10080099 CITY OF CUPERTINO BUILDING PERMIT
tUILDING ADDRESS: 10650 S DE ANZA BLVD
PCONTRAICTOR: PERMIT NO: 10080099
tDATE ISSUED:08/16/2010
)WNER'S NAME: BYER PROPERTIES i�C1�h-c�-' PHONE NO:
ER'S PHONE: 4156267844
] LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
.icense Class �� Lic.# -Z Ai 1—� / MECH r RESIDENTIAL r COMMERCIAL r
'ontractor/ D b ��Ih wt �(/r�/'dK Date (- /10
JOB DE SCRIPTION:REPAIR APPROX 30LF OF DRYROT EXTERIOR WALL,
[hereby affirm that I am licensed under the provisions of Chapter 9 BASE
;commencing with Section 7000)of Division 3 of the Business&Professions OF WALI UP TO 4'INCLUDES DEMO OF EXTERIOR STUCCO,
Code and that my license is in full force and effect. PLYWOOD REPLACEMENT
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 t Sq Ft FI)or Area: Valuation:$20000
permit is issued.
APPLICANT CERTIFICATION arc Occu Type:
I certify that I have read this application and state that the above information is APN Nu nber:36937027.00 P Y
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, PERMIT EXPIRES IF WORK IS NOT STARTED
costs,and expenses which may accrue against said City in consequence of the
W[THIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,the applicant understands and will comply
with all non-poi)7
regulations per the Cupertino Municipal Code,Section 181) DAYS FROM LAST CALLED INSPECTION.
9.18.
U Date: OPl�jo
Signature Date G /O Issued �y'
V OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS:
the following two reasons: All roof;shall be inspected prior to any roofing material being installed.If a roof is
I,as owner of the property,or my employees with wages as their sole compensation, installer without first obtaining an inspection,I agree to remove all new materials for
will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection.
Business&Professions Code) Signatu'e of Applicant: Date:
I,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
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 HAZARDOUS MATERIALS DISCLOSURE
Compensation,as provided for by Section 3700 of the Labor Code,for the
I have -ead the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued.
California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compli ince with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material.
permit is issued. Additionally,should I use equipment or devices which emit hazardous air
I certify that in the performance of the work for which this permit is issued,I shall contan dnants as defined by the Bay Area Air Quality Management District I will
not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Compensation laws of California. If,after making this certificate of exemption,I
Health&Safety Code,Sections 25505,25533,and 25534.
become subject to the Worker's Compensation provisions of the Labor Code,I must Owner or authorized agent:
forthwith comply with such provisions or this permit shall be deemed revoked. Date:
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is
I heret y a
correct.I agree to comply with all city and county ordinances and state laws relating affirm that there is a construction lending agency for the performance of work's
for this permit is issued(Sec.3097,Civ C.)
to building construction,and hereby authorize representatives of this city to enter e is Name
upon the above mentioned property for inspection purposes.(We)agree to save Lender's
unify and keep harmless the City of Cupertino against liabilities,judgments, Lende is Address
,and expenses which may accrue against said City in consequence of the
&canting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section AR ECT'S DECLARATION
9.18.
I understand my plans shall b u as ub is r
Signature Date
Licen.ed Professional
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING D►IVISICnEMOLITION
ADDRESS: DATE: REVIEWED BY:
APN: BP#: 'VALUATION: $20,000
*PERMIT TYPE: Demolition Permit 1'1,:1` (.'!h J K !`t: '
PRIMARY Commercial Building APPLICATION 1COMMLDEM
USE: TYPE:
WORK
SCOPE
FEE ID FLR AREA,
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1 DEMOCOM 1
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NOTE: Thesefees are based on the preliminary in ormation availab to and are only an estimate. Contact the De t or ad n'1 info,
FEE ITEMS(Fee Resolution 09-051 E 7'L,70) FEE QTY/FEE MISC ITEMS
.
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supp1. PC 1"CIC
1,11110), `.Afech. flan CI'cuk:
Permit Fee: $507.00
Suppl. Insp. Fee.0 Reg. Cl OT 0.0 hrs $0.00
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li-o cl 1)i,Ctl/F7unlotior? Fces:
Strong Motion Fee: IBSEISMICO $4.20 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
H +
„y �B $512.20 $0.00
p C Q;512.20
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Revised: 8/12/2010