The URL can be used to link to this page

12120041CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7543 DONEGAL DR CONTRACTOR: K1 ROOFING & REPAIR PERMIT NO: 12120041 OWNER'S NAME: LIN JY -JINE J TRUSTEE 2561 DUMONT CT DATE ISSUED: 12/10/2012 OWNER'S PHONE: 4086879363 SAN JOSE, CA 95122 PHONE NO: (408) 625 -0565 2— LICENSED CONTRACTOR'S DECLARATION 1— r BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class L 3 i // Lic. # Contractor 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 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. 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 upon the above mentioned property for inspection purposes. (We) agree to save 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 with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature �i"� �— Date ❑ OWNER- BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of 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) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: 1 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. 1 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. 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 become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. 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 upon the above mentioned property for inspection purposes. (We) agree to save 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 with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date MECH I— RESIDENTIAL F COMMERCIAL f— JOB DESCRIPTION: REROOF REMOVE SHAKE INSTALL COMP 33 SQ CLASS A Sq. Ft Floor Area: I Valuation: $13500 APN Number: 36616065.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. ��_ f�`j� Issued by: Date: , (J RE- ROOFS: 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. Signature of Applicant: 7L Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE 1 have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous 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 the Health & Safety Code, Sections 25505, 25533, and 25534. Owner or au a ent: Date: 2- // _Z_ CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of Hork's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CUPERTINO REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • buildingOcugertino.org R ReroofApp_201 1. doc revised 03116111 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION FEE ID ROOF AREA s.f. 1REROOFFRES 3,300 ADDRESS: 7543 Donegal Dr. DATE: 12/10/2012 REVIEWED BY: jsg 1- i�>cli_ I'erruir F'ce: APN: BP #. *VALUATION: 1$13,500 *PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re -roof PRIMARY SFD or Duplex USE: I PENTAMATION 1SFDWLR00F I PERMIT TYPE: WORK Reroof, remove shake instal comp SCOPE Sit/)/)/, hiss Fee FEE ID ROOF AREA s.f. 1REROOFFRES 3,300 NOTE. This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District etc ). These tees are based on the oreliminary information available and are only an estimate. Contact the Dent for addn'1 info. FEE ITEMS (Fee Resolution 11 -053 Fff.' 711!12) Atc,h. 1 aij i'ht,(k PhoO). P11(m Chc( 11: f'If?C. i'(i1f? ChL'eli 1- i�>cli_ I'erruir F'ce: P,'ntr.b. F'c.ri7zi/ F`�:re: I;Icc. F'arxrit I c'e: 0,4 r ;llcc h. ( lbcr I'lrnnh Irtsp. 0//1,, l lec. My, Li 34"x11. h?75P. FCC : Pl tttn 17.; t 1ech. iI'l cc It?v -), Fce: NOTE. This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District etc ). These tees are based on the oreliminary information available and are only an estimate. Contact the Dent for addn'1 info. FEE ITEMS (Fee Resolution 11 -053 Fff.' 711!12) FEE QTY/FEET MISC ITEMS Plan C.'hec /c. FCC.* :Swill. PC FCc Pl tttn 17.; t 1ech. iI'l cc Permit Fee: $495.00 Sit/)/)/, hiss Fee Pltrtrtlr. %ilech.; Flee; f' /unth.i "alec h. %I'iec Permit Fc e: (.`onso-ltction .Tax: A(linhiistrative Fee: Work Without Permit? Yes (E) No $0.00 ,(,hate cd I'lannirr- FCC . 1 ral i l )ocionentaliol7 /'c cE N: Strong Motion Fee: IBSEISMICR $1.35 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $497.35 $0.00 TOTAL FEE: 1 $497.35 Revised: 10/01/2012 CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014 -3255 Telephone: 408 - 777 -3228 Fax: 408 - 777 -3333 JOB ADDRESS: g g Ocn ` f-- BUSINESS NAME PERMIT # OWNER'S NAME: A,.z PHONE # odr (o GENERAL CONTRACTOR: '�v t i(' BUSINESS LICENSE # ADDRESS: 1 r'-- C-4- CITY /ZIPCODE: S' ,,1 j e- GX- / 2 *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Please check applicable subcontractors and complete the following information: Date e4;�;a_ Owner / Contractor Signature Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile e4;�;a_ Owner / Contractor Signature Date