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15050095 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10784 JOHNSON AVE CONTRACTOR:TITAN GENERAL PERMIT NO:15050095 CONSTRUCTION OWNER'S NAME: YINAN WANG 46509 MISSION BLVD STE 118 DATE ISSUED:05/15/2015 OWNER'S PHONE: 4088968822 FREMONT,CA 94539 PHONE NO:(408)883-8668 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL ❑ DEMOLISH RESIDENCE(897 SQ FT)AND GARAGE(260 SQ License Class_ Lic.# �� F FT). Contracto,T ft,L g,� 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:$11000 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:37531003.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION l 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 Issued by Date: granting of this permit. Additionally,the applicant understands and will comply with all non-point soa regu ' s per the Cupertino Municipal Code,Section 918. RE-ROOFS: Signature Date �— r s —!S 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 the CupErthro4junicipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,2553 ,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date:5,—S—1/ 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 0 o [a COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333•building _cupertino.org PROJECT ADDRESS O ] cj� �hnSON AV,e, ' �,�lyyp APN# 7E_ 31 _ Do3 OWNER NAME t o`t' yl PH NE E-MAIL ln04 W R o��Q6- �2- nannai? Way®,Va& ,cQ� STREET ADDRESS `0Z7O T�/�� , ,^ CITY, STATE,ZIP /)�s/>p,ri �! G/1 Q1 �j/ FAX CONTACT NAME I k„/y (� I PHONE I/.nD �•/iJ/ Q(� EMAIL STREET ADDRESS I Z�jL`+4 to SGY� A a wa Vej'CA0 ITY>STATE,"rZ°IP�I�a�(r� 6� n Q/ �� FAX 'L-0 - 4.4^(5-3 2 OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT � CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT`1❑ENGINEER ❑ DEVELOPER 1:1 TENANT CONTRACTOR NAME b NyCe® t VI 8 LICENSE NUMBER (�r d17 7• LICENSE TYPE��rZBUS.LItC'# COMPANYNAME FAX G1,em169'Stc -P,,1 M -tfm I ® dI4111021n STREET ADDRESS CITY,STATE,ZIP S40 T PHONE+�O O n=^e _ O�_77 3 2 Phelan AVS DESCRIPTION OF WORK RESIDENTIAL lrf( � #DWELLING OFFICE TISE ONLY FLOOR AREA r UNITS d - i �' USE= 7'OCC. =.TYPE S .FT. " EVALUATION . COMMERCIAL ' T FLOOR AREA .,nI .., SFr , TYPE OF CONSTRUCTION #STORIES AQMD JOB NUMBER RECEIVED BY TO VALUATI J 4AI O UO 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 red 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 construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: tP 3 AIF SUPPLEMENTAL INFORMATION REQUIRED PRIOR TO ISSUANCE OF DEMOLITION PERMIT :` oFFic usE oitiY _Provide Job Number from Bay Area Air Quality Management District www.baagmd.org @ 415-749-4762. PLAT,CHECkTYPE Provide three copies(Residential)or six copies(Commerical)of a site plan showing protection for any trees 10' FxPx>ss in diameter or more at 3'above grade. 0 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 02113113 CITY OF CUPERTINO D FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 10784 Johnson Ave DATE: 05/15/2015 REVIEWED BY: SEan APN: BP#: "VALUATION: $11,000 *PERMIT TYPE: Demolition Permit PLANCHECK TYPE: PRIMARY SFD or Duplex PENTAMATION 1 SFDWL-DEM USE: P PERMIT TYPE: A WORK Demolish residence 897 sq ft and Garage 260 sq ft). SCOPE FEE ID FLR AREA s.f. 1 DEMORES 1,157 a3 ire— 21 a ,. y= WK- llech. flan CheckPhlmb. Plant('heck Elec.Plan(`heck tlech. Permit Fce: Plumb. Permit Fee: Islec. Permit Fee: Other Hech. Irtsn. Other Plumb Insp_ Oiher Elec.Imp. 11ech. Insp. Fee: Plumb. hasp.Fee: E;lec.Ins"),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 onl an estimate. Contact the De t or addn'l info. FEE ITEMS (Fee Resolution 11-053 E . 7( /f 1/13) FEE QTY/FEE MISC ITEMS Plan Check:Fee: suppl. Pt'Fee Platna h.L�1�cc•1a.%Flea Permit Fee: $574.00 Suppl. Insp. Fee:Q Reg. ® OT 0.0 hrs $0.00 1'lzttnf�. [Yleeh.;I1lccr l'Irrntb./11 clr.il>'lc:c Permit Pee: Construction :lax: ,ldininistrcative Fee: T,Fork Wzthortt Permil? "Idvaneed Planning Fees: Travel Docurnentation Fees: � Strong Motion Fee: IBSEISMICR $1.43 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 $576.43 $0.00 , Toa FEE: , $576.43 �x w — » Revised: 05/07/2015 7�- /-/3 i I RECEIVED STORM 95.36 yy y MANHOLE 13 swrrAar 95.,0 _ _ MAY MANHOLE �2 MONUMENT d �-EDGE OF SIDEWALK ADJACENT PROPERTY OFFICE COP d� v 96.11 `AT�. OF�ET 97,4610770 JOHNSON AVE. _ _ I/ _ _ i LANDSCAPE �Y W 98.84 > 3 Fi. RE . FENCE PROPERTY UNE 101.39' GUTTER -5 FT. FENCE 6 FT. REDWOOD FENCE 99.44 99.58 99.60 GROUND GROUND 1► W 97.16 99.58 99.50 GROUNDup / CURB GROUND GROUND W 97.46 8.54 99 6 m LANDSCAP LANDSCAPE DSCAPE A' � I / 97.22 T' -------------I r---------I J STREET I 99.46 '"" I I Cluj Z 2 W c $' SLAB ( I METAL SHED I V) W f CLEAN OUT SEWER SHED I 1 9'-10' x 13'-2' 01� N F- W FACE OF CURB S/W 1. 99.20 M (O K ) I I \ I BE REMOVED 99.84 Lj Q LANDSCAPE b I �------,-J (- FACE OF CURB I WATER SERV I 1 ' Slag W U E \ I I 98. 99.38 W/H -ELECTRIC SERVICE METER L-L. N 97 LAN E SLAB EXISTING RESIDENCE CUTTER 1 99.80 97.76 I =__ 10784 JOHNSON AVE. � 99 2 Q CURB (TO BE REMOVED) I NO z . /W 99.35 ~�� 1 99.64 0 D/W CONC. SLAB i _ I PATIO SLAB GROUND O (� I I 99.70 8'DIM(. v• GAS MAIN) I +' SLAB FRUIT TREE m O SLAB IF a I F/PX J O i 11100..004, 100.29 O W o z 99.80 ! r"""" DOOR THRESHOLD 1 J W zo St I 99.10 GATE I ' 99.eo 100.1 O Q in a v �L g� ----------tIIIII­ 99.76 GROUND OROyND . Z97.52 I S/W S N c tC GUTtER CONC. DRIVEWAY 99.80 99 88 99.80 97.90 GROUND S S/W W LU CURB ~ 99.18 \-5 FT. REDWOOD FENCE 0 97.96 I D 100 6 Fr. REDWOOD FENCE DA 100.04 99.82 GROUND 100.12 100.18 99.58 (�pUNp GROUND GROUND NORTH r 98.04 TER VALVE 6 Ff. REDWOOD FENCE D/w " LANDscAPE 99.74 GROUND / PROpERt1 UNE 92.69' O P M E N T D E PART 3DWD / BUILDING DIVISION - CUPERTINOENT m 97.84 I 98.10 97.65 STREET _ _ APPROVE© [�I STREET o ADJACENT PROPERTY This set of plans and specifications MUST be kept at the Y a REfE(tENCE NE _ 98.05 �. CURB 10800 JOHNSON AVEjob site during construction. It is unlawful to make any � W Z �• `�" changes or alterations on sanne, or to deviate I therefrom, withouIt approval from the Building Official. � «" ale a The Stamping cf p p W R1 p y h,s Ian and s eci cions SHALL NOT CL be held to permit or to bean approval of the violation ��• 10000 ' of any provisi ns of any City rdinance or State Law. U DATUM E4 100.18 1 BY- DATE /� •/5 �, PERfL11T# /SGS O� .� t STORM SEWERMANHOLE MONUMENT tri I CENTER OF STREET I �J