15030176 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10893 WILKINSON AVE CONTRACTOR:R E ROOFING& PERMIT NO: 15030176
CONSTRUCTION INC
OWNER'S NAME:
SAN JOSE,CA 95124 PHONE NO:(408)626-9320
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL E]
TEAR OFF(E)WOOD SHAKE,INSTALL(N)30#FELT OVER
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. Sq.Ft Floor Area: Valuation:$13000
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:35613025 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 FROM LAST ALLED 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 ?f Z 1
grant'
2 ` / AI
Date:
the following two reasons: VERINGS TO BE CLASS"A"OR BETTER
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)
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. 1 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. 'tionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air c
Date 7
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 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
918.
Signature Date
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 10893 WILKINSON AVE DATE: 03/27/2015 REVIEWED BY: MELISSA
APN: 356 13 025 BP#: *VALUATION: 1$13,000
*PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Duplex PENTAMATION 1SFDWLR00F
USE: PERMIT TYPE:
WORK TEAR OFF E WOOD SHAKE INSTALL N 30#FELT OVER E PLY & N COMP CLASS A ROOF
SCOPE SYSTEM (23 SQ'S)
FEE ID ROOF AREA
s.f.
1REROOFFRES 2,300
v
.•'
Mech. Plan(.'heck Phimb. Plaut Check IJea Plan(.`heck
aleclt. Permit Fee: Plumb. Permit fee: I Islec. Permit Fee
Ocher AJech. 1nsp. Other Plumb Insp. Other 1,lec.Insp.
Werth. Insp. Fee: Plumb. hzsp. Fee: 151ec°.Insp. Fee:
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). Thesefees are based on the prelimina information available and are only an estimate. Contact the De t or addn'1 info.
FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13) FEE QTY/FEE MISC ITEMS
Plan C'hec'k Fee:
Suppl. .P(_'Fee
1'larrnb.,%.:1 tech.i:I'Zer�
Permit Fee: $391.00
uppl. Insp Fee
Phlmh '1lecJr.;lilez'
1'JrrtrrZr.:-L1<ch.!1"le£° Per snit Fee:
Construction Tax:
A(llniniStrative Fee:
Work Without Permit? ®Yes (j) No $0.00
A(.1vanee d Planning Fees:
TrUvel Documentation Fees:
Strong Motion Fee: IBSEISMICR $1.69 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
$393.69 $0.00101, rnOT FEE: $393.69
Revised: 02/14/2015