11070081CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10450 GLENVIEW AVE
CONTRACTOR: G T BUILDERS
PERMIT NO: 11070091
OWNER'S NAME:
MONTE SERENO, CA 95030
PHONE NO: (408) 390-5670
❑ LICENSED CONTRACTOR'S DECLARATION
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PLUMB
Q� c�
J License
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BUILDING PERMIT INFO: BLDG ELECT
Class Lic. tl J
F RESIDENTIAL r COMMERCIAL r—
Contractor - Date I/ ( f
MECH
I hereby aflir that I a n c ed under the provi ions o Chapter 9
JOB DESCRIPTION: 2 SKYLIGHTS, 24 INCHES X 48 INCHES,MOUNTED
(commencin with Sectio 7000) of Division 3 of the Business &Professions
BETWEEN TRUSSES (NO CUT TRUSS), SIDE BY SIDE, INSULATE SHEETROCK
Code and th my license is in Cull 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
performance of the work for which this permit is issued.
Sq. Ft Floor Area:
Valuation: $2500
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: 36911017.00
Occupancy Type:
APPLICANT CERTIFICATION
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
PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupert gainst liabilities, judgments,
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs, and expens may accrue again - City in consequence of the
180 DAYS FROM LAST CALLED INSPECTION.
granting of s permit. Ad onally, the cant understands and will comply
with al l n n-point source re tions Cupertino Municipal Code, Section
9.18.
Issued by: Date:��/
Signature Date �3
❑ OWNER- DER DECLARATION
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
I hereby a . that I amexempt from the Contractor's License Law for one of
installed without first obtaining an inspection, I agree to remove all new materials for
the folio ng two reasons:
inspection.
I, as own r pro
pprty, or my employees with wages as their sole compensation, of the e
wil I do the work, and the structure is not intended or offered for sale (Sec.7044,
Signature of Applicant: Date:
Business & Professions Code)
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
I hereby affirm under penalty of perjury one of the following three
declarations:
HAZARDOUS MATERIALS DISCLOSURE
I have and will maintain a Certificate of Consent to self -insure for Worker's
I have read the hazardous materials requirements under Chapter 6.95 of the
Compensation, as provided for by Section 3700 of the Labor Code, for the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
performance of the work for which this permit is issued.
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
I have and will maintain Worker's Compensation Insurance, as provided for by
Safety Code, Section 25532(a) should I store or handle hazardous material.
Section 3700 of the Labor Code, for the performance of the work for which this
Additional" ould I use equipment or devices which emit hazardous air
'ants
permit is issued.
coots as efined the Bay Area Air Quality Management District I will
m#ain compy c.wittupertino Municipal Code, Chapter 9.12 and the
I certify that in the performance of the work for which this permit is issued, I shall
& Safety ode, Secti ns 5533, and 25534.
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, 1
�wner or rized agen
become subject to the Worker's Compensation provisions of the Labor Code, I must
ate:
comply with such provisions or this permit shall be deemed revoked.
NSTRU TI N LENDIN A ENCY
APPLICANT CERTIFICATION
yhereby rm ere is a construction lending agency for the performance of work's
I certify that I have read this application and state that the above information ishis
p it is issued (Sec. 3097, Civ C.)
correct. I agree to comply with all city and county ordinances and state laws relatiame
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
Lender's Address
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
ARCHITECT'S DECLARATION
with all non -point source regulations per the Cupertino Municipal Code, Section
I understand my plans shall be used as public records.
9.18.
Licensed Professional
Signature Date
CITY OF CUPERTINO
FM_7 FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 10450 glenview
DATE: 07/13/2011
REVIEWED BY: bob s.
APN: 3(pCl It �( --�—
I BP#:
"VALUATION: 1$2,500
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
PENTAMATION 1GENRES
PERMIT TYPE:
WORK
SCOPE
NOTE: These fees are based on the nreliminarv, information available and are onlv an estimate. Contact the Dent for addn'l Info.
FEE ITEMS (Fee Resolution I1-053 R(f'.' 711111)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
0 #
$392.00
Skylight
ism<IOSF <= 10 s.f.
Suppl. PC Fee: 0 Reg. 0 OT
0.0 1
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee.e Reg. 0 OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Acoustical Fee: 0 Yes 0 No
$0.00
0
E)
Work Without Permit? 0 Yes 0 No
$0.00
Planning Fee:
$0.00
Select a Non -Residential Q
Building or Structure 0
li r! < ; Ir>, r��rtc r�Icrrinrt .T'� t
Strong Motion Fee: 1BSEISMICR
$0.50
0.5 hrs
$41.00
Admin./Clerical Fee
IADMIN
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$1.50
$433.00
TOTAL FEE:
$434.50
Revised: 07/04/2011