13110171 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10661 CARVER DR CONTRACTOR:RICCARDO FORLEO& PERMIT NO: 13110171
DOROTHY LIN
OWNER'S NAME: RICCARDO FORLEO&DOROTHY LIN 10661 CARVER DR DATE ISSUED: 11/26/2013
OWNER'S PHONE: 4088288426 CUPERTINO,CA 95014 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL
License Class Lic.# SFDWL DEMO LIVING(1213)DETACHED GARAGE(210)
SQ
Contractor Date FT TOTAL
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. Sq.Ft Floor Area: Valuation:$3000
l 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:37534050.00 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.I agree to comply with all city and county ordinances and state laws relating WITffiN 80 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 DAY F M LAST 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: Date:l�.0
with all non-point source regulations per the Cupertino Municipal Code,Section ra
9.18.
RE-ROOFS:
Signature Date All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed without first obtaining an inspection,l agree to remove all new materials for
inspection.
OWNER-BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I,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 ,Chapter 9.12 and the
declarations: Health&Safety Code,Section 25532(a)should I st e o handle hazardous
1 have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipme vi es which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined bythe ay A it u ty Management District I
performance of the work for which this permit is issued. will maintain compliance with upe n M n' al Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sec on 25 53 nd 25534.
Section 3700 of the Labor Code,for the performance of the work for which this t.7 —
permit is issued. /
Owner or authorized agent: Date:
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 CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,l must I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall he 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 prop for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION
indemnify and keep harmless e Ci of Cupertino against liabilities,judgments,
costs,and expenses which m acc against said City in consequence of the I understand my plans shall be used as public records.
granting of this ermit.Addi onall ,the applicant understands and will comply
with all non- t source re to s per the Cupertino Municipal Code,Section Licensed Professional
9.18. 7
Signature r Date//` C
CITY OF CUPERTINO D
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 10661 carver dr DATE: 1112612013 REVIEWED BY: Mendez
APN: BP#: 'VALUATION: 1$3,000
*PERMIT TYPE: Demolition Permit
PRIMARY SFD or Duplex PENTAMATION 1SFDWL-DEM
USE: PERMIT TYPE:
WORK sfdwl demo living 1213 detached garage 210 sq ft total
SCOPE
FEE ID FLR AREA
s.f.
1 DEMORES 1,423
Li
"NjeHf_ _
NOTE: This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). These ees are based on the relimina in ormation available and are onl an estimate Contact the De t or addn'l in o.
FEE ITEMS (Fee Resolution 11-053 Eff LL113J FEE QTY/FEE MISC ITEMS
Permit Fee: $557.00
Suppl. Insp. Fee-.0 Reg. Q OTFO-01hrs $0.00
f'hrl,il).;1 Ie'Ci;•.'1�'1ec
Strong Motion Fee: IBSEZSMICR $0.50 Select an Administrative Item
Bldp-Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $558.50 $0.00 TOTAL FEES $558.50
Revised: 10/01/2013