10120050 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22045 REGNART RD CONTRACTOR:RANDAZZO PERMIT NO: 10120050
ENTERPRISES INC
OWNER'S NAME:
CASTROVILLE,CA 95012 PHONE NO:(831)633-4420
LICENSED CONTRACTOR'S DECLARATION I� r— C"
BUILDING PERMIT INFO BLDG ELECT PLUMB
License Class Lic.#
pp CC Y� MECH RESIDENTIAL COMMERCIAL
Contractoh*Q&A'zo L YOT Date ��
OB DESCRIPTION: DEMOLITION OF 2 HOUSES(#1),GARAGE#2,&
I hereby affirm that I am licensed under the provisions of Chapter 9 J
SHED ATTACHED TO GARAGE#3-(3350SQ)
(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:$19000
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 APN Number:36646004.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT ETDS
WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 1F 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 DAYS T 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 �z y
granting of this permit. Additionally,the applicant understands and will comply Issued by: Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. -
RE-ROOFS:
Signature � �/ Date `1 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)
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
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections .
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date::�&
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 CONSTRUCTION LENDING AGENCY
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.)
Lender's 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 inconsequence 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
DEMOLITION
FM-7
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 22045 Regnart Rd.
DATE: 12/08/2010
REVIEWED BY: gs
APN:
BP#:
`VALUATION: 1$19,000
'PERMIT TYPE: Demolition Permit
PL-IN CHECK TYPE:
PRIMARY SFD or Duplex
USE:
PENTAMATION 1SFDWL-DEM
PERMIT TYPE:
WORK
Demo house 1 & 2 Garage 2 1 Shed attached to garage 3
SCOPE
FEE ID FLR AREA
s.r.
1 DEMORES 3,350
1�fE:ch. Plan Check
Phunh. Pfan C'hecr,
Elec. Plan Cheek
FL%ch. Perri! I ::
Phimh. l'. -; �. , _
F;lec. Pcrnrir F"'.. l
Other ,Lfech. Insp.
Other Plumb Insp.
Other Elec. Insp.
h hz,��. %,'�.�,.
r,i'. L1.cp. I �:
Elec.Insp.
NOTE: These fees are based on the Dreliminary information available and are onlv an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 09-05I Eff. 7/I/10)
FEE
QTYIFEE
MISC ITEMS
P/un ("beck I've.,
'Sztppl. PC' Fee
Plumb.iMech./Elec Plan Check:
Permit Fee:
$633.00
Suppl. Insp. Fee{' Reg. 0 OT
0.0
hrs
$0.00
Plumb.IMech./Flee Unit 1'"cC:
Plumb,/Mech.iElec Permit I_ ,
Conso-action Tax
Acoustical Review Fee:
Work Without Permit?
Planning Fees:
i
Travel Documentation Fees:
Strong Motion Fee: 1BSEISMICR
$1.90
Select an Administrative Item
Bldg; Stds Commission Fee: 1BCBSC
$1.00
SUBTOTALS:
$635.90
$0.00 TOTAL FEE:
$635.90
Revised: 12/07/2010