13100141 C1<TY OF CUP1E]L87I INO BUR JING PERMIT
BUILDING ADDRESS: 18651 CYNTHIA AVE CONTRACTOR:CINDY SUEHUI PERMIT NO: 13100141
OWNER'S NAME: CINDY SUEHUI 10551 JOHANSEN DR DATE ISSUED: 10/22/2013
OWNER'S PHONE: 4088938007 CUPERTINO,CA 95014 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL O COMMERCIAL
License Class Lic.# DEMOLISH()E)1,150 S.F.S FIID(IBP#13080144)
Contractor Date
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:$11000
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:37523004.00 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 FORK IS NOT STARTED
ESD
correct.I agree to comply with all city and county ordinances and state laws relating WITMN 180 DA 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 AILILIE�D 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 II Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
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,I 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
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
tom+ construct the project(Sec.7044,Business&Professions Code). 1 have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. I will
1 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(x)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
performance 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 25505,2553 ,and 25534. E
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Owner or authorized agent ^ Dater
/ 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,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 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
9.18. /J r
Signature 1ADate (O 1Z l3
cCl[' Y OF cCUPER'�M D
FEE IESTMATOR— BUILDING DIVISION
A®®KESS: 98659 CY�TC�VA A!!E DATE: 110122120113 REVIEWEID BY: MELISSA
APN: 375 23 004 1BP#: I *VALUATION: 1$11,000
*PERMIT TYPE: Demolition Permit PIAN CHECK TYPE:
PRIMARY SFD or Duplex PENTAMATION 1SFDWL-DEM
USE: PERMIT TYPE:
FS
oRK DEMOLISH E 1150 S.F. SFD BP# 13080144COPE
FEE ID IF�,R AREA
s.ff.
1 DEMORES 1,150
Mech. flan Check Plrrnrb. Plan Check Elec.—Plan Check
iikch. Permit Fee: Plumb. Permit Fee: Elec.Permit Fee:
Other Afech.Imp. Other Plumb In.T. Usher Elec.Insp.
.11ech. hzsp.Fie: Plumb. hrsp.Fee: Elea.Insp.Fe' e:
NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). TheseLees are based on the prelimmina information available and are onl an estimate. Contact the De t or addn 7 info.
FEE ITEMS (Fee Resolution 11-053 EJf 7/1/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
S'uppl, PC Fee
Plumb.i"lVlech./Elec
Permit Fee: $557.00
Suppl. Insp. Fee:E) Reg. ® OT Q Q hrs $0.00
Phnnh.111ech./Elec
Plumb.IiWech./Elec Permit Fee:
Construction Tar:
Adtninis trati ve.Fee:
ff,'ork Without Permit?
Aelvewwed Planning Fees:
Travel Documentation Fees:
Strong Motion Fee: IBSEISMICR $1.10 Select an.Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $559.10 $0.00 TOTAL FEE: $559.10
Revised: 10/01/2013