15050034 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 6371 ATHERWOOD AVE CONTRACTOR:CUPERTINO ROOF,INC PERMIT NO: 15050034
OWNER'S NAME:
SAN JOSE,CA 95129 PHONE NO:(408)973-9427
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL 0
REMOVE(E)COMP ROOF&LAY OVER(E)PLY(1)CLASS
License Class �gLic.# 317M 7 A COMP ROOF SYSTEM(22 SQ'S)
Contractor �!ti�(-` 12,4 °1 Date 10"
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
erformance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$10000
Vhave 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:36916009.00 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�180APERMIT 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 D LLED 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 y b
//
granting of this permit. Additionally,the applicant understands and will compl I II)ate:
with all non-point source regulations per the Cupertino Municipal Code,S ion
9 18.
�^ tt RE-ROOFS:
Signature ----- —�" Date "lfl`L�'�1 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 r c
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
1,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)
I,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(x)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 Zapf
Owner or authorized agent:
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
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
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 6371 ATHERWOOD AVE DATE: 05/06/2015 REVIEWED BY: MELISSA
APN: 6916 009 BP#: *VALUATION: j$10,000
*PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Duplex PENTAMATION 1 SFDWLROOF
USE: PERMIT TYPE:
WORK REMOVE E COMP ROOF & LAY OVER E PLY N CLASS A COMP ROOF SYSTEM 22 SQ,S
SCOPE
FEE ID ROOF AREA
s.f.
1REROOFFRES 2,200
ech /11:at Alzviib.PJ'an(,'heck ElE>c..1'1t�r.t:7uc1
:ytctcie.P'..'rrzit Fee: Fit?wba Per?nii Fee: E1ec.Perrzii Fui::
Ocher',We'clt. hup. Other P vi"b IY.v)5
fEtE;'a.17zr1;.Fee: 1'tzwib.In.sw; F!e•: Etec.nsp.Fee:
NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.). These ees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution.11-053.F_ff. 7/1/13) FEE QTY/FEE MISC ITEMS
Man("heck'.I'es.':
St.j,q.)1. .P( 1 e'
t'1rcr�lJ.%�i:le;�;lE„�fsle;r;
Permit Fee: $374.00
.Siq)j)1. lns/?F''ei.
Pe rinit.(ee:
�.'£JP1�11"tiC'Tl(Jid ,1wc2'i:
Administr alive Fee:
Work Without Permit? Yes No $0.00
,9.,1vcrnce11.P1annin1,7.Fees:
ravel Documentation.F'ee's: A
Strom Motion Fee: IBSEISMICR $1.30 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTbTALS $376.30 $0.00 TOTAL FEE_ $376.30
Revised: 04/01/2015