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15040200 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21815 LOMITA AVE CONTRACTOR:K&M DEVELOPMENT PERMIT NO: 15040200 INC OWNER'S NAME: 21815 LOMITA AVE LLC PO BOX 2535 DATE ISSUED:04/27/2015 OWNER'S PHONE: 4083905127 CUPERTINO,CA 95015 PHONE NO:(408)253-9787 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL F] COMMERCIAL F] �j DEMO(E)930 S.F.SFD(PERMITS 15030083& License Class Li..# / 15030084) Contractor?e%40%_?L4��cDate LS I hereby affirm that I am licensed under the provision of Ch pter 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:$15000 ave 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:35716061 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 DAY SSUANCE 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 DA T ED 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 Z� granting of this permit. Additionally,the applicant understands and will comply sue with all non-point source regulations per the Cupertino Municipal Code,Section 918. RE-ROOFS: Signat Date Z8 �� 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. 13OWNER-B ECLARATION 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 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 25505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this ��_ permit is issued. Owner or authorized a en • Date: 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 918. Signature Date r1� � V DEMOLITION PERMIT APPLICATION O 1/ Igo COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION 10300 TORRE AVENUE-CUPERTINO,CA 95014-3255 CUPf1TINCJ (408).777-3228-FAX(408)777-3333-buildin cupertino.org PROJECT ADDRESS 7/(2It /t v� APN# S� /,�; - O�6/ OWNER/N IE L� 9 t,"61 G�C P ON .z E-MAIL f ../i S✓ 90_S/ -tea `4Q STREET ADDRESS CITY,STATE,ZIP FAX CO /�/ZM{7�� pC/�J�✓C9 P ONE STREET AD RESS , CITY,STA ,ZIP ' OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER /❑TENANT CONTRACTOR NAME�2 /) / /LICENSE NUMBER LICENSE TYPE BUS.LIC# ZZ 'e74 .�. CO PANY NAMEE-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PH jE 39n S/ DESCRIPTION OF WORK RESIDENTIAL #DWELLRJG 30 "'� �, �,..,a.'. '' :, t FLOOR AREA UNITS COMMERCIAL FLOOR AREA - Fk ,, TYPE OF CONSTRUCTION #STORIES+► .,g , '�` i AQMD JOB NUMBER TOTAL VALUATION: J#: By my signature below,I certify to each of the following: I am the property owner oraWferized agent to the propertis behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and ve' It is accurate ee to comply with all applicable local ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter thea entified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION RE EDP OR TO ISSUANCE OF DEMOLITION PE IT "_0MChUSB;oNLY' Provide Job Number from Bay Area Air Quality Management District www.bp-gmd.org @ 415-749-4762. PGAIVCHECK-TYPE, Provide three copies(Residential)or six copies(Connnerical)of a site plan showing protection for any trees 10 � sxr> ssr in diameter or more at 3'above grade. �j 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 an Hazardous Materials.Letter to be initiated b "pAt p y y person(s) 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: 21815 LOMITA AVE DATE: 04/27/2015 REVIEWED BY: MELISSA APN: 35716061 BP#: "VALUATION: 1$15,000 *PERMIT TYPE: Demolition Permit PRIMARY7 PENTAMATION 1SFDWL-DEM USE: SFD or Duplex PERMIT TYPE: i WORK DEMO E 930 S.F. SFD PERMITS 15030083 & 15030084 SCOPE FEE ID FLR AREA s.f. 1DEMORES 934 � 7a t s o- m" i,` jSi y-Meg Wech. Plan Check EPlumb. Plan Check Elec. Plan C°heck Lle& Peprnit Tree Plumb, Permit Fee: Elec. Permittee: D/her-Wech. In Other Plumb Insp. Other klec Insp. Lletcia. Insp_ tee: Plumb. hasp.Fee: L'leC.Insp.Fee: 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 . 7ff /1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: suppl. .P(- FCe I'lzrrnl�.;'11ech.;Islet Permit Fee: $574.00 Suppl. Insp. Feer Reg. ® OT Q,Q hrs $0.00 1'l7trnl�.%'�t�e cla.;'Islec t'ta�nzh.l�lsch..�Zslec Permit Fee: Consta-action Tax: Administrative Fee: iG'ork Without Permit? Advanced Planning Fees: Travel Documentat.h n Fees: Strong Motion Fee: IBSEISMICR $1.95 Select an Administrative Item Bldy Stds Commission Fee: IBCBSC $1.00 $576.95 i0.00 e AI1E'EE ` $576.95 Revised: 04/01/2015 �UpERTI40 �u �n 97-27 97. FL E .3�ildin4 Oet� ONFO Rt EXISTING�cNC'eTC 9E (CONFC2S REMOVED @ 7H1S SECTION �1 �1 ��� _ TREE PROTECTION FENCE OS �� 4.5, 51_i `. is, to .' APR L SEE CITY STANDARD DETAIL vi ' .',,,•a °yC �,O�IP'-`�`,lC,' a�.,, NO-1ZO0'E ..=�+: - ._19aazCM \apq \yqa�' •'`'°' t�5•I \ c°�q1?; �11 �Cl.! N O°1'2'00'E ?%A� -���� -.:f\ '�1 `- - �� -.-�� -- �� - •�� - -• •. b1 1•' '\ '� 193.42' .4Z 4g ppey I ,/�.e;�G' /' �°3 0 P•:.•..1eZ Q q1� y� 8.017. v�q1 \`• ' 1' '� ve1FfBd U a1 y �.^�v yb ,� m Ny _. _ .. q10 "�./�' 4H q .� °j C'+� �jb ./�r� y s �'. ¢ •/ 1 Rp�jl� I a 12 91h ( 1y\ 1°Y' 8•.•. - C� °'1 v7 y0 `�,0,Z �7 a / ,� 9 " DRY wELL / 6 121 8.SX8 1 ° 10� '-0' c a SEE OEL I/C•S if. C' m b s 1 co r 1 a.. a'1•. `Ca1`1° . .O,Z Zy ��`q yimp qar .. y N 1`�• y \YM11 .^ In 1? v°i C q a Q q9 �:ry i1J V r l P 97.75 GARAGE O A FRUIT-TRE'e • 'f n••�:•'.�/ a J '� RC�i 16 75.17 I4' 017130 / 1 l��' ► ga DI Ci I iL � - - - - �— �- - - -�=•-^-_-.-•-_- - d- - - - - - - - --- - - - -gig - - _: --=� .•1: $ f � � - • - _. _ ..._.__ — N 0"12'00"E 19 mt C ° nl �N 19• +-.���1 ._��16y._. �,^� cap' . . .i� '� / s A° 1 . 1 q D �.1 4' 9 I oo 3 ♦ DRY WELL ti\ �- ¢ u'. 1 I I Bsxs sxs DEEP :: o i db01 SEE DET.1lC•5s .! •, 3° GARA�'iAE a 26'-g' 1.7% <�..i�._.�� j'q• 3 3.� �1 og c A. AR QJ I PARCEL•A Za q} qq i`• qA �.� by�ep9°' FF.101.00 `�•b"� FRUIT TE i/ q G p Z 1 1 PAD 99.00 Z 13 09 \c9VALNUT qQr• qq ..,, � 1 ,g q0 qq• j• �qqq>' �Z.Z�y 8'AD @ ; O 1La�,by �Ab!a3 t�q�1A q - qq INV,91L r ./ ' BEAR 17• 1% p0a?Ra T co MW = PMENT P�iR'Ybl �. ' --�� --,n, •�,-- 9i'�� sEe e ' � I �I V I S N O.1700'E po•193.42 qS -• --f_f. - -'��'- -��•- - - •. - tee• "�'"T-�iiL�j171��' ''�-f• '.-:-..`°. 1 r- J _ _ �•��-��� ••I• ;. 1 •99.A .ai',•.1 •- 4"y° '/-� . o G •-! �91j G'qq •"'vf.' J�G••F VED �'qq /.� N01200'E 18.42' GPRIVET /14' PRN ITAL CYPRESS �.'�. qq ?RNET 1g�OED( N �� This set of plans antl spe'i (cations MUST be kept at the -• ,� EXISTING FENCE TO BE 4 job site during construction. It is unlawful to make any REMOVED @THIS sEcnoN a � Q ;i s LEGEND: changes or alterations on same, or to deviate yC »- O DOWNSPOUT AND SPLASH BLOCK therefrom, wilout approval from the Building Official. \3� e3 y 0 5' 10' 20' 40' The Stamping tys'I tan an ;.,;; ,,s. HALL N be held to pe ` i of the violation " ! ' of an I nce or State Law. 1-7; 4 '17 E� DATE. Z / ERMOUS A ALCULATON .4 1.7 2014 PERMIT# WORK OUANn11ES .j� `w D� ' P R P NO cVPER-C