15040073 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10282 MENHART LN CONTRACTOR:D&D CONSTRUCTION PERMIT NO:15040073
AND DEVELOPMENT
OWNER'S NAME: BROBERG ROBERT NEAL III AND SAN W PO BOX 3565 DATE ISSUED:04/09/2015
OWNER'S PHONE: 4087720715 FREMONT,CA 94539 PHONE NO:(510)579-2353
I LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL E]
T� & S SFDWL DEMO LIVING 1078 SQ FT,GARAGE 225 SQ FT
License Class Lie.#
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:$2000
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:37517016.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXP"SIF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 18 YS 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 DAY AST CALLED INSP CTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments, ^
costs,and expenses which may accrue against said City in consequence of the Issued b Date: (,�
granting of this permit. Additionally,the applicant understands and will comply 3''
with all non-point source regulations per the Cupertino Municipal Code,Section
918.
RE-ROOFS:
Signature Date Q 1 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)
1,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(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,Sectio s 25 5,25533,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. 14
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
9 18.
Signature Date
DEMOLITION PERMIT APPLICATION n/
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (,�U
C U P E RT I N O (408)777-3228• FAX(408)777-3333•buildingCc)cupertino.org r V
PROJECT ADDRESS APN# 7-5--
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OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONI RACTOR NLICENSE NUMEE 7, / :,3 LICENSE TYPE BUS.LIC#
COMP f NAME E-MAII 1O FAX
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DESCRIPTION OF WORK ryry�� � � _ � 1
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RESIDENTIAL #DWELLING y h SOFRICE iJSE ONLY
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FLOOR AREA ��� UNITS
COMMERCIAL
FLOOR AREA
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TYPE OF CONSTRUCTION #STORIES h _
AQMD JOB NUMBER t �� RECEIVED BY { TOTAI�ATION:
J#: 4
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 build' g construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: r Date: — ^2-0 1 s—
UPPLEMENTAL INFORMATION REQUIRED fR IOR TO ISSUANCE OF DEMOLITION PERMIT oFal`cE usE onJ Y
vide Job Number from Bay Area Air Quality Management District www.baagmd.org @ 415-749-4762. PLAN-cHEcxTYPE,
_ rovide three copies(Residential)or six copies(Commerical)of a site plan showing protection for any trees 10' +,ExPREss'
in lamPter or more at 3'above grade. STAI�DAxD
P de letter from PG&E(408-725-3325)stating all gas and electric has been disconnected. LARGE
de a letter of inspection,tests,and abatement of any Hazardous Materials.Letter to be initiated by person(s) M tJOR
<rtified in asbestos,mercury and/or hazardous material examination.
rang Dept clearance to verify building is not considered an historical landmark.Allow 10 business days.
_ Ovide letter of clearance of all vermin from a licensed pest control contractor.
LLApplicant 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_2413.doc revised 02/13113
CITY OF CUPERTINO D
lollFEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10282 menhart In DATE: 04/09/2015 REVIEWED BY: Mendez
APN: BP#: *VALUATION: 1$2,000
*PERMIT TYPE: Demolition Permit PLANCHECK
PRIMARY PENTAMATION 1SFDWL-DEM
USE: SFD or Duplex PERMIT TYPE:
WORK sfdwl demo living 1078 sq ft garage 225 sq ft
SCOPE
FEE ID FLR AREA
s.f.
1DEMORES 1,303
Wch. Plart Check Plumb. Plan Check I.lec.Plan(Iectc
�1ech, Permit Fee: Plumb. Permit Fee, Elec. Permit Fee:
Other Alec°h. Irisp. Other Plumb Insp. EI-L--70thei, lec.Insp. p2A
Gtech. Ins/). Fee: Plun1b. h"l). T ec,. slz Fire:
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 prelimina information available and are only an estimate. Contact the Dept for addn'1 info,
FEE ITEMS (Fee Resolution 11-053 E . 711/13) FEE QTY/FEE MISC ITEMS
Plein C'he'ck Fee:
Suppl, PC'I ee
Plzttnb. "llecla./Ilec
Permit Fee: $574.00
Suppl. Insp. Fee:Q Reg. ® OT 0,0 hrs $0.00
I'lrtrnb./,1 tcc{a.;'"1�'lc�c:
1'ltararh.; 19 ch.%lslec Pe}r^nrit Fce:
Construction Tax:
,ldministrative Pee:
14,'ork H'ithoutPermit?
zldvaltced Planning 14'ees:
Truvel Doeurnentatiun Fees:
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
011
V� $575.50 T AL7 � $575.50
$0.00
Revised: 04/01/2015
Site Demolition Plan Scope:Remove existing house and garage (1882 sq ft),driveway, concrete patios
and walkways, exterior firepit, all fences& gate along Menhart and Wunderlich
Address: 10202 Menhart Ln,Cupertino CA 95014 (excluding the fence along adjacent properties), and all shrubbery and trees not
marked for protection on the plan diagram. As shown in the diagram,the elm tree
Owners: Robert Broberg & Wendy San on the corner of Menhart and Wunderlich and the lemon tree in the backyard will
be protected via fencing as per standards during demolition.
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