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15050099 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21815 BENETTI CT CONTRACTOR:BOB'S BOBCAT PERMIT NO: 15050099 SERVICE,INC. OWNER'S NAME: JENNY CHANG&YOUWAN KANG 567 ARLETA AVE DATE ISSUED:05/15/2015 OWNER'S PHONE: 4082426562 SAN JOSE,CA 95128 PHONE NO:(408)998-8766 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL F] COMMERCIAL ❑ ? DEMOLISH SWIMMING POOL(525 SQ FT) License Class �� Li..# � 0 q� Contractor dD S Q7 �P.t'd�`lYr¢ s lS��S 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:$12000 1 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:32649032.00 Occupancy Type: e . >s,ssued. 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 /✓ �G granting of this permit. Additionally,the applicant understands and will comply Issued by: �� Date with all non-point source regulations per the Cupertino Municipal Code,Section 918. 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 I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 1,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,Sectio s 2 0 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. 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 DEMOLITION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228•FAX(408)777-3333•buildingacupertino.org PROJECT ADDRESS// �j j� / APN#�Y6 - L OWNER NAMEe to A.'. �/ 4 t-j t' PHONE!m 8'��r 41 e4EMAIL STREET ADDRESS (,/ �` ��L L' /1 CITY STAPeZ j j�b // r+�O/ FAX CONTACT NAME �,.o � 7 T (y PHONE`Y09 , -(j�� E-MAIL. STREET ADDRESS -�J CITY, ATE, ZIP FAX S G? r-k- a-e /d�u .SSS-e �� l'S'i ,:r —7 6 ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT p✓CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME kfo�� /// �� LICENSE NUMBER, LICENSE TYPPES BUS.LIC# COMPANY NAME6. S C 1 � EMAIL /� b S bQ �� y , FAX�f 29,`7KGs STREET ADDRESS l/J/�bv Ate CITY A(w T�,(� IPJ 60/4 . A �/�' /��j PF NF7! DESCRIPTION OF WORK (' '`�+ /f ( jj oa a env 3 RESIDENTIAL #DWELLING - �.�h. d I.I IW FLOOR AREA UNITS - �ik41"i�'; .Fr m �` a ' �� ` Tf9,II� ",.121115'1-1� ftR ",meCOMMERCIALFLOOR AREA aG ; F� �a TYPE OF CONSTRUCTION #STORIES AQMD JOB NUMBER -t, `^--" T VALUAT�IIgqN J#: _ _ JOU 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 buildi g constructio . I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMAT16 REQ D PRIOR TO ISSUANCE OF DEMOLITION PERMIT Provide Job Number from Bay Area Air Quality Management District www.baaamd.org @ 415-749-4762. 4JPC �GXP>i Provide three copies(Residential)or six copies Commerical of a site plan showing Protection for any trees 10" in `flrrx'E�ss Yf�x; diameter or more at 3'above grade. r $, Provide letter from PG&E(408-725-3325)stating all gas and electric has been disconnected. Provide a letter of inspection,tests,and abatement of any Hazardous Materials.Letter to be initiated by person(s) a certified in asbestos,mercury and/or hazardous material examination. ai b i r 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. ;g� _ fl` 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 Benetti Ct DATE: 05/15/2015 REVIEWED BY: Sean APN: BP#: *VALUATION: 1$12,000 *PERMIT TYPE: Demolition Permit PLAN CHECK PRIMARY PENTAMATION USE: Swimming Pool, Res. PERMIT TYPE: 1SFP00LDE i WORK Demolish Swimming Pool 525 sq ft SCOPE FEE ID #POOLS 1DEMOPRES H9 - W{ # Mech. Plan Check Plumb. Plan Check Elec.Plan C°heck Meeh. Permit Fee: Plumb, Permit Fee. Iaec. Pennir Fee- Other A1ech. Irrsp. Other Plumb Insp. Li Other 1'.lec.Insp, Li Ile& Insp. Fe-, Plumb. Insp. Fee: klec.Insp. Fee: NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). Thesefees are based on the preffiftWdna information available and are only an estimate. Contact the Dept-for addn'1 info, FEE ITEMS(Fee Resolution 11-053 E . 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: suCppl. N: Fee I'htmb.%r��lec•Ia.iF.,lec, Permit Fee: $329.00 Suppl. Insp. Feer Reg. ®OT 0,0 hrs $0.00 Plztm/3.%1leclz. Elec Ylzznzh.i;llec°1z./1:'lec Perna t Fee: Construction Tax: Administrative Fee: H,ork Without Permit:? Advanced Phinning lees: Travel Documenlatzon Fees: Strong Motion Fee: IBSEISMICR $1.56 Select an Administrative Item Blde Stds Commission Fee: IBCBSC $1.00 Now $331.56 $0.00 $331.56 Revised: 05/07/2015 �:- Al r4i- OWED M. Y U1 5 DEMO foot. ri z , _ -- - c., 1 , � S : I / O>< Pv : - I TY E LOp D I — Q _. DFV G i\,l �RTM" NT __. _.... P 1 E L�1-T -. - _. _ - l� � sit f .f � E : : I : o �ii`C lJ � pan OV catren �� d c, `r r eke t r � s� , : s i t (C - - -_� - �,ark � t:n �truc,ion. 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