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11120041 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19885 STEVENS CREEK BLVD CONTRACTOR:FRESH AIR MECHANICAL PERMIT NO: 11120041 OWNER'S NAME: CUPERTINO INVESTMENT PARTS LLC 5069 BENGAL DR DATE ISSUED: 12/06/2011 ER'S PHONE: 4089212814 SAN JOSE,CA 95111 PHONE NO:(408)438-7678 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r License Class i,.N_B l 235 MECH r RESIDENTIAL r COMMERCIAL r Contractor Date_I2-- 6 —l I hereby efiirm t at I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: PARKING LOT IN BACK OF CORT FURNITURE- (commencing with Section 7000)of Division 3 of the Business&Professions DEMOLITION U Code and that my license is in full force and effect. STRASH ENCLOSURE AND SOME PARKING LOT RFACE(140SQFT) 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. Sq.FI Floor Area: Valuation:$10000 APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is AIN Number:31621031.19885 Occupancy Type: 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, PERMIT EXPIRES IF WORK IS NOT STARTED costs,and expense which may accrue against said City in consequence of the granting of this it. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non-po' source re lations per the Cupertino Municipal Code,Section 180 DAYS FROM LAS CALLED INSPECTION. 9.18. '1 r Signature Date Issued by: v•� Date: • OWNER-BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS: the following two reasons: All roofs shall be inspected prior to any roofing material beug installed.If a roof is 1,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection. Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: Dale: construct the project(Sec.7044,Business&Professions Code). 1 hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 1 have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain Section 3700 of the Labor Code,for the performance of the work for which this compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Safety Code,Section 25532(x)should 1 store or handle hazardous material. permit is issued. Additionally,should I use equipment or devices which emit hazardous air 1 certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District 1 will not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Compensation laws of California. If,after making this certificate of exemption,I Health&Safety Code,Sections 25505,25533,and 25534. 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. rout rized agent:Ooo2c Dste:a64 APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY 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 I hereby affirm that there is a construction lending agency for the performance of work's to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.) upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name indemnify and keep harmless the City of Cupertino against liabilities,judgments, ift and expenses which may accrue against said City in consequence of the Lender's Address WWng of this permit.Additionally,the applicant understands and will comply I 11 non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION 9.18. 1 understand my plans shall be used as public records. Signature Dale Licensed Professional • CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 31621031.19885 DATE ISSUED. . . . . . . : 12/06/2011 RECEIPT #. . . . . . . . . : BS000015504 REFERENCE ID # . . . : 11120041 SITE ADDRESS . . . . . : 19885 STEVENS CREEK BLVD SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : CUPERTINO INVESTMENT PARTS LLC ADDRESS . . . . . . . . . . : 1975 HAMILTON AVE UNIT 33 CITY/STATE/ZIP . . . : SAN JOSE, CA 95125 RECEIVED FROM . . . . : FRESH AIR MECHANICA CONTRACTOR . . . . . . . : RANFERI GOMEZ LIC # 32837 COMPANY . . . . . . . . . . : FRESH AIR MECHANICAL ADDRESS . . . . . . . . . . : 5069 BENGAL DR CITY/STATE/ZIP . . . : SAN JOSE, CA 95111 TELEPHONE . . . . . . . . : • FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 10, 000 .00 1. 00 0. 00 1.00 0. 00 1BSEISMICO VALUATION 10, 000.00 2. 10 0. 00 2 .10 0. 00 1DEMOCOM SQ FEET 140.00 523 . 00 0. 00 523 . 00 0.00 _ ---------- ---------- ---------- ---------- TOTAL -------- TOTAL PERMIT 526 . 10 0 . 00 526 .10 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 526.10 VISA --------------- TOTAL RECEIPT 526. 10 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 704 DEMO • CITY OF CUPERTINO D FEE ESTIMATOR—BUILDING DIVISION • ADDRESS: 19885 stevens creek blvd DATE: 12/06/2011 REVIEWED BY: larry s APN: BP#: "VALUATION: $10,000 *PERMIT TYPE: Demolition Permit PLdN CIIECK T'FPE: PRIMARY Commercial Building PENTAMATION 1COMMLDEM g USE: PERMIT TYPE: WORK trash enclosure and some parking lot surface SCOPE FEE ID FLR AREA s.f. 1DEMOCOM 140 vee h. PLur Chech 116onh, Man Cheek Gkre, f'laru ChccM ,tech_Permit Fee_ Plumb. Pao pi t Fees 1(<e'. Perna!F=r,: t:Jlhcr Hoch,Insp. 0111i".Numb Lrsp. ED OIh<:r Ele;r.. Lrsp. El Vech. /nep. Pee: 111unrb. III I("': Rte! Ince. Pen: NOTE: This estimate does not Include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District etc. . These fees are based on the prellaina In ormation ava!lable and are only an estimate. Contact the Dept for addn7 into. FEE ITEMS L1'Cc Resolution 11-053 EK 7/U111 FEE QTYLFEE MISC ITEMS Plan Clunk Fac: Suppl. PC Fee F'lurnb.%A:Iech./1s7ei Permit Fee: $523.00 Suppl. Insp. Fee:Q Reg. Q HE hrs $0.00 Plumb.iAdmch,e1lc=c 1'Inmb._:Lleclt.iF.lecPermit Fee: (;Cnrxetrrurthm Ta' Administrative Fee: 6t urk 4V"ithout Permit? Aciraruxel Plarminl;III !'ravel Dveannewation Ties: Strong Motion Fee: IBSEISMICO $2.10 Select an Administrative Item • Bldg Stds Commission Fee: IBCBSC $1.00 SOBTOTALS: 1 $526.10 $0.001 TOTAL FEE: I $526.10 Revised: 1 0101/2 01 1 DEMOLITION PERMIT APPLICATION D COMMUNITY DEVELOPMENT DEPARTMENT" BUILDING DIVISION 10300 TORRE AVENUE "CUPERTINO, CA 95014-3255 pIO (408) 777-3228 ' FAX(408) 777-3333'buildinal�cuoertine.ore PROTECT ADDRESS 1 9 _ OJ n C `4ok/ S (/I-P-r' f7 YbQ. APN q f f��/ I 4 I•L� V t ) OWNERNAME C( ! q. G [� PHONE LQ, lZl� fi-MAL. Z O �'I i/ STREET ADDRESS LArt\n,{i. I � . 9TATF.Z[P FAX CONTACT NAk[S lt't PHONE E-MAIl. STREET ADDRESS CITY.STATE, ZIP FAX ❑OWNER ❑ OWNER-a UTL///D��ER ❑ OWNERACE SOM CTOR ❑CONIAACTORAOENT ❑ AACHnBCr ❑ENONEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME 41''VL LICENSE NU11BER`2-� IICENSE TYPE EUs.LIC a ^ �L.tQ✓A, �/' �p��^y V COMPANY NAME E FAX STAEEi ADDREtOG9 ��r PHONE GU K30 t DESCRIPTION OF WORK RESIDENTIAL aDwELL¢ao &OORAREA UNITS uii MMEERCrAL r C. DO _ 7 — •. _ - F a TYPE OF CONSTRUCTION a sroRrFs -• `, ' ;�. _ AQMD JOB NUMBER }}yy IfEnEIiLBkLpY „L�i a j TOTAL VALUATION: J R. By my signature below,I certify t0 each of a following: I am the property owner or authorized agent to act on the property owner's behalf. I have mad this _ application and the information I have pro a i l correct I have read the Descnpron of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to buil M241on. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature ofApplicant7Agent i" Data: SUPPLEMENTAL INFORMATION REQUIRED PRIOR TO ISSUANCE OF DEMOLITION PERMIT _Provide lob Number from Bay Area Air Quality Management District wwuv.baacmA.orP(o)415-749-4762. -- .�cAn.`eaE«•'�'� r:§r>i —Provide three copies of a site plan showing protection for any trees 10"in diameter or mare at 3'above grade. - °Ll• sr. - Provide letter tiom NIPARD PG&E(408-725-3325)stating all gas and electric has been disconnected. - i _Provide a letter of inspection,tests,and abatement of any Hazardous Materials.Letter to be initiated by persons) "` certified in asbestos,mercury and/or hazardous material examination. Isux' =� —Planning Dept clearance to verify building is not considered an historical landmark.Allow 10 business days. L _Provide letter of clearance of all vermin from a licensed pest control contractor. —Applicant shall call the Public Works Department at 408-777.3104 and schedule a"habitable dwelling"inspection. _Provide signed Debris Bin and Recyclable Materials farm. . •7�: r _Commercial Buildings Only: Provide Fire Dept clearance for fire suppression/alarm system review. DemoApp_2011.doc revised 03/16/11