10060151CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10240 PHAR LAP DR
I' vNER'S NAME:
❑ LICENSED CONTRACTOR'S DECLARATION
License Class
Contractor
Lic. #
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.
Si "nature Date
CONTRACTOR: ARMSTRONG PERMIT NO: 10060151
INS7 ALLATION
4575 SAN PABLO AVE DATE ISSUED: 06/23/2010
EMLRYVILLE, CA 94608 PHONE NO: (510)777-1234
BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
MECH r RESIDENTIAL r COMMERCIAL
JOE DESCRIPTION: JOIST REPLACEMENT EXTERIOR WOOD DECK 2X2,10-12
IN
LEN, 3TH;DRYROT DAMAGE 4X4 AREA @GARAGE& DRYROT
DAN AGE @EXTER WALL @SUNROOM REPLACED W/PRESSURE
Sq. lit Floor Area:
APP Number: 32639026.00
Valuation: $2000
Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Isst ed by:
❑ OWNER -BUILDER DECLARATION I-
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
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.
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
the above mentioned property for inspection purposes. (We) agree to save
mify and keep harmless the City of Cupertino against liabilities, judgments,
c.....s, 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.
Date
Date:
RE -ROOFS:
All oofs shall be inspected prior to any roofing material being installed. If a roof is
inst:.11ed without first obtaining an inspection, I agree to remove all new materials for
inspection.
Sigr ature of Applicant:
Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I hs ve read the hazardous materials requirements under Chapter 6.95 of the
Cal.fornia Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Saf .-ty 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
He..lth & Safety Code, Sections 25505, 25533, and 25534.
Owner or authorized agent:
Date:
CONSTRUCTION LENDING AGENCY
I he reby affirm that there is a construction lending agency for the performance of work's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Leader's Address
ARCHITECT'S DECLARATION
I ur derstand my plans shall be used as public records.
Licensed Professional
CITY OF CUPERTINO BUILDING PERMIT I
BUILDING ADDRESS: 10240 PRAR LAP DRI CONTRACTOR: ARMSTRONG I PERMIT NO: 10060151 I
INSTALLATION
'1WNER'S NAME:
V LICENSED CONTRACTOR'S DEQCLARATION
License Class 3 -J{Lic. #-
Contractor
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. ( W\
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 so ce regulations per the upertino Municipal Code, Section
9.18. %
Signature
Dat4 3 ! G
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
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.
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
,on the above mentioned property for inspection purposes. (We) agree to save
iemnify and keep harmless the City of Cupertino against liabilities, judgments,
-osts, 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
45''5 SAN PABLO AVE
EMERYVILLE, CA 94608
DATE ISSUED: 06/23/2010
PHONE NO: (510)777-1234
JC B DESCRIPTION: RESIDENTIAL U COMMERCIAL
JOIST REPLACEMENT EXTERIOR WOOD DECK 2X2,10-12
IN
L':NGTH
Sc . Ft Floor Area:
Valuation: $2000
A'IN Number: 32639026.00 I Occupancy Type: I
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
I., sued Date:
RE -ROOFS:
A It roofs shall be inspected prior to any roofing material being installed. If a roof is
it stalled without first obtaining an inspection, I agree to remove all new materials for
inspection.
Signature of Appl
Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
F raintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
r raterial. Additionally, should I use equipment or devices which emit hazardous
s it contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cuper ' o Municipal Cog!, Chapter 9.12 and
the Health & Safety Code, Sections 5 , 25533, and 5
Owner or authorized agent: z�l6
CONSTRUCTION LENDING AGENCY
hereby affirm that there is a construction lending agency for the performance of
vork's for which this permit is issued (Sec. 3097, Civ C.)
,ender's Name
Lender's
ARCHITECT'S DECLARATION
[ understand my plans shall be used as public records.
Licensed Professional
CITY OF CL PERTINO
FF.F FISTIMATOR - BUILDING DIVISION
ATnTC. T,,tined , ., fho nraRminnry infarsnatian avail ahte and are anly an estimate. Contact the Dept for addn 7 info.
----------------
FEE ITEMS (Fee Resolution 09-051 Ef: 7'1/09)
ADDRESS: 10240 pharlap dr.
------
QTY/FEE
DATE: 06/23/2010
REVIEWED BY: building
APN:
BP#:
"VALUATION: $2,000
PERMIT TYPE: Minor Building Permit
PLAN CHECK TYPE: Re -roof
PRIMARY SFD or Duplex
USE:
TOTAL
ROOF AREA:
O
S .f
APPLICATION
TYPE:
w
rpolace one at Pxtermor wood
deck for SE
a o"
O�
ATnTC. T,,tined , ., fho nraRminnry infarsnatian avail ahte and are anly an estimate. Contact the Dept for addn 7 info.
----------------
FEE ITEMS (Fee Resolution 09-051 Ef: 7'1/09)
------------
FEE
------
QTY/FEE
MISC ITEMS
��l f
Permit Fee:
$0.0C
Work Without Permit? Q Yes No
$0.0(
Strong Motion Fee: IBSEISMICR
$0.50
2.0 hrs Standard Hourly Rate
$252.00
131d.T Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:,
$1.50
$252.00 TOTAL FEE:
$253.50
Revised: 5/27/2010