15040063 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 1044 WEST HILL CT CONTRACTOR:RIDGETOP DBA CAL- PERMIT NO: 15040063
PAC ROOFING
OWNER'S NAME:
CAMPBELL,CA 95008 PHONE NO:(408)370-3332
JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL
LICENSED CONTRACTOR'S DECLARATION
q C / TEAR OFF(E)WOOD SHAKE,
License Class_ Lic.# / `LG INSTALL(N)METAL TILE OVER(E)PLY(ESR#3098 @
1.3#PER S.F.)30 SQ'S
Contractor G A- I r`� Date
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 Valuation:$20000
per _ ance of the work for which this permit is issued. Sq.Ft Floor Area:
e and will maintain Worker's Compensation Insurance,as provided for by
tion 3700 of the Labor Code,for the performance of the work for which this APN Number:36227044.00 Occupancy Type:
rmit is issued.
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 LLED INSPECTIO
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS F
indemnify and keep harmless the City of Cupertino against liabilities,judgments, " IJ
costs,and expenses which may accrue against said City in consequence of the Date: 6
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Muni i Code,Section
918, E-ROOFS:
Signature Date u b 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 rem all new materials for
inspection. 44 (Zfr
❑ OWN - U DER DECLARATION Signature of Applicant: Date: /
I hereby affirm t t exempt from the Contractor's License Law for one of
the following asons: ALL ROOF COVERIN 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) HAZARDOUS MATERIALS DISCLOSURE
I,as owner of the property,am exclusively contracting with licensed contractors to
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. 1 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
the Health&Safety Code,Sections 25505,2 33,and 25534.
I have and will maintain Worker's Compensation Insurance,as provided for this
I
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date:q
permit is issued.
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 CONSTRU LENDING AGENCY
Compensation laws of California. If,after making this certificate of exemption,I
I hereby affirm
become subject to the Worker's Compensation provisions of the Labor Code,I must firm that there is a construction lending agency for the performance of
work's for which this permit is issued(Sec.3097,Civ C.)
forthwith comply with such provisions or this permit shall be deemed revoked. 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 ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
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
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 1048 WEST HILL CT DATE: 04/08/2015 REVIEWED BY: MELISSA
APN: 362 27 044 BP#: *VALUATION: $20,000
*PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARYPENTAMATION 1 SFDWLROOF
USE: SFD or Duplex PERMIT TYPE:
WORK TEAR OFF E WOOD SHAKE INSTALL N METAL TILE OVER E PLY ESR#3098 1.3# PER
SCOPE S.F.) 30 SQ'S
FEE ID ROOF AREA
s.f.
1REROOFFRES 3,000
4�
Niech. Plan Check Phimb. Plan Check Elec.Pian Check
Mech. Perwit Fee: Plumb. Permit Fee: Flec Permir Fee:
Other A/fech, 1rup. other Plumb lnsp- 01hef,Elec.Insp.
�i/lech. Insp_ Fee: Plumb. h"j).Fee: klec`.Insp, Fee:
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,eta). These fees are based on the pnelimina information available and are only an estimate. Contact the Dept for addn'l info,
FEE ITEMS (Fee Resolution 11-053 E . 7fi /1/13) FEE QTY/FEE MISC ITEMS
Plan Check bee:
,Suppl. P(.`Fee
00
PIT.tYnl1.�i���£'t'h.i L'lec
Permit Fee: $5 .00
Stglvpl. Insp Fee
plzcrr2lec
/'IZcrtah.%'11ech.%l lec Permit Fee:
Cc�tastr�ttctitan Tax:
A.dministrafive Fee:
Work Without Permit? ® Yes No $0.00
ACIt'txrtced Fees: T__= 0 3 ��
TrOlvel Docurneniatiun Fees.,
Strong Motion.Fee: IBSEISMICR $2.60 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
$513.60 $0.00 y AL FEE. $513.60
Revised: 04/01/2015