11060075CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10485 STERLING BLVD
OWNER'S
❑ LICENSED CONTRACTOR'S DECLARATION
License Class a Lie. 4 / 0 R1 } `Z
Contractor �lc�S Pc�s�'o„ 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.
l 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
__��
❑ 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)
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
1 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
, and 25534.
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
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
Date
DEMOLITION
CITY OF CUPERTINO
WN FEE ESTIMATOR — BUILDING DIVISION
191
ADDRESS: 10485 sterling blvd.
I DATE: 06/10/2011
REVIEWED BY: bobs.
APN:
I BP4:
'VALUATION: 1$7,000
71
*PERMIT TYPE: Demolition Permit
PRIMARY SFD or Duplex
USE:
PENTAMATION 1 SFDWL-DEM
PERMIT TYPE:
WORK
o 1 storV and shed.
SCOPE ��
FEE ID FLR AREA
(s.f.)
1DEMORES 800
IVOTF-- These foov are ha -cod an the nroliminary inlarmafinn availahip and are only an ovdinato- Cnntart the Dent for addnl info_
FEEITEMS (Fee Resolution 09-051 Eff 711110)
FEE
QTY/FEE
MISC ITEMS
Plan
�,'Ijppt, PC i. "?c
Choc.,
Permit Fee:
$507.00
Suppl. Insp. Fee-0 Reg. OT
0.0
hrs
$0.00
llcovsric,al R(,vii!w Fee:
Work f:', Permai,','
Stroniz Motion Fee: IBSEISAHCR
$0.70
Select an Administrative Item
—1
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$508.701
$0.00 TOTAL FEE.
$508.70
Revised: 04/29/2011