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14110123 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21088 LAVINA CT CONTRACTOR:_:�V J39%MH69 PERMIT NO: 14110123 OWNER'S NAME: PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL License Class Lie.# ff 7 Ll D 6 DEMOLITION OF EXISTING RESIDENCE(1191 SQ FT). Contract cD1`d�7/ (mak Date I hereby affix n that I am licensed under the provisi�hapter (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:$8000 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:32608026 00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF 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 FROM LAST 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 granting of thi it. Additionally,the plicant understands and will comply Issued by: v Date: with all non oint so r gu o the Cupertino Municipal Code,Section 9 18. / RE-ROOFS: Signatu Date ` IL 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 t pertino Munici 1 Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code, Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized ag 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 in consequence 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 PERMIT APPLICATION its COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228•FAX(408)777-3333•buildinq(aDcupertino.org PROJECT ADDRESS ` O g Q J�V A,"_ Cf • (�,t �r�S"-- APN# 32-1 — a J—b OWNER CONTACT vn` [ CITY,STATE, ZIPg jGLt, TO S Q6 `" N ! s-3 FAX TOWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME' 7 LICENSE NUM ER LICENSE TYPE ,� BUS.LIC,H VIOLA S,1 d R-r . ,�o �- COMPANY NAMEt` E-MAIL FAX r� d_rr aro f qqq frt,c e>12tAd-erbro-r►tevs @ c,if� y _Q r STREET ADDRESS 5 d ( Tti f usy r'p� �j. * CITY,STATE,ZIP r k��� y �y P 2O 3 3` DESCRIPTION OF WORK -t 1 1 ..Q/In�I•V,.� 1/_ ,'" Q J Pa � I i2 ;7 OFFICE�TTSONIY RESIDENTIAL #DWELLING _ r � . s UNITS - TYPB I FT. VALUATION FLOOR AREA UN COMMERCIAL �� =tet 1r�1 FLOOR AREA TYPE OF CONSTRUCTION /� #STORIES AQMD JOB NUMBER �/ RRCEIVEDBY r T014L©UATION J#: N 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 comply with all applicable local ordinances and state laws relating to building constgaction.javthorize re resentatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: If r f 2--/ l SUPPLEMENTAL INFORMATION REQUIRED PRIOR TCISSUANCE OF DEMOLITION PERMIT OFFICEusE ONLY Provide Job Number from Bay Area Air Quality Management District www.baagmd.ora @ 415-749-4762. PLAN CHECK TYPE i Provide three copies(Residential)or six copies(Commerical)of a site plan showing protection for any trees 10" ❑ EXPRESS" `in diameter or more at 3'above grade. STANDARD /Provide letter from PG&E(408-725-3325)stating all gas and electric has been disconnected. LARGE Provide a letter of inspection,tests,and abatement of any Hazardous Materials.Letter to be initiated by person(s) MAJOR / certified in asbestos,mercury and/or hazardous material examination. Planning Dept clearance to verify building is not considered an historical landmark.Allow 10 business days. 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. DemoApp_2013.doc revised 02/13/13 CITY OF CUPERTINO D FEE ESTIMATOR— BUILDING DIVISION ADDRESS: 21088 Lavina Ct DATE: 11/20/2014 REVIEWED BY: Sean Al BP#: *VALUATION: $8,000 xPERMIT TYPE: Demolition Permit P/,, % CHECK 1111 PRIMARY PENTAMATION 1 SFDWL-DEM USE: SFD or Duplex PERMIT TYPE: i WORK Demolition of existing residence 1191 sq ft). SCOPE FEE ID FLR AREA S.f. 1DEMORES 1,191 LF , c,rr Plan Cktec Cl?+wih. Plan E.`heoil 1%c' 11U��Check Ltx;l 1'er-77itFee• I'rrmitFet,:: I I - x'e? '`<'E' t),rrc v r"r c'6:. ImT? Other I" Mb Ini`I+. (r't er 1 lc(, Irsp. llhu0hi p. Fee. !<i;c'.Ir NOTE: This estimate does not include fees due to other Departments(he.Planning,Public Works,Fare,Sanitary Sewer District,School District,etc.). These fees are based on the prelimina information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Tee Resolution 11-053 Eff. 7/1/13) FEE QTY/FEE MISC ITEMS Plan Cliec:h "(X: PC 1, Permit Fee: $574.00 Suppl. Insp. Feer Reg. 0 OT 0,0 hrs $0.00 Permit 1,ee: t�'rTtph' r�tt"!'1(71{t�eC7`i71t77 "4c:1L'ujlee(l/=%1(7'1{=ing ]`Oes: Strong Motion Fee: IBSEISMICR $1.04 Select an Administrative Item Bldy,Stds Commission Fee: 1BCBSC $1.00 s , $576.04 $0.00 , T(aAL'FEE: $576 04 Revised: 10/01/2014 ;Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 C O P E RT I N O Telephone: 408-777-3228 Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS:Qloglk v/r7 PERMIT# OWNER'S NAME ,� PHONE# GENERAL CONTRACTOR:5n /`0 &7n6- . ',c BUSINESSLICENSE'# ADDRESS: CITY/ZIPCO:DE:' cf5(5a jr? *Our municipal code requires all businesses working in the city,to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL-BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND UB ORS HAVE OBTAINED A-CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: l/o� Signat a ate Please check applicable subcontractors and complete the following information: 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 ---- C Elvis NOV_ ® �O�n f ANGELA LEE 'V Y '7 I aE�jt" @k 3 I. ARCHITECT .n L/+Vtn IcPY ?Z %J rZ— C•� '1 _ -- — ttEniU�p(650132t�5>e2 , a PLOT PLATYS —W— Inol. CHECKED B/9Y�)//'j jp l { J° DA C'QMMUNITY DrlG P►�AFNT DEPARTMENT NG DEPT. j ¢ > ? M BUILDINGA ISDN,-CUPERTiNO PLAN . qPROVED DATE G . Thl s t of puns a�d speclflcations MUST be kept at the I job site.ourong construction.;it is uniawful to;make any ; BLDG.:_DEPT: I changes or aiteration�same,or to deviate i W therefrom,without prOvaFfrQm fibs guildingA#ficial. n F jN4 Tia star�ninc of this pian ane spec4icst'sons SHALLNOT; v 5 he held to PeTnif or to-heath approval of thA violation of&ay_proviq,lons of arty City Ordinance or State Law. T ^"° - �Y � >� _ naeK-cmc�xG�r�as a TP ' T1f.D W0 uta.JR DATE �,� _ z, K �,, �la o i 141.3 PERIMIIT NO. -