13040093CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10229 SCENIC BLVD
CONTRACTOR: ALLEN HSU
PERMIT NO: 13040093
OWNER'S NAME:
JOSE, CA 95129-3946
PHONE NO:
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIALS
❑ LICENSED CONTRACTOR'S DECLARATION
DEMO (E) 882 SQ FT SFD & 378 SQ FT ATTACHED
License Class Lic. #
GARAGE
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
APN Number: 35709010.00
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
PERMIT ISSUANCE OR
WITHIN 18�09TVLL
to building construction, and hereby authorize representatives of this city to enter
180 DA CALLED INSPECTION.
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,y
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.
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
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)
1, 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
the Cupertino Municipal Code, Chapter 9.12 and
performance of the work for which this permit is issued.
will maintain compliance with
the Health & Safety Code, Sections 25505, 25533, and 25534.
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
Owner or authorized agent: Date:
�y
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 the Worker's
CONSTRUCTION LENDING AGENCY
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
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.)
Lenders 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.
Date
Signature
CITY OF CUPERTINO
1 " I FEE F.STIMATOR - BUILDING DIVISION
LAADDRESS:
10229 scenic blvd
DATE: 04/11/2013
REVIEWED BY: MELISSA
APN: 357 09 010
;P
BP#: f 3 f 746�
*VALUATION: $11,000
*PERMIT TYPE: Demolition Permit PLAN C,'/lE(:'I( TYPE:
PRIMARY SFD or Duplex
USE: P
PENTAMATION 1SFDWL-DEM
PERMIT TYPE:
WORK
DEMO E 882 SQ FT SFD & 378 SQ FT ATTACHED GARAGE
SCOPE
FEE ID FLR AREA
s.f.
1 DEMORES 1,260
Dfech, Plana Check
Phurrh. Plan Creek
Elec, PI(m Check
Ifech. Permit Fee:
Plmrrh, Permit Fee:
Elec. Permit Fee.,
-0-1-
Other Alech. hash
Other Plumb hlsp,
Other Elec. Imp,
biech. Insp. Fee:
Phnuh. hrs). Fee:
Elec, hasp. Fee:
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
D' ' TI are based on the relindnar in orniation available and are onl an estimate. Contact the Dept or addn'l info.
isit ct, etc Z. iese ees
FEE ITEMS (Fee Resolution 11-053 E . ZI 12)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
i
Suppl, PC Fee
Plitinb.1 fech./Elec
Permit Fee:
$534.00
Suppl. Insp. Fee:Q Reg. Q OT
0,0
hrs
$0.00
Plaonh./Rfech./Flee
Phtnih,blfech./Elec PerniitFee:
.
Construction Tax:
Administrative Fee:
Work PVithoutPerntit?
Advanced Planning Fees:
�
Trove/ Doctonentutiort Fees:
Strong Motion Fee: IBSEISMICR
$1.10
Select an Administrative Item .
Bldg Stds Commission Fee: 1BCBSC
$1.00
SUBTOTALS:
$536.10
$0.00 TOTAL FEE-T
$536.10
Revised: 04/01 /2013