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10110019I CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10540 WUNDERLICH DR OWNER'S NAME: ❑ LICENSED CONTRACTOR'S DECLARATION License Class Lic. N 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. 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 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. Date OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of 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) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). ) T 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 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-p ' Cupertino Municipal Code, Section 9.18. Signature Date CONTRACTOR: JASON TAN 10540 WUNDERLICH DR CUPERTINO, CA 95014 PERMIT NO: 10 1100 19 DATE ISSUED: 11/05/2010 PHONE NO: ' BUILDING PERMIT INFO: BLDG r ELECT F PLUMB F MECH r RESIDENTIAL r COMMERCIAL r JOB DESCRIPTION: DEMO WHOLE STRUCTURE(1006SQ) & RETAINING FOUNDATIOIN & BUILD UP NEW SFDWL Sq. Ft Floor Area: I Valuation: $9000 APN Number: 37527037.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued br. Date;l`f 7b RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first : 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 I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous 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 the Health & Safety Code, Sections 25505, 25533, and 25534. Owner or authorized agent: Date: 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 Professional DEMOLITION CITY OF CUPERTINO W-M-7 FEE ESTIMATOR - BUILDING DIVISION ADDRESS: DATE: REVIEWED BY: APN: BP#: 'VALUATION: 1$9,000 *PERMIT TYPE: Demolition Permit P1,i X CHECK T)'7JL'; PRIMARY SFD or Duplex USE: PENTAMATION 1SFDWL-DEM PERMIT TYPE: WORK SCOPE FEE ID FLR AREA s.0 1 DEMORES 1,006 f � 7•i a] = '•1• s > e ..ti!" �" %clv ti��:"Ir w<y�., L:,. '7 'ya'.' •S '�S: rig ,i'� .� rc� � s' ? S r� . I' { . S •✓ fir( ] \ S.t yi n'.f. .. s .r.:- • ! i .�<•L. Via• ' � i i r� r rr� �i, .u,_ y sf •S, . -i. �.r.N ,,�5. > �... :i _ s �s ,..� � �.. , I ,• , .v ..r , r 7f ,, c 3 • 11 (, t'" s=n S`.,✓ r � . 1} � tf2.- .� �.�. ..t+ . :::r ' fF . �,�, 3 l �. } C.s.z : �.•.4:: ` r,.., y c .f 3 <li \ ar',;•'.i: S.. r. ...'z, h[ r I .3 . • • .....,r.. £, J. • t I r.� �� 3 � I i .; � 1 .�5� i tf � r .a. ;.S r-: �..� F„9 .• :,r.:��.. E.•>S .t � s y.;y .. � .�::•. �:7, "1' .:), ti ,157 �x. # 4 � s 13[ .r .1�� i ! / arc' _ . s : �.r _ r . ", i .� . 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M.�,p. Foie. NOTE: These fees are based on the nreliminary information available and are onlv an estimate. Contact the Dent for addh7 info. FEE ITEMS (Fee Resolution 09-051 Ef. 711110) FEE QTY/FEE MISC ITEMS Plan Check Fec: Suppl. PC Fee Plunb./11lech,/Elec Plan Check: —DY f Permit Fee: Suppl. Insp. Fee10 Reg. © OT 0.0 hrs $0.00 t Plumb./MecklElec Unit Fee: Plumh./Mech,;Elec Permit Fee: Construction Tax Acoustical Revic-ti Fee: 1,Vork Wi.'lhout Permit? Planning Fees: I Travel Doc•iunentation Strong Motion Fee: IBSEISMICR $0.90 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 �':] 4.it•''tii ¢. 'i 7�\.'' `v4•r ';:. r.S".'rr;'• '`. ., :5: :y'. �,..1'n L°z:\�! .:1 t, t:t!s .�•:ai.�.[�sA.%f,�1�Rrri�S?121111'.G\:�r�]fs!Y7rrr?l.�fli��:�.,.hrS:>i:a�S::f>:1�,..23.t.�:::�c• s=rY�tE `Csi'.YTlr3=4°.'i�-= :�rJs-'-1'S�r!•i'7- :£?:C'z=.�.`•_ $0.00 ;j•_�Fc`c��';'`"tiSS.F\�t'){�cl`�%z� �3*.J,�s >� j.�, D/7reG /C121 `7, fU Revised: 10/17/2010