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12070098CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10140 BYRNE AVE CONTRACTOR: ZV CONSTRUCTION INC PERMIT NO: 12070098 OWNER'S NAME: MOUNTAIN VIEW, CA 94043 PHONE NO: (650) 213-6512 ❑ LICENSED CONTRACTOR'S DECLARATION License Class "I� Lic. # q% Contractor � tA(,T! pK� W I!iate 7L22QJJ2 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. 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 permit is issued. APPLICANT CERTIFICATION 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, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with al I non- urce r Iations per the Cupertino Municipal Code, Section 9.18. �. Signature Date ❑ NER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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. 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 permit is issued. 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 theWorker's Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 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, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with ail non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r— MECH r— RESIDENTIAL F COMMERCIAL r JOB DESCRIPTION: SFDWL DEMO 1,330 SQ FT Sq. Ft Floor Area: I Valuation: $3000 APN Number: 35716046.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Date RE -ROOFS: 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. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. f..�� I F774i , CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of Hork's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed c� �►� g y NM CITY OF C PERTINOI FEE ESTIMATOR - BUILDING DIVISION FEE ID FLR AREA s.f. 1DEMORES 1,330 ADDRESS: 10140 byrne ave DATE: REVIEWED BY: larry s 1'r�r, wf Fec APN:35-1 JU BP#: 'VALUATION: 1$3,000 PERMIT TYPE: Demolition Permit Pt;: [:1 CHECK TYPE: PRIMARY SFD or Duplex USE: Numb." -h ' PENTAMATION 1SFDWL-DEM PERMIT TYPE: WORK demolition of sfdwl-1330 sq ft SCOPE Suppl. Insp. Fee -.0 Reg. Q OT FEE ID FLR AREA s.f. 1DEMORES 1,330 NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on therelimina information available and are on ly an estimate. Contact the De t or addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff 7/1/11) Prov C'ht:rk P114111b. Picot) C 1" Ch:?ck 1'r�r, wf Fec Plumb 1',•rn=1t F. fi1tc. Per, ;;l r •, ch..lnslr 01h(T Plumblrr.V1Li U,.r-rElt'r.lrzsp, Numb." -h ' NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on therelimina information available and are on ly an estimate. Contact the De t or addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff 7/1/11) FEE QTYIFEE MISC ITEMS %J/. [ Numb." -h ' Permit Fee: $534.00 Suppl. Insp. Fee -.0 Reg. Q OT 0,0 hrs $0.00 1'l rrinl;.; ;l9t�c:•lr.!I�'le'c rSli7lC'tlCJYI iax. ,ldmilllsfo tipe FGe: 1,k,orl; 1'F'ithollt P� i'Yiili? 1dV(J0fc•(qf 1,141nning Fees: � Ircltic'I Drx•rnncrrtutir�n f��c's•: Strong; Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item Blde Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $535.501 $0.00 TOTAL FEE: $535.50 Revised: 07/01/2012