11020026CITY OF CUPERTINO BUILDING PERMIT I
BUILDING ADDRESS: 20557 BLOSSOM LN CONTRACTOR: RYAN HU PERMIT NO: 11020026
OWNER'S NAME:
SAN MATEO, CA 94401 PHONE NO: (650)343-8038
1-1 LICANSED CONTRACTOR'S DECLARATI$2N
License Class 15' Lie. # 7 I(?r— � — 76,
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 folcyv
Section 3700 of the Labor Code, for the performance of die work for which this
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above infbrmatiaei�
correct. I agree to comply with all city and county ordinances and state laws re ing
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-p� . � Cupertino Municipal Code, Section
9.18.
zTA
Signature Date
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)
1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sce.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
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
BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
MECH r RE' SIDENTIAL r COMMERCIAL r
JOB DESCRIPTION: DEMO OF SFDWL (930SQFT-APPX)
Sq. Ft Floor Area: I Valuation: $15000
APN Number: 35918033.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
. ----7 -- Date:e�p'—,,--) 2-1/
Issued It
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: . Date:
ALL ROOF COVE' RINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements tinder Chapter 6.95 of the
California Health &Safety Code, Sections 25505,25533, and 25534. 1willmaintain
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 & Safe"cle, Section 505,25533,aiid2553
0
CONSTRUCTION LENDING AGENCY
I hercky, affirm that there is a construction lending agency for the performance of NNork'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
DEMOLITION
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
imADDRESS:
20557 Blossom Ln
DATE: 02/07/2011
REVIEWED BY: RDW
IJI'lech. permilue(",
APN:
I BP#:
VALUATION:
1$15,000
*PERMIT TYPE: Demolition Permit
PIAN (-,'11E0\'7-)'PE:
PRIMARY SFD or Duplex
USE:
I Elec. 111sp, Fce:
PENTAMATION 1 SFDWL-DEM
PERMIT TYPE:
WORK
$507.00
SCOPE
1 —0,01
FEE ID FLR AREA
(S.f.)
1DEMORES 930
NrOTF.- These fees are hased on the Preliminary information available and are onlv an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Lee Resolution 09-05��
,kfe0i, Plan
P11110), P/a/1 Chcc/�
Elcc� Mai? Chcch-
IJI'lech. permilue(",
I plumb. pomil rce:
-L-
I Flcc' Permit
Other,lkch. lr�sp.
0/ho, PhImb lav�. F-1
0/her Elec layl), Li
Aleck fay, Fce:
Plumb, lay, Fcc:
I Elec. 111sp, Fce:
NrOTF.- These fees are hased on the Preliminary information available and are onlv an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Lee Resolution 09-05��
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee.-
A
Suppl, PC'Fec
phollb.1114ec-11.1r"Iec P/c/11 Chec/".,
Permit Fee:
$507.00
Suppl. Insp. Fee.0 Reg. 0 OT
1 —0,01
hrs
$0.00
Ph1mh.A1J(-ch.1E1e(,, UnilFec.-
P111mb.1"IlleclUE, Iec powlifuec.-
Coiislrticlion Tax
Acouslical RcNeiv Fee:
[,V(,)I-k [Filhout Permil?
Plonnina Fecs:
A
Travel Docionenlolion Fees:
Strong Motion Fee: IBSEISMCR
$1.50
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$509.50
$0.001 TOTAL FEE-
F $509.50
Revised: 01/15/2011