11070085I CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10215 ALHAMBRA AVE LOT I
OWNER'S NAME:
S DECLARATION
License Class6 -T Lic. N e D 2155
11//
Contractor �,r�A t2 eQT/{_ Date L
I hereby affirm that 1 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:
1. 1 have and will maintain a certificate of consent to sell' -insure for Workers
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
2 1 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
1 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 inspecti es. (We) agree to save
indemnify and keep harmless the City pertin ainst liabilities, judgments,
costs, and expenses which may e agains rd City in consequence of the
granting of this permit. tionally, th understands and will comply with
all non -point sourc Code, Section 9.18.
Signatur Date__��
9
1 hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
1. 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)
2. I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
1 hereby affirm under penalty of perjury one of the following three declarations:
1. 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.
2. 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.
3. I certify that in the performance of the work for which this permit is issued
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
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
all non -point source regulations per the Cupertino Municipal Code, Section 9.18.
CONTRACTOR: CALIFORNIA HOME PERMIT NO: 11070085
BUILDERS & DESIGN
1775 JUNCTION AVE DATE ISSUED: 07/14/2011
SAN JOSE, CA 95112 PHONE NO: (408) 392-8200
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
DEMOLISH ONE STORY HOUSE (1,084) AND DETACHED
GARAGE
(616)
Sq. Ft Floor Area: I Valuation: $7000
APN Number: 32623042.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued Date: 7—
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 Appli
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 1 store or handle hazardous material.
Additionally, should I use equip r devices which emit hazardous air
contaminants as defined aSetino
rea Air Quality Management District I will
maintain complia ith t:hs
Municipal Code, Chapter 9.12 and the
Health & S Code, Sec ' 25 5, 25533, and 25534.
or
f 14.,dl
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professiona
Signature Date
CITY OF CUPERTINO
FM-7 FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 10215 alhambra ave.
DATE: 07/14/2011
REVIEWED BY: bobs.
APN:
I BP#:
-VALUATION:
1$7,000
*PERMIT TYPE: Demolition Permit
PRIMARY SFD or Duplex
USE:
PENTAMATION 1SFDWL-DEM
PERMIT TYPE:
WORK
1 story sfd and detached garage.
�demo
SCOPE
FEE ID FLR AREA
(S.f.)
1DEMORES 1,700
NOTE.- These fees are hated on the nroliminary infnrmafinn availahlo and are nn1v an oviimato- 4-antart the Dent far addn 11 i"fn
FEE ITEMS (Fee Resolution 11-053 Eff 711111)
FEE
QTY/FEE7
MISC ITEMS
flif.,11 Check 1--ev:
Slem"L PC Fee
Permit Fee:
$523.00
Suppl. Insp. Fee4S Reg. 0 OT
1-0-.0-1
hrs
$0.00
Strong Motion Fee: IBSEISAffCR
$0.70
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
1
SUBTOTALS:
$524.701
$0.001 TOTAL FEE:
$524.70,
Revised: 07/04/2011