13010019 CITY OF CUP ERTINO BUILDING PERMIT
BUILDING ADDRESS:.10 159 S BLANEY AVE CONTRACTOR ;jG, PERMIT NO: 130100.19
OWNER'S NAME: LAKE BILTMORE APARTMENTS �� S dLyb DATE ISSUED:03/27/2013
OWNER'S PHONE: 6509313457: Rx'. . (� PHONE NG:Z1505— ;�-",
❑ ]LICENSED CONT'RACTOR'S DECLARA'T'ION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIALE]
License Class Lic.# DEMO FOR GARAGE(S)ADJACENT TO VACANT]LOT
Contractor Date
T 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:$3000
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this APN Number:36903008.10159 Occupancy Type:
permit is issued.
.APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating W)«]ECI<N ®DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DA lF OM LAST CALLED ][N�1PlE TffON.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the l
granting of this permit. Additionally,the applicant understands and will comply Issued by: Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Sig ture Date All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date:
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.9$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 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 t ay Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance wit th pertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Se tic is 05,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
Owner or authorized agent: Date:
permit is issued.
I certify that in the performance of the work for which this permit is issued,l 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(Sec.3097,Civ C.)
Lender's Name
APPLICANT CERT'IFICAT'ION 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 hanvless the City of Cupertino against liabilities,judgments,
costs,and expe es which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of thi it.Additionally,the applicant understands and will comply
with all no -p ' ource regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature d ° Date A
MY OF cCUP ERTINO
FEE IE��IIvIA�OIB—ISI RLDIN G DIVISION
ADDRESS: 1.0155 s Blaney DATE: _j REVIEWER)BY:
APN: ]BP#: /-00/00/
*VALUATION: $3,000
*?ERMIT IITPE: Demolition Permit PIAN CHECK TYPE:
?RIIlM[A Y PENTAN ATION
IIISI Commercial Building PEYtMIIT TYPE: 1COMMLDEM
VORK
SCOPE
FEE RD
AREA
s.f
1DEMOCOM 1,700
hlec:h Plan Check Phunb. Plan Cheek Elec.Plan(:'heck
Mech. Permit Fee: Plumb.Permit Fee: lilec. Permit Pee:
Other Mech.Insp. Other Plumb Insp. Other Elec.Insp. Ll
.1Lech.Insp. Fee: Phmrb. Insp. fee: Elee.Insp.Fee:
NOTE: This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,eta). These fees are based on the prelimina information available and are onl an estimate, Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 11-053 Ef'. 7/1/12) FEE QTY/FEE MISC ITEMS
Am free,
Suppl.PC.Fee
Phvnb./Hech./E1ec
Permit Fee: $534.00
Suppl. Insp, Feeia Reg. 00 0 0 hrs $0.00
Plumb.111ecfi./Elec
Plum.h,/t�fech,/I;lee Permit Fee:
Construction TON
Administrative.Fee:
Work WithoutPerrnit?
Advanced Planning Fees:
T ravel Documentration Fees:
:Strong Motion Fee: IBSEISMICO $0.63 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $535.63 $0.00 TOTAL FEE: $535.63
Revised: 10/01/2012