14100090CITY OF CUPER'TINO BUILDING PERMIT
BI;ILDING ADDRESS: 21061 GARDENA DR
CONTRACTOR: HOMESTEAD PERMIT NO: 14100090
CONSTRUCTION INC
OWNER'S NAME: KALIYAPOR.UMAL MUTT IU AND KOTHANDAP
10080 STERN AVE DATE ISSUED: 10115/2014
OWNER'S PHONE: 4086463286
CUPERTINO, CA 95014 PHONE NO: (408) 255-8999
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
DEMO (E) SFD,1,259 S.F TOTAL
License Class Lic.#_
is �I G i 0-,,n
Contractor H Date--i-44S;4-34
I lrereby affirm that I am licensed trader 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 haveand 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
Sq. Ft Floor Area:
Valuation: $7000
performance of the work for which this permit is issued
1 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: 32608085.00
Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I ecrtify 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 pudding construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
180 DAYS F_IWWItAS--T ED INSPE
inc.emnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
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s Date; ��
gre,rating ofthis permit. Additionally, the applicant understands and will comply
withq all non -point source regulations per 14 Cupertino Municipal Code, Section
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RE -ROOFS:
Signature Date
All roofs shall be inspected prior to any roofing material being installed. if a roof is
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installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
OWNER -BUILDER DECLARATION
Signature of Applic ant:____ Date: _
1 I hereby affirm that I arra exempt from the Contractor's License Law for one of
the: following two reasons:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
1, as owner of the property, or my employees with wages as their sole compensation,
wiiI 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
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 912 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. Additionally, should I use equipment or devices which emit hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the
air contaminants as defined by the Bay Area Air Quality Management District I
pes for-mance of the work for which this permit is issued,
will maintain compliance with the Cupertino Municipal Code. Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sections 2S O5, 2553a—,A rd 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
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Owner or authorized agenS
pemut =s issued
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I c;crtify 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 (Sea 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
9.i8.
Signature Date
DEMOLITION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
ct I IFEKT040 (408) 777-3228 - FAX (408) 777-3333 - building QcuI2Qjino.oW
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OWNER A(iFNr CANTRACTOR 1-1 CONTRACTOR AGENT Cl ARCIUTECT
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DemoApp_X13, doe revised 02113113
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0 IL
CITY OF CUPERTINO
wwv FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 21061 GARDENA DR
DATE: 10/1612014
REVIEWED BY: MELISSA
APN: 326 08 085
BP#: 13120036
*VALUATION:
TERMITTYPE: Demolition Permit
El
PRIMARY SFD or Duplex
USE:
L
PENTANIATION 1SFDWL-DEM
PERMIT TYPE:
DEMO (E) SFD, 1,259 S.F TOTAL
IWORK
SCOPE
$574.00
FEE ID LR AREA ! (S.f.) —
A IDEMORES 1,259
YVOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
Distri.r.t. etc )- These fees are haled on the nrelindnary information available and are onlv an estimate. Contact the Dent for addu 11 info.
FEE ITEMS o 3)
L�AJL �-TYU-4��L -
FEE
QTY/FE
MISC ITEMS
-7
El
Ll
YVOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
Distri.r.t. etc )- These fees are haled on the nrelindnary information available and are onlv an estimate. Contact the Dent for addu 11 info.
FEE ITEMS o 3)
L�AJL �-TYU-4��L -
FEE
QTY/FE
MISC ITEMS
-7
Permit Fee:
$574.00
Suppl. Insp. Fee -0 Reg. 0
irs
WOO
0 A
Pern"'i't Fee'.
Strong Motion Fee: IBSEISMICR
$0.91
Select an Administrative Item
31da Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$575.91,
$0.00 TOTAL FEE:
$575:.91
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Revised: 08/2012014