15030049 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10585 FLORA VISTA AVE CONTRACTOR:UNIK HOMES INC PERMIT NO: 15030049
OWNER'S NAME: RANGASWAMY GOPI K AND NAGARAJ SUSHM 15185 ALONDRA LN DATE ISSUED:03/09/2015
OWNER'S PHONE: 3108490146 SARATOGA,CA 95070 PHONE NO:(650)240-8483
10 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL E]
SFDWL DEMO; 1458 SQ FT ;ATTACHED GARAGE 600 SQ
License Class Lic.4 FT
Contractor VA(k_ { T2L S Date ?, T,l S�
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
e ormance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$12000
ave 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:32608028.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct. 1 agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building 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 T CALLED INSPECTION.
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 Issued by: Da
with all non-point source regu do er the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature DateAll 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.
❑ WNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date:
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,
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 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. I will
I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous
I have and will maintain aCertificate 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
performance of the work for which this permit is issued, will maintain compliance with the Cupertino 4unicipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code Sections 25505,25
Section 3700 of the Labor Code,for the performance of the work for which this
Owner or authorized agent: Dater
permit is issued.
I certify that in the performance of the work for which this permit is issued,1 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,1 CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must 1 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(Sec.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
indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION
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
9.18.
Signature Date
CITY OF CUPERTINO D
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10585 flora vista ave DATE: 03/09/2015 REVIEWED BY: Mendez
APN. BP#: 'VALUATION: 1$12,000
PERMIT TYPE: Demolition Permit
PRIMARY SFD or Duplex PENTAMATION 1 SFDWL-DEM
USE: PERMIT TYPE:
WORK sfdwl demo; 1458 sq ft ; attached garage 600 sq ft
SCOPE
FEE ID FLR AREA
s.f.
1DEMORES 2,158
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.). Theseees are based on the prelimina information available and are only an estimate. Contact the De t or addn'1 info.
FEE ITEMS (Fee Resolution 11-053 E : 711,113) FEE QTY/FEE MISC ITEMS
Permit Fee: $574.00
Suppl. Insp. Fee-0 Reg. Q OT Q Q hrs $0.00
j r
i
c)t t .E. f.
,
Strong Motion Fee: IBSEISMICR $1.56 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $576.56 $0.00 TOTAL FEE: 1 $576.56
Revised: 02/14/2015