Loading...
15040077 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22364 RIVERSIDE DR CONTRACTOR:NEIGHBORS ROOFING PERMIT NO: 15040077 AND GUTTERS OWNER'S NAME: SAN JOSE,CA 95138 PHONE NO:(408)472-3869 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL 7 RE-ROOF 37 SQ-REMOVE(E)SHAKES INSTALL 1/2 OSB; License Class < Lic.# INSTALL LIFETIME 30LB FELT CLASS A Contractor � No© ,.Date —1 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: ave 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:$15945 performance of the work for which this permit is issued. Sq.Ft Floor Area: 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 APN Number:35602011.00 Occupancy Type: permit 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 upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS F AST 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 Issued by: Date: i granting of this permit. Additionally,the applicant understands and will comply 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. ❑ OWNER-BUILDER DECLARATION Signature of Applicant: Date: 5 I hereby affirm that I am exempt from the Contractor's License Law for one of ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER the following two reasons: 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 1,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. 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 will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and performance of the work for which this permit is issued. ided for by the Health&Safety Code,Sections 25505,25533,and 25534. 1 have and will maintain Worker's Compensation Insurance,as prov Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date: 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 CONSTRUCTION LENDING AGENCY Compensation laws of California. If,after making this certificate of exemption,I 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 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 9 18. Signature Date CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 22364 riverside dr DATE: 04/09/2016 REVIEWED BY: Mendez APN: BP#: "VALUATION: $15,945 *PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof PRIMARY PENTAMATION 1 SFDWLROOF USE: SFD or Duplex PERMIT TYPE: WORK re-roof 37 sq- remove a shakes install 1/2 osb; install lifetime 301b felt class a SCOPE FEE ID ROOF AREA s.f. 1REROOFFRES 3,700 wSNOW,_ >. . - mech. Plan Check Plarrrrb. Ilan Check Elect.Plan Check L1ec6r. Permil Fee: 1'Itamb. 1'i:rmlt FE<e: Elec. Permit Vee. _D2:�j orher hlech. Insjr. Other Plumb Insp. 0!12er Is'lec.Imp. #decla.Insp. Fee: Pl unib. Trash.Tee: Illec.Imp. Fee: NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). These fees are based on the prelimina information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS(Fee Resolution 11-053 E . 7f /1/13) FEE QTY/FEE MISC ITEMS Plan (:"heck Fee: suppl. PC Fee 1'la nn b. '11e c°t 1.:1:1 ec Permit Fee: $629.00 Supp/. In p Fee 1'lurn b./�11ech.;Zslec F'T.unth.%: 1<�clz.�Hlec Perrnil Fee: C.onstruch.on Tear: ,161ministrative Fee: Work Without Permit? ®Yes (E) No $0.00 Advanced Planning Fees: Trrrnel Doculnenlation Fees: � Strong Motion Fee: IBSEISMICR $2.07 Select an Administrative Item Bldp,Stds Commission Fee: 1BCBSC $1.00 $632.07 $0.00 To= AI.FEE. $632.07 Revised: 04/01/2015