13020050CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22750 STEVENS CREEK BLVD
CONTRACTOR: UPPAL CONSTRUCTION
PERMIT NO: 13020050
CO
OWNER'S. NAME:
MILPITAS, CA 95035
PHONE NO: (408) 507-6750
JOB DESCRIPTION: RESIDENTIAL COMMERCIALS
LICENSED CONTRACTOR'S DECLARATION
# OcI52 q�
**1650 SF DEMO**COMPLETE DEMOLISION (E) HOUSE
License Class Lic.
(BUILDING PERMIT # 12100214)
Contractor
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 udder penalty of perjury one of the following two declarations:
1 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
Valuation: $10000
performance of the work. for which this permit is. issued.
Sq. Ft Floor Area:
I have and will maintain Worker.'s Compensation Insurance, as provided for by
APN Number: 34214026.00
Occupancy Type:
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
PERMIT EXPIRES IF WORK IS NOT STARTED
correct, I agree to comply With all city and county ordinances and state laws relating
WITHIN 180 D 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 AST CALLED 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
-
Date:
granting of this permit:. Additionally, the applicant understands and will comply
s ed by:
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
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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
HAZARDOUS MATERIALS DISCLOSURE
construct the project (Sec.7044, Business & Professions Code).
I have read the hazardous materials requirements under Chapter 6.95 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 the Bay Area Air. Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
performance of thework which this permit is issued.
'
for by
the Health &Safety Code, Sections 2555, 25533, and 25534.
�
I have and will maintain Worker's Compensation Insurance, as provided
for this
1
7
Section 3700 of the Labor Code, for the performance of the work which
Owner or authorized agent: Date:__a
permit is issued.
I
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
CONSTRUCTION LENDING AGENCY
Compensation laws of California. If, after making this certificate of exemption, I
I hereby affirm that there is a construction lending agency for the performance of .
become subject to the Worker's Compensationprovisions of the Labor Code, I must
work's for which this permit is issued (Sec. 3097, Civ C.)
forthwithcomply withsuch provisions or this permit shall be deemed revoked.
Lenders Name
APPLICANT CERTIFICATION
Lender's Address
I certify ihatl hav6.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.
Signature Date
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
:MaADDRESS: 22750 STEVENS CREEK BLVD DATE: 02/11/2013 REVIEWED BY: MELISSA
PN: 342 14 025 *VALUATION: $10,000
*PERMIT TYPE: Demolition Permit PLAN C11E0\ T) PE:
PRIMARY PENTAMATION 1 SFDWL-DEM
USE: SFD or Duplex PERMIT TYPE: i
WORK COMPLETE DEMOLISION E HOUSE BUILDING PERMIT # 12100214
SCOPE
Mech. Plon Check Pltu)ib. Plarr Cheek Elec. Ptcui Check
Afech. Pcu-mit Fee: Plrnnh. Permit Fee: F,lec. Permit ree:
Other blech, lnsli: ' Other Plumb 1AT Other Dee. Insp.
0
Phtmb• ha Fee: Elee, 1nsp. Fee:
xllc:ch. Insp. Fee:l
NOTE: This estimate does not include fees due to other Departments (i,e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). These fees are based on the prelitninar in orntation available and are onlyan estimate. Contact the Dept or addn'l info.
FEE ITEMS (Fee Resolution 11-053 Ef 7/f 1/12) FEE QTY/FEE MISC ITEMS
Plan Check Fee.
Sitppl, PC Fee
Phanb./tllech./Elec
Permit Fee: $534.00
Suppl. Insp: Fee:Q Reg. Q OT 0,0 hrs $0.00
Phonb./1lech.X.Iec
PlulnbAllfech./Elec Permit Fee:
Cotzstruclion Tax:
Adttjinistrative Fec:
lfoi'k. Wi.thoutPerinit"
A�1Vr�rn�ed.Plavhirig hgcS:
Tr�trnel 'Dociunentation Pees:
Strong Motion Fee: IBSEISMICR $1.00 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
SUBTOTALS: $536.001 $0.00 TOTAL FEE: $536.00
��! Revised: 01/01/2013 .