11120081CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22017 SAN FERNANDO CT CONTRACTOR: CRISANTO'S QUALITY PERMIT NO: 11120081
CONSTRUCTION INC
OWNER'S NAME:
NEWARK, CA 94560 PHONE NO: (510) 713-8770
❑ LICENSED CONTRACTOR'S DECLARATION
License Class Lie.N �
Contractor ��„65��6kXOVDate z
1 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.
l 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
l 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
Q.
Signature Date
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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)
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 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
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 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.
BUILDING PERMIT INFO: BLDG F ELECT F PLUMB f—
MECH r— RESIDENTIAL i COMMERCIAL r
JOB DESCRIPTION: DEMOLITION OF SINGLE FAMILY
STRUCTURE(I471 SQFT)IN
ORDER TO CONSTRUCT NEW HOME
Sq. Ft Floor Area: I Valuation: $5000
APN Number: 35712005.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 D YS FROM rALLED INSPECTION.
Issued by ^ Z / 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. 1 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 1 use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District 1 will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
Owner o uthorized agent:
Date:
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for the performance of Aork's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's
ARCHITECT'S DECLARATION
Date
1 understand my plans shall be used as public records.
Licensed Professional
CUPERTINO
• Building Department
10300 Tone Avenue
Cupertino, CA 95014
Phone (408) 777-3228
Fax (408) 777-3333
PROCEDURE FOR DEMOLITION PERMITS
The demolition application should be applied for before or at the same time as the new
construction permit application (these are separate permit applications & fees). Plan check
fees are due at the time of applicatiorVplan submittal. The new construction permit will not
be issued until the demolition permit is issued.
BEFORE DEMOLITION PERMITS CAN BE ISSUED, THE FOLLOWING STEPS MUST BE COMPLETED:
SIGNATURE/DATE:
/ 1. A demolition/ plot plan will be required showing any trees 10 inches in diameter at 3 feet
above grade on the subject property, and what means will be taken to protect same. Three
copies of this plan are required for review by the Planning Department. These need to be
submitted at the time of permit application, to the Building Department.
-a-� 2. P.G.& E. must be contacted AS EARLY AS POSSIBLE prior to demolition to schedule the
abandonment. Contact P.G.& E. at (408) 725-3325. A letter from P.G.& E. shall be provided
to the City, stating that all gas and electric has been disconnected. (This step can be time
consuming, so it is important to begin the process immediately)
3. Provide a letter of inspection, tests, and abatement of any Hazardous Materials. Letter to be
initiated by person(s) certified in asbestos, mercury and/or hazardous material examination.
4. Check to see if the building is considered an historical landmark. Obtain clearance from the
Community Development Planning Department. Allow 10 working days.
5. Provide a letter of clearance of all vermin from a licensed pest control contractor.
2 - ` 6. Important: Prior to the issuance of the demolition permit, the applicant must call the Public
Works Department at (408) 777-3104 and arrange a "habitable dwelling" inspection.
7. Debris bin and Recycling sheet: read, sign and date. The sheet will remain in the project's
building permit file for the duration of the project. L .3000,96
8. Prior to issuance of the demolition permit (commercial only), the Fire Department must review
the plans for fire suppression/alarm systems that shall remain in service or be modified during
Demolition or that shall be replaced with the new construction.
Revised 05/26/10
CITY OF CUPERTINO
FM-7 FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 22017 san fernando ct.
DATE: 12/14/2011
REVIEWED BY: bobs.
APN:
BP#:
"VALUATION:
1$5,000
IPERMIT TYPE: Demolition Permit
-
PRIMARY SFD or Duplex
USE:
PENTAMATION 1SFDWL-DEM
PERMIT TYPE:
WORK
construct new 2 story sfd.
SCOPE
FEE ID FLR AREA
s.f.
1 DEMORES 1,471
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etch These fees are hated on the nrelininary information availahle and are only an estimate_ Contact the Dent tar addn 11 info_
FEE ITEMS (£ee Resolution 11-053 ZsfJ.' 711111)
FEE
QTY/FEE
MISC ITEMS
Permit Fee:
$523.00
Insp. Fee-0 Reg. Q OT
0.0
hrs
$0.00
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Strong Motion Fee: IBSEISINICR
$0.50
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$524.50
$0.00 TOTAL FEE:
$524.50
Revised: 12104/2011