ILDC ELECT PLUMB MECH
UMGROUND R.S,D,,,TIAi, r COMMLRCIA'L �
PAW$BT SACK -C=T JOR DESCRIPTION: REMVE SHi VJ8 AND rE ASHINGS COMPUITE. INSTALL
Ili/22 27 SQRS
URBAN INTERFACE FIRE AREA r ERA
TO ARRANGE, INSPECTION
Call 77%4228 between 7:30 am and 3:30 pm Monday through Riday, at least 24 boars
before required Inspection, Job address and permit Numbers are needed when
requesting an inspection.
CUPERTINO SANITARY DISTRICT
Closed circuit video inspection of property line cleanout,'pofnt of connection
and street lateral required prior to passing FINAL CITY PLUMBING
INSPECTION. Coll the District (408-253-7071) for an appointment"
NO BUILDING FINALS INSPECTIONS UNTIL ALL REQUIRED
BUSINESS LICENSES ARE OBTAINED
PERMIT EXPIRES IF WORD; 15 NOT STARTED WI'I RIN 180 DAYS OF PERMIT
ISSUANCE OR 180 DAYS MOM LAST CALLED INSPECTION.
IMPORTANT
When a portrait Etas expired, a charge totaling oone-haIf the fees to obtain anew permit
must be paid in order to reactivate the permit. If a permit has bean expired for more
than one year, a charge totaling the fg1I fees to obtain a new permit must be paid
to reactivate the permit.
NOTLB:
ELEcrR1CNMR RELRAASa
SPECIAL INSPECTIONS Inspector; Data;
ROOF INSPECTIONS
PRE -INSPECTION: Inspector. Date:
TEAM -OFF: Inspector: Date;
PLYWOOD: Inspector_ bate:
BA77ENS: Inspeet0c Date:
IN PROGRESS: Inspector: Pete;
FlNAT.: Inspector' Data; �� L
NOTE: OSTIA• APPROVED ACCE O ROOF SUALL BE PROVIDED ROI, IGVSPEt:TION:
OCCUPANCY OF BUILDING NOT IMMMITTED UNTIL I3UMI)TNGy I+INAL IS SIGNED BY
IMPACTOR
•
'
GAS TEsTmenm 2 MIRASB
GRAM- KMt IC WORKS
FIRE -CALL (.109).SIB-4010
PLANNING (108)x17-3305
SANITARY (405) 253-7071
BLBCTTWCAL
MECHANICAL
-
PLUMBING
HANDICAP
L'NEROY
BUILDTN'Q
CL`R77FICATE OF OCCUPANCY °
CI'T'Y OF CUPERTINO BUM -DING PERMIT
IWILbING ADDRESS: 10369 NORWICH AVE
CONITRACrOk; DAN ELLIOTT'S
PERMIT NO: 14120137
1Z0O1:T G CO
OWNER'S NA vw
SAN' JOSE, CA 95159
PHONE NO; (406)559-7327
17 UCWS19D CONTAACTOR'R DEC.r, ARAMON
D'Ll7LbING PERMIT INFO: BLDG r T,L,,, r— PL 0M8 r
License Class Lie. IE
MCU F R23&lIIENTL�L r C.M.M.AY. r
Contractor bate
JOE DESCRIP'T'ION: RF,MOVE SEAM ANI) PLASHNGS COIULETS.IN5TALL
1552 27 SQM
I hereby affirm that 1 am licensed under the provisions of Chapter 9
(cmmmencingwith Section 7000) of blvislan 3 ofthe Business & Professions
Code and that my license [a In full force and effect.
I hereby affirm under penalty of perjury one of tot: following two declaratioeg;
I have and will maintain a cerilficate of consent to self -insure for Worker's
Compensation, as provided for by Section 3700 ofthe Labor Code, far the
Sq. Ft Floor Area: 0
'Valuatlont $9507
performance of the work for whicbthis permitis issued.
I have and will maintain Woricces Compensation Insurance, as provided for by
Section 3700 ofiihe Labor Code, for Oho performance of Ste work tbrwihich this
permit is issued.
APN Number; 3162906040
Occupancy Type;
APPLICANT CERT( (CATION
I certify that I have read thin application and state that the above Information is
PERMIT E70'IRE% S IF WORK IS NOT STARTED
correct. I agree to comply with All city and cotmty ordinances and state laws relating
to building construction, and hereby audioriza representatives of ibis city m cuter
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
upon the above mentlonedpropetty for inspcctionpurposcs. (Vie) agree to save
180 DAYS PROM LAST CALLED INSPECTION.
indemnify and keep harmless theClty of Cupertino aortst liabilities, judgments,
costs, and expenses which rosy accrue against said City in consequence ofthe
granting ofthls pernut. Additionally. the tppllcant understands and will comply
laded by: bate:
with all notrpolntsouroe regulations per tbeCupertlno Municipal Code, Section
9.18.
Signature Data
$E-R00F3i
All teofs shall be inspectedprior to any roof5ngmatoriel being installed. If it roof is
installed without Srst obtaining an inspection, I agree to remove all new materials for
inspection.
13 9-V&N1t-HUILb1r,R DECLAxa_ TION
1 herieby a[firm fust I am exempt from the Contractor's License Law for one of
Signature ofApplieant Date:
elhe following (we reasons:
1, as owner ofthe property, or my employees with wages as their sots compensation,
ALL kOOF COVERINGS TO BE CLASS "A" OR BETTER
will do the work, and the structure is not intended or offered for sale (Seo.7044,
Business & Professions Code)
i as owner ofthe property, am cxclusivoly contraoling with licensed contmotors to
IIAZARDObe i1 =RIALS DISCLt1SURT
construct the project (Seo.71)44, Business & Pro2sssions Code).
I have read the hazardous materials requirements under Cbapter6,95 of the
I hereby affirm ruder penalty of perjury one of the fallowing three.
California Health & Safety Code, Sections 25SOS,2M33,and 25539. Iwill
mzlntaln compliance with the Cupertino Municipal Code, Chapter 9.12 and the
der:lerallons:
I have andwill.maiaWn a Certificate of Consentio self insure for Worker's
health Bt Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the
air contaminants no defined by the Bay Area Air Quality Management District 1
performance ofthe work fbr whlchthis permit is issued,
will malntaiq complialrce with the Cupertino Itlunirlpal Code, Chapter9.12 and
1 have and will maintain Worfter's Compeasstion Insurance, as provided for by
the 1Tealth & Safety Code, Sections 23303, 25533, acid 25334.
Section 3700 ofthe Labor Code, fur the performance of the work for which this
pormlt is issued.
Owner or nuthorized agent: Date:
1 certify that in the performance ofthe work fm which this permit is issued, I shall
not employ any person inany manner so as to bocome subjectto the Worker's
Compensation Laws of Califomia. If; atter making this certificate of exemption, l
CONSTRUCTIQ K LENDING AGENCY
bocome subject to the worker's Compensation provIdoas ofthe Labor Code, I must
1 hereby affirm that there is a construction lendlog agenoy for the performance of
fodhwi4i comply with such provisions or this permit shall be deemed revolved,
work's ibrwhich this permit is issued (Seo. 3097, Civ C.)
Lender's Name
AkELLCAtM CCRTIP[CATIQN
Lender's Address
I certify duit I have reed this application and state thatthe above intbrmation is
eorreet. I agree to comply with all city and county ordinances and state laws relating
to building construction, and hereby authorize mptesontatives ofthis city to ontor
upon the above mentioned property for Inspection purposes. (We) agree to save
indormaify and Imep harmless the city of Cupertino against liabilities, judgments,
p1iC1f11TECTOs DECLAR6T70N
costs, and expenses which may seem against said City in consequence of One
I understand my planssholl be used as public records,
grunting mfthis permit. Additionally, the applicant understands and will comply
will%allctorrpointsource regulations per the Cupertino Municipal Code,Section
LieenzedProfessional
9.1 EL
Signature Date