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090400483omZ Op ogZ n=Z z� ;a O 'm O 0z 7 C a W? �z UC wF O 9L Uz CITY OF CUPERTINO y>; BUILDING DIVISION PERMIT dl'Y Lill a lf) BUILDING ADDRESS: PERMIT NO. 22641 ALCALDE RD ACE DEM OWNER'S NAME: PERMrr ISSUE DATE PHOi�ASHIEDI!PERPRISESNOVA' 2889 CONTROL NO. (408) 871-3366 ARCHrIECT/ENGINEER. BUILDINO PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is In full font and =, I & HOUSE & GARAGE DEMO (1.7 0 0 SQ ) Date ccoo�tIncmr Q�� * *4 / 8 / 9 CONTRACTOR, ACE DEMO&HAULING r PD FOR BSL ARCHITECTS DECLARATION 1 understand my plats shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractors License Law for the following mason (Section 70313, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demol-sh, or repair any structure ' prior to is issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 Sq. Ft. Floor Area Valuation (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption Any violation of 17 0 0 APN Number Occupancy P Y Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (Ss00). 34229036.00 ❑ L as owner of the property, or my employees with wages as thew sole compensation, Required Inspections will do the work and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Conuactoes License Law does not apply to an owner of property who build& or Improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale If, however, the building or Improvement is sold within one year of completion, the owner - builder will have the burden of proving that he did not build or Improve for purpose of sale.). ❑ I, as owner of the property, am exclusively contracting with licensed contractor; to construct the project (Sec. 7044, Business and Professions Code:) The Contractors L1- cense Law does not apply to an owner of property who builds or Improves thereon, and. who contracts for such projects with a contractor(s) licensed pursuant to the Contractors License Law. ❑ I am exempt under Sec , B & P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations ❑ I have and will maintain a Certificate of Consent to self-Insum for Workers Compen- sation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is Lssrud- ❑ f have and will maintain Workers Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is Issued My Workers pmpensation low rana carrier and Policy num erri/e��//� 1� Cartier. Policy No.: ` — —( �� CERTIFICATE OWEXEMFIION FROM WORKERS' COMPENSATION INSURANCE C1 his section need not be compkicd if the permit is for one hundred dollars ($100) or Icss.) 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 Workers' Compensation Laws of California. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is issued (See. 3097. Civ. C.) Lenders Name Lenders Address I certify that 1 have read this application and state that the above information Is ' correct 1 agree to comply with all city and county ordinances and state laws relating to building construction, and hereby wthoria representatives of this city to enter upon the above-mendoned property for Inspection purposes (We) agree to save, Indemnify and keep l umles the City of Cupertino against liabilities, judgments. costs and expenses which may in any way accrue against said City in consequence of the grunting of this permiL APPLICANT ANDS A WI COMPLY WITH ALL NON -PO N-r Issued by: Date %— 2 yr SOURCE '10 Re -roofs — Sign of AIica.Tt1ConMacuTr Da HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code. Chapter 9.12. and the Health and Safety 25s3z(a)7 Code, Section0Yes ❑Yes All roofs shall be inspected prior to any roofing material being installed. ,�70 If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building occupant use equipment PP g P q pment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. mwict7 ❑Yee R('No . lb aw read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Hcalth do Safety Codc, Sections 255a5, 25533 and 25534.1 understand that if time building does not curreak have a tenant, d t It my responsibility m notify the occupant of the requirem h I c met -a Certificate of Occupancy. G� Signature of Applicant Date All roof coverings to be Class " a' or better g Date ' or wtho agent DEMOLITION CITY OF CUPERTINO MM-7, FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 22641 alcalde rd. DATE: 11/17/2010 APN: #: l CqC-k:� 4 REVIEWED BY: building *VALUATION: j$10,000 -PERMIT TYPE: Demolition Permit PL,1N CHECK TYPF': PRIMARY SFD or Duplex USE: PENTAMATION 1SFDWL-DEM PERMIT TYPE: WORK SCOPE FEE ID FLR AREA s.f. 1 DEMORES 1,700 Xkdi. Plan Check F111ai. Permit Fee., otlier Mech. Insp. - Vkt h. troop. Fae: Phrm10. Plan Owl b P wnh. Pr,; -mil rce.- 0,11wr Plumb Imp.Lj I Plumb. Li'lec. Plan. Check Flac. Per?'' 1 ;% Other Elec- In p. Ll Etc(. L•rsp, Fcc- NOTE: These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addh7 info. FEE ITEMS (Fee Resolution 09-051 E . 711110) FEE QTYIFEE MISC ITEMS Plan Check Fee: Stipp/. PCIce Plvmh./Mech./Flcc: Plan Cheek: Permit Fee: $507.00 Suppl. Insp. Fee-0 Reg. 0 OT FO.0 I hrs $0.00 Plumh./M ch.;7:1ec Unit Fee: Plumh.lHech./Elec Permit Fee: Construction Tax Acoustical Review Fee: Rork Without Permit? Plcmnind Fees: I Travel Doctunenlation Feees: Strom Motion Fee: IBSEISMICR $1.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $509.00 $0.00 TOTAL FEE: $509.00 Revised: 11 /08/2010