10100214CITY OF CUPERTINO BUILDING
BUILDING ADDRESS: 10265 STERN AVE
OWNER'S NAME: CHUNHUA HAN
OWNER'S PHONE: 4085052889
0 LICENSED CONTRACT R'S DECLARATIQN
License Class/� t++ ` Lic. # 1_ S q C 6 7
Contractor til k l Y�Y{'o rF1►ngr4tkDate ) 2- 1 O -- ( O
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:
1. 1 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.
2. 1 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 C.. ! '
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. Additi ally, the applicant understands and will comply with
all non -point source regulati s per the Cupertino Municipal Code, Section 9.18.
Signature Date_Z
11 OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
1. 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)
2. 1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
1 hereby affirm under penalty of perjury one of the following three declarations:
t. 1 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.
2. 1 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.
3. 1 certify that in the performance of the work for which this permit is issued, 1 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, 1
become subject to the Worker's Compensation provisions of the Labor Code, 1
must forthwith comply with such provisions or this permit shall be deemed
revoked.
APPLICANT CERTIFICATION
certify that I have read this application and state that the above information is
:orrect. I agree to comply with all city and county ordinances and state laws relating
D building construction, and hereby authorize representatives of this city to enter
ipon the above mentioned property for inspection purposes. (We) agree to save
ndemnify and keep harmless the City of Cupertino against liabilities, judgments,
osts, and expenses which may accrue against said City in consequence of the
ranting of this permit. Additionally, the applicant understands and will comply with
Il non -point source regulations per the Cupertino Municipal Code, Section 9.18.
Signature Date
CONTRACTOR:
1821 S BASCOM AVE
CAMPBELL, CA 95008
PERMIT NO: 10100214
DATE ISSUED: 12/10/2010
I PHONE NO: (650) 690-4662
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
SFDWL DEMO 898 SQ FT
Sq. Ft Floor Area: I Valuation: $4500
APN Number: 37510044.00 I Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued 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 2553i(a) should 1 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 1 will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
Ownil r aforized 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 Address
ARCHITECT'S DECLARATION
1 understand my plans shall be used as public records.
Licensed Professional
iJ'Jf1f� jS11f'11J11'�r1�11 �Jri JL I!.+
I File Edit Actions Details Links Favorites Help
Permit " Property
Zoning Applicant
Contractor " Defined Fields
Permit Details
Perrnir
Permit Type "
1 SFDWLDEM
1()11 ISFDTffL DEMO 898 SQ FT
-1tion
F
t Permit Number "
-
10100214
_
N/A
I Address' I 10265 STERN AVE
Status "
C - Closed
Applied Value "
City/State/Zip CUPERTINO
Master Number
SQUARE FT.
I CLI Notes
0
APIJ 37510044.00
Project
- -
- IRI
Unit
Apply Date "
10/29/2010
h Operator
Sy!viaM
Fiv,.;ner Entity Infi,rrnatton
Permit Issue Date
1 2/1 0/2010
Operator
suety
I Owner Name xl CHUNHUA HAN
f Certificate Issued
01 /11 /201 1
Operator
jeffreyg
Use Default
Certificate Type
CC - CERTIFICATE OF COMPL
Address Home STERN AVE
Certificate Number
_-10265
I
City/State/Zip CUPERTINO
Permit " Property
Zoning Applicant
Contractor " Defined Fields
Permit Details
Purpose/Special Conditions
Permit Type "
1 SFDWLDEM
1()11 ISFDTffL DEMO 898 SQ FT
SINGLE FAMILY DWELLING
DEMOLIT
__ SCANNED/ FILiIHD 812011/
Usage Class "
N/A
IRI
NON APPLICABLE
Applied Value "
4500'
SQUARE FT.
0
Calculated Value
0 [�
US C-404 Type
434
ALT: RESIDENTIAL
Permit Form x
AUTOPERM -PERMIT
4 j
Ownership
1 - Private
Project Size
EXPRESS -EXPRESS
Permit issued 12J1OJ2010
FnFar Fhp ni +rnnco nr .�nw cr.Frial rnnrlihinnc Fnr Fhic nprm.&
CA 95014
CA 95014
ICOAdd Default Text
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10265 STERN AVE CONTRACTOR: FEMEX PERMIT NO: 10100214
OWNER'S NAME: CHUNHUA HAN 1821 S BASCOM AVE DATE ISSUED: 12/10/2010
OWNER'S PHONE: 4085052889 CAMPBELL, CA 95008 PHONE NO: (650) 690-4662
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
�Q p� SFDWL DEMO 898 SQ FT
License Class_ _yaLic. # f 5 14 66 7
Contractor C. l (11 hCG Y� � {^P► rL a of r! )ate (Z-10-10
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.
Sq. Ft Floor Area: Valuation: $4500
I hereby affirm under penalty of perjury one of the following two declarations:
t. 1 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.
2. 1 have and will maintain Worker's Compensation lnsurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION b . l ' �
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. Additio ally, the applicant understands and will comply with
all non -point source regulati s per the Cupertino Municipal Code, Section 9.18,
Signature Date 12--/o ^ o
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
i. 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)
2. 1, 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:
t. 1 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.
2. 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.
3. 1 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 Califomia. If, after making this certificate of exemption, 1
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 -point source regulations per the Cupertino Municipal Code, Section 9.18.
Signature Date
APN Number: 37510044.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: Date/2�Gy"'
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, 1 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. I will maintain
compliance with the Cupertino Municipal Code, Chapter 9.I2 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.
Ownhr at
ized agent:
Date: 12--/0-/0
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 Professiona
CITY OF
CITY OF' CUPERTIN',d' - -
DEMO
PERMIT APPLICATION FORM
CUPERTINO /o1OD n '�
APN#t b y �
Date:
. V�
V
D -
'
Building Address:
5 -T E - P k A-U.�_ C O PES
cA 5a 1
Mailing Address (if different from building address):
1SFDWL-DEM
0 -125 Ga 8(zw_*- C Cu a
e Y+ �Io CA -
Owner's Name(- ❑, q V e-�
B
Phone:
C
1BCBSC
Lj o?- 505- 2-33
Contractor: G7l Ii _?Y+- —Fe-1y_n cPA4 �
ALL PERMIT
TYPES
Phone: � � r s OOr- 8;
1BSEISMICRE
Seismic Residential
Fax:
Contractor License #:
Cupertino Business License #:
Contact: + 16A~zzyrlu 04 �
Phone: q OS, 5
40 9 -'S VO- (0 11 Z
Fax:
Residential [ Sq Footage gq'� Commercial
❑ Sq Footage
Job Description:
I( I n rr
coV�
I�C�i+n G✓1
Valuation: 4 � S(5C7 r
Project Size: Express ❑ Standard []" Large ❑ Major ❑
Please complete relevant portions of the Green Building Checklist
& attach it to the application
or if applicable, include on the plan set & the sheet index.
V
Quantity
Fee ID
Fee Description
Fee Group
Permit Type
1DEMORES
Demo -Residential
B
1SFDWL-DEM
1DEMOPRES
Pool Demo Residential
B
1SFP00L-DEM
1BCBSC
Cal Bldg Standards
Commission Fee
B
ALL PERMIT
TYPES
1BSEISMICRE
Seismic Residential
B
Revised 01/07/09
CUPER-I-INO
CONTRACTOR / SUBCONTRACTOR LIST
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
JOB ADDRESS: -.r f'
PERMIT # 2 l
OWNER'S NAME: A
PHONE # p .
GENERAL CONTRACTOR: Ci.k I b e.r T�Mk 0 r
BUSINESS LICENSE #
ADDRESS: ( 167 w_ Zrjff
CITY/ZIPCODE:
*Our municipal code requires all businesses working in the city'o`have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors: iC� o
Signature Date
Please check applicable subcontractors and complete the following information:
V
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring / Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner / Contractor Signature
Date
DEMOLITION
CITY OF CUPERTINO
WE FEE ESTIMATOR — BUILDING DIVISION
ADDRESS:
DATE:
REVIEWED BY:
ITEMS
APN:
BP#:
VALUATION: 1$4,500
PERMIT TYPE: Demolition Permit
PRIMARY SFD or Duplex
USE:
PENTAMATION 1 SFDWL-DEM
PERMIT TYPE: A
WORK
Permit Fee:
$507.00
SCOPE
0.0
hrs
FEE ID FLR AREA
(s.f.)
1DEMORES 898
-7
NOTE- These Peps are haled an the nreliminary infarmatinn availahle and are nniv an -vfimat.-- Cnntart /he Dent far addn'l infa-
FEE ITEMS (Fee Resolution 09-051 Elf 7-1,10MISC
FEE
QTY/FEE
ITEMS
A
Permit Fee:
$507.00
Suppl. Insp. Fee -E) Reg. 0 OT
0.0
hrs
$0.00
A
Strong Motion Fee: IBSEISMICR
$0.50
Select an Administrative Item
1
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
1 $508.501
$0.00 TOTAL FEE:
$508.501
Revised: 10117/2010