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15030015 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19240 TILSON AVE CONTRACTOR:D&D CONSTRUCTION PERMIT NO:15030015 AND DEVELOPMENT OWNER'S NAME: BENG-TAK TING PO BOX 3565 DATE ISSUED:03/03/2015 OWNER'S PHONE: 4085062610 FREMONT,CA 94539 PHONE NO:(510)579-2353 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL DEMO SFDWL 1032 SQ FT License Class_ Lic.# O b Contractor Date 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: 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:$500 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:37540057 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 FROCALLED INSPE ION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, (7 costs,and expenses which may accrue against said City in consequence of the Issued by Date: granting of this permit. Additionally,the applicant understands and will comply with all non-poi t sour egulations per the Cupertino Municipal Code,Section 9 18. _�� ��,� RE-ROOFS: Signature Date 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. 1 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(x)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 t559",233,and 25534. _ 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 CONSTRUCTION LENDING AGENCY 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 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 918. Signature Date DEMOLITION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION 10300 TORRE AVENUE-CUPERTINO,CA 950143255 CUPERFINO (408)777-3228-FAX(408)777-3333-building@rtin cupeo.org PROJECT ADDRESS 19240 Tilson Ave,Cupertino,CA 95014 APN# 375-40-057 OWNERNAME Benjamin Ting PHONE 408-506-2610 E-MAH. bting@hotmail.com STREET ADDRESS 19240 Tilson Ave CITY,STATE' Cupertino CA 95014 FAX CONTACT NAME Benjamin Ting I PHONE 408-506-2610 EMAIL bting@hotmail.com STREET ADDRESS 19240 Tilson Ave CITY,STATE,ZIP Cupertion CA 95014 ', FAX M OWNER ❑ OWNER-BUILDER ❑OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTORNAME C,G'W�.':f Al j XL LICENSE NUMBER 8.��zQ7LICENSETYPE BUS.LIC# 33,519 p-1{} T,r COMPANY NAME V XUk I O O(9 y o'.kA G(7 FAX �j STREET ADDRESS ,Z � CITY,STATE,ZIPj^y"G PHONE -5,o 7 27 5-5{ C DESCRIPTION OF WORK RESIDENTIAL /s1�1 #DWELLING 1OMCE USE ONLY FLOOR AREA ✓P' UNITS USE OCC TYPE so.M VALUATION COMMERCIAL FLOOR AREA TYPE OF CONSTRUCTION New #STORIES 2 AQMD JOB NUMBER 4T 6C9 RECEIVED BY. TO f�U]A/'f�ON: J#: LVJ `�.y�i- By my signature below,I certify to each of the following: I am the property owner or authorized agent to act a property owner's behalf. I have read this application and the information I have providedis Treethe Description of Work and verify it is accurate. I agree to comply with all applicable local 1 r9id ordinances and state laws relating to buildin resentatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: 2015 UPPLEMENTAL INFORMATIO D PRIOR TO ISSUANCE OF DEMOLITION PERMfT OFFICE USE ONLY- ' e Job Number from Bay Area Air Quality Management District www.baagmd.org @415-7494762. PLAN CHECK TYPE X,'1'4�edfde three copies(Residential)or six copies(Commerical)of a site plan showing protection for any trees 10" 0 EXPRESS inter or more at 3'above grade. ❑ STANDARD Vide letter from PG&E(408-725,3325)stating all gas and electric has been disconnected. ❑ LARGE X de a letter of inspection,tests,and abatement of any Hazardous Materials.Letter to be initiated by person(s) ❑ MAJOR fled in asbestos,mercury and/or hazardous material examination. XEjazpg Dept clearance to verify building is not considered an historical landmark.Allow 10 business days. w a letter of clearance of all vermin from a licensed pest control contractor. Ar .090 ,�est shall call the Public Works Department at 408-777-3104 and schedule a"habitable dwelling"inspection. igned Debris Bin and Recyclable Materials form. CITY OF CUPERTINO D FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 19240 TILSON AVE DATE: 03/02/2015 REVIEWED BY: Mendez APN: BP#: *VALUATION: $500 *PERMIT TYPE: Demolition Permit PRIMARY PENTAMATION 1 SFDWL-DEM USE: SFD or Duplex PERMIT TYPE: WORK DEMO SFDWL 1032 SQ FT SCOPE FEE ID FLR AREA s.f. 1DEMORES 1,032 ;. Fit.- 0i r2;i m o ' ,lleeh. Flan Check Plrrrxb 1'larr Cdreck ISlec. Nan.C'heck 9eclr. t'ermit Fees Pltemb.Permit Pee; Islet. Permit Pee: Other,leech. trup. Ocher Plumb Trap. other Islet. Insp. .14ech. Insp. Fee Plumb. hup. Fee: L-lec.Imp. bee: 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 therelimina in ormation available and are onlyan estimate. Contact the Dept or addn'l info. FEE ITEMS(Fee Resolution 11-053 E . 711113) FEE QTY/FEE MISC ITEMS Plan Check Pee: Sulpl. .PC Fee 77�:] Plztm .illcclz.iElec Permit Fee: $574.00 Suppl. Insp.Fee-0 Reg. ® OT 0,0 hrs $0.00 1'latrnF3./t 1ec1�.;7s'lec Pl2�rstb.r1ec/z.ilslec Permit Fee: Construction Tax: iclininistrative Fee: bi�ork Without Permit? Advanced Planning Fees: 7'M vel Documenfalion Fees., Strom Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldp,Stds Commission Fee: 1BCBSC $1.00 m $575.50 $0.00 TOAL FEE: $575.50 Revised: 02/14/2015 UUM&O RE00[DEE B-DE � o g�o Tj3a[L,(;3oa aW[�o N86'38'49'W 61.00' 1044 I � N I 67F, ST S I PLA►,NNING DEPT 0 w CUPERTIN© - - - � a c I I DEMOLISH (E) ONE I I N STORY HOUSE AND rp u�` I ATTACHED GARfp� t=f ' a� C�gU11-10, � � L tat the � � aof puns �. I I This cor truct}cn. r lob site durtn� er2,�1°ns cn �R. ,�, ort o .9`r, chane ora nroa.sl frot,� tr,a��;,� o I therefrom, Its plan and So• ('i.. `` a, I Cvc us i e"-tmPiMl ! r t0 be B�ar:5 SGi; Gr Sij w be L aw.�r°vist I N Q:z d� 00 OVA ?F-ami'C N©. I N N86'38'49"W 61.00' SITE PLAN s: 1/16'=t'-o"