10110060CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19050 PRUNERIDGE AVE
CONTRACTOR: XL CONSTRUCTION
PERMIT NO: 10110060
OWNER'S NAME: APPLE
851 BUCKEYE CT
DATE ISSUED: 11/09/2010
OWNER'S PHONE: 6506284354
MILPITAS, CA 95035
PHONE NO:(408)271-242s
❑ LICENSED CONTRACTOR'S DECLARATION
r r r
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic.#
r r r
Contractor %�1i t�(�`-'� f ��� Date
MECH RESIDENTIAL COMMERCIAL
1 hereby affirm that 1 am licensed under the provisions of Chapter 9
JOB DESCRIPTION: FLR I & 2 - DEMOLITION & ASBESTOS ABATEMENT OF
(commencing with Section 7000) of Division 3 of the Business & Professions
EXISTING IST FLOOR & PARTIAL 2ND FLOOR (38,441 SQ)
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: $50000
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 w 'ch this
permit is issued.
APN Number: 31606033.00
Occupancy Type:
APPLICANT CERTIFICATION
certify that 1 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
PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs, and expenses which may accrue against said City in consequence of the
granting of this ermit A ditionally, the applicant understands and will comply
180 DAYS FROM LAST CALLED INSPECTION.
with all non -poi t so e r gulatio per the Cupertino Municipal Code, Section
9.18.
J�
b Date:
OIssued
�1Lq
Signature Date 11
❑ OWNER -BUILDER DECLARATION
RE -ROOFS -
All roofs shall be inspected prior to any roofing material being installed. If a roof is
I hereby affirm that I am exempt from the Contractor's License Law for one of
installed without first obtaining an inspection, I agree to remove all new materials for
the following two reasons:
inspection.
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,
Signature of Applicant: Date:
Business & Professions Code)
1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
1 hereby affirm under penalty of perjury one of the following three
declarations:
HAZARDOUS MATERIALS DISCLOSURE
1 have and will maintain a Certificate of Consent to self -insure for Worker's
I have read the hazardous materials requirements under Chapter 6.95 of the
Compensation, as provided for by Section 3700 of the Labor Code, for the
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain
performance of the work for which this permit is issued.
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
1 have and will maintain Worker's Compensation Insurance, as provided for by
Safety Code, Section 25532(s) should 1 store or handle hazardous material.
Section 3700 of the Labor Code, for the performance of the work for which this
Additionally, should I use equipment or devices which emit hazardous air
permit is issued.
contaminants as defined by the Bay Area Air Quality Management District 1 will
-ance
maintain com with the Cupertino Municipal Code, Chapter 9.12 and the
I certify that in the performance of the work for which this permit is issued, 1 shall
Health Saf ty ode, Sections 25505, 25533, and 25534.
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
Owner isu rued a e
become subject to the Worker's Compensation provisions of the Labor Code, l must
Date:
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION
I hereby affirm that there is a construction lending agency for the performance of work's
1 certify that I have read this application and state that the above information is
for which this permit is issued (Sec. 3097, Civ C.)
correct. I agree to comply with all city and county ordinances and state laws relating
Lender's Name
to building construction, and hereby authorize representatives of this city to enter
'upon the above mentioned property for inspection purposes. (We) agree to save
Lender's Address
pdemnify and keep harmless the City of Cupertino against liabilities, judgments,
1sts, and expenses which may accrue against said City in consequence of the
"Ling of this permit. Additionally, the applicant understands and will comply
ARCHITECTS DECLARATION
% all non -point source regulations per the Cupertino Municipal Code, Section
1 understand my plans shall be used as public records.
Licensed Professional
tore Date
DEMOLITION
FM-7
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 19050 pruneridge ave.
DATE: 11/09/2010
REVIEWED BY:
APN:
BP#:
*VALUATION: 1$50,000
*PERMIT TYPE: Demolition Permit
Pt, fN CI / CK TYPE
PRIMARY Commercial Building
USE:
PENTAMATION 1COMMLDEM
PERMIT TYPE:
WORK
SCOPE
FEE ID FLR AREA
s.f.
1 DEMOCOM 38,44.1
.Tech. pion(",' ;;
,.:. h'ir ( heck
ie . Plon Check
_Ltrch. Pr; .ei! Fee:
�.;. i F cc:
a:h t.. P�;13at i .
Orlrer arech. lrec�z
Orhe'r• Phu.. �;. ;,.
O/luor f ln. 11nsp
DzsP. Pee:
f'hrnYi,. h.,F,. 1-ec.
Is'!t'r Imp. Pcc.
NOTE. These fees are based on the Preliminary information available and are only an estimate. Contact the Dept for addn'1 info.
FEE ITEMS (Fee Resolution 09-051 E . 711110)
FEE
QTY/FEE
MISC ITEMS
Plun Check Fee:
,S'uppl. PC .Fere
Plznnb.idfech./Elec Plan Check:
Permit Fee:
$3,543.00
Suppl. Insp. Fee10 Reg. 0 OT
FO.0 1
hrs
$0.00
Plumb./1lec�lz./Flee Unit Fee:
Plumh.%Mee h./Flee Permi7
Cons [tctlon lax
Acousrcul fle vices Fee:
[G"ork t 'ithout Pernzir'
Plunninr Fees:
Travel Docrunentazion Fees:
Strong Motion Fee: IBSEISMICO
$10.50
Select an Administrative Item
Bldy_ Stds Commission Fee: IBCBSC
$2.00
SUfffOTALS:
$3,555.50
$0.00 TOTAL FEE:
$3555.50
Revised: 11108/2010