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11060002CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 6 RESULTS WAY I CONTRACTOR, ) I PERMIT NO: 11060002 I OWNER'S NAME: EMBARCADERO CAPITAL PARTNERS /nhal k 6k& Gly 6 l DATE ISSUED: 06/01/2011 fl, `NER'S PHONE: 6503731232 CJ LICENSED CONTRACTOR'S DECLARATION License ClassA•NAZ C-21 Lic. # q o o 2 6 �, Contract&r"IJ'ffit naV;t4an.'_fr1 Date 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 whic is permit is issued. I , Al APPLICANT CERTIFICATION u 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. Signature I Date V \ 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 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, and expenses which may accrue against said City in consequence of the .ng of this permit. Additionally, the applicant understands and will comply wan all non -point source regulations per the Cupertino Municipal Code, Section 9.18. PHONE NO: BUILDING PERMIT INFO: BLDG I— ELECT f— PLUMB r— MECH f— RESIDENTIAL �f— COMMERCIAL JOB DESCRIPTION: STE 7 & 8 EXTERIOR - DEMO PARAPET WALLS AT EXISTING COMMERICAL SHELL BUILDING Sq. Ft Floor Area: I Valuation: $13000 APN Number: 35720041.6 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued b}. 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 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: � -- ��l 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 Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Signature Date I Licensed DEMOLITION CITY OF CUPERTINO rw--w-7A FF.F FIqTIMATOR - HITILDING DIVISION FEE ID FLR AREA (s.f.) 1DEMOCOM -T- NOTE. These fees are based on the Preliminary information available and are onto an estimate. Contact the uept for aaan't in/o. FEE ITEMS (Fee Resolution 09-05.1 Iff, ------ I FEE QTY/FEE MISC ITEMS Permit Fee: $507.00 Suppl. Insp. Fee -0 Reg. 0 OT 0.0 hrs $0.00 F --1 Stroniz Motion Fee: IBSEISMCO - $2.73- Select an Administrative Item Bldg Stcls Commission Fee: IBCBSC 1 $1.001 1 1 SUBTOTALS: 1 $510.731 $0.001 TOTAL FEE .T $510.731 Revised: 04/29/2011 ADDRESS: 6 results way --DATE: 06/01/2011 REVIEWED BY: bob s. APN: BP#: VALUATION: 1$13,000 *PERMIT TYPE: Demolition Permit PRIMARY Commercial Building USE: PENTAMATION ICOMMLDEM PERMIT TYPE: WORK demo parapet walls at existing commercial shell bldg. SCOPE FEE ID FLR AREA (s.f.) 1DEMOCOM -T- NOTE. These fees are based on the Preliminary information available and are onto an estimate. Contact the uept for aaan't in/o. FEE ITEMS (Fee Resolution 09-05.1 Iff, ------ I FEE QTY/FEE MISC ITEMS Permit Fee: $507.00 Suppl. Insp. Fee -0 Reg. 0 OT 0.0 hrs $0.00 F --1 Stroniz Motion Fee: IBSEISMCO - $2.73- Select an Administrative Item Bldg Stcls Commission Fee: IBCBSC 1 $1.001 1 1 SUBTOTALS: 1 $510.731 $0.001 TOTAL FEE .T $510.731 Revised: 04/29/2011 CUPERTINO DEMOLITION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT " BUILDING DIVISION --"� 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 " FAX (408) 777-3333 - buildingl5cu6ertino.org ©ATE PRO CT AD SS / ' / r G/ APN #� 5� � f\ O N PHONE 2 E-MAIL a C c qjg,�g b 0 -123 STREET ADDRESS F I �O Or (1�2��►'lovl C 00 v "� CONTACT NAME i I PHONE E-MAIL STREET ADDRESS CITY ST TE, ZIP FAX 13o i 0eJrwoKC4 V00t f2 -OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CO CI'OR N . LICENSE NI IMBER LICENSE TYPE BUS. LIC # AX COMPANY NAME E-MAIL e-► c o -?Y4- YDS STREET ADDRESS CITY, STATE, ZIP ONE eeoA�geo%li-zo(& 5/0 J Y-7 - V yo0 DESCRIPTION OF WORK rr je /k % h RESIDENTIAL # DWELLING '-OOR AREA UNITS COMNIERCL4L " = FLOOR AREA a r, TYPE OF CONSTRUCTION FTOZ; . ".- - AQMD JOB NUMBER TA1 IALUA7125: 00 J#• By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to cdmply with all applicable local ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent Date: SUPPLEMENTAL INFORMkn0)4 REQUIRED PRIOR TO ISSUANCE OF DEMOLITION PERMIT �" cieuscxv�' Provide Job Number from Bay Area Air Quality Management District v,-wv.baaamd.org cCi 415-749-4762. Prbvide three copies of a site plan showing protection for any trees 10" in diameter or more at 3' above grade. -` Provide letter from PG&E 408-725-3325 stating all gas and electric has been disconnected.--�F. _ 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. raw';?.. - Planning Dept clearance to verify building is not considered an historical landmark. Allow 10 business days. `� P - 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 form. 'h Commercial Buildings Only: Provide Fire Dept clearance for fire suppression / alarm system review. DemoApp_2011.doc revised 03/16/11