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15090013CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10149 S TANTAU AVE CONTRACTC PERMIT NO: 15090013 CcZwL/�`r� /3ro t OWNER'S NAME: WANG R TRUSTEE & ET AL I I DATE ISSUED: 09/01/2015 1 OWNER'S PHONE: 4083958016 1 , I PHONE NO: LICENSED CONTRACTOR'S DECLLAARRATION License Class Lic. # Contractor4WV,)/,i ,1 31-05 Date 9 / I hereby affirm that am licensed under the provisions of Chapter 9 (commencing with Spetion 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. IF 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 permit is issued. APPLICANT CERTIFICATION 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permits Additionally, the applicant understands and will comply/ with all non -point soWdce regulations per the Cupertino Municipal Code, SeoEie 9.18. Signature 0� Date u I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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 construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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. 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 permit is issued. 1 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 become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with, such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 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 constructioo, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep halrmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit! Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Date JOB DESCRIPTION: RESIDENTIAL [] COMMERCIAL ❑ DEMO (E) SFD (1746 S.F.). LEAVE ELECTRICITY FROM (E) MAIN PANEL FOR USE DURING DEMO (OK PER PG&E) Sq. Ft Floor Area: I Valuation: $15000 APN Number: 37507018.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST GALLED INSPECTION. 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. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 251505_,2553/3, aqd 25534. Owner or authorized agent: Date: CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CUPERTINO DEMOLITION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildinciacupertino.ora /�/�r� rJ/3 PROJECT ADDRESS L St APN # r 6 1 l %1 �-q V -e, OWNER NAME PHONE, E-MAIL STREET ADDRESS' J L G1+1 %CIG` %/ CITY. STATE, "LIPC r�©�L/ FAX CONTACT NAME ,y /G�j PHONE �, _ KI E-MAIL pF/ C 1/ /I ul STREET ADDRESS CITY, STATE, ZIP �- ( 64,E Ar // V n 4r FAX ;��tirr f>✓- 0 ❑ OWNER ❑ OWNQR-BUILDER ❑ OWNER AGENT [A CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAM / LICENSE NUN B K ,�%%`j LICENSE TY,j'E BUS. LIC # L1 COMPANY E-MAIL FAX v� STREET ADDRESSF & ^ j/C/ CITY, STATE, ZIP / PHONED ,5 ! L t' O DESCRIPTION OF WORK �t-- �v�,� /iS��, S��,fGhi —C RESIDENTIAL 4 # DWELLING OFFICE USE ONLY FLOOR AREA UNITS USE OCC. TYPE SO,FT. VALUATION COMMERCIAL FLOOR AREA TYPE OF CONSTRUCTION Vv _! _ d _ # STORIES AQMD JOB NUMBER J #: cm 20-0 orgL ALUATION By my signature below', I certify to each of the following: I am the property owner or authorized agent to act olao�operty owner's behalf. 1 have read this application and the intbrmation I have provided is correct. I have read the Description of Work and veri 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 ApplicanUAgent: Date: SUPPLEMENTAL. INFORMATION EQUIRED PRIOR TO ISSUANCE OF DEMOLITION PERMIT OFFICE USE ONLY PLAN CHECK TYPE Provide Job Number from Bay Area Air Quality Management District www.baaamd.org @ 4I5-749-4762. Provide three copies (Residential) or six copies (Commerical) of a site plan showing protection for any trees 10" ❑ EXPRESS in diameter or more at 3' above grade. ❑ STANDARD _ Provide letter from PG&E (408-725-3325) stating all gas and electric has been disconnected. El LARGE _ Provide a letter of inspection, tests, and abatement of any Hazardous Materials. Letter to be initiated by person(s) El 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. CITY OF CUPERTINO M1 FEE ESTIMATOR - BUILDING DIVISION 1AADDRESS: 10149 S TANTAU AVE � DATE: 09/01/2015 REVIEWED BY: MELISSA APN: 375 07 018 BP#: -VALUATION: [$715,-000 *PERMIT TYPE: Demolition Permit PRIMARY 8FD or Duplex USE: PENTAMATION lSFDWL-DEM PERMIT TYPE: WORK DEMO E SFD (1746 S.F.). LEAVE ELECTRICITY FROM (E) MAIN PANEL FOR USE DURING SCOPE DEMO (OK PER PG&E) FEE ID 1DEMORES F 7-, FLR AREA 1,746 0 q NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School i Di.vtrirt. etc.). These teev are hated an the nrPliminary information availahle and are only an estimate_ Contact the Dent for addnl info. FEE ITEMS'(Fee Resoluflon 11-053 Eff. 711113) FEE QTY/FEE MISC ITEMS Permit Fee: $574.00 Suppl. Insp. Fee. -(F) Reg. 0 OTT 0.0 hrs $0.00 A Strong) Motio IBSEISMICR $1.95 Select an Administrative Item Bldg Stds Corhmission Fee: IBCBSC $1.00 SUBTOTALS:.7$576.951 $0.00 TOTA�t FEE: $576.95 Revised: 07/02/2015 CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: 10 / 14 S, �"gv. L PERMIT #` D 7 00 OWNER'S NAME: � (,✓� � PHONE # O 47fd GENERAL ONTRACTOR: oc , BUSINESS LICENSE # ADDRESS: ;l6, lg % 6r/l G C - CITY/ZIPCODE: CaLmj9be1t O *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS��HA E OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not usin any subcontractor l5 S' nature Date Please check applicable subcontractors and complete the following information: Owner / Contractor Signature Date SUBCONTRACTOR BUSIN NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Lin*um / Wood Glass Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastejring Plurn6ing Roofing Septic; Tank Sheet iMetal Sheet (Rock Tile Owner / Contractor Signature Date A ft N D A V f-1 �d�N `dam i � n lid � � 7 u x o� 0° 51 MUMS aBvgt &iW�W�IaN A+pS�ppaPiS -7,777 eswx oµvo94Wary EunsP;3loattsTcl bI066 V,-3 `omuadnD . amreAV nMu'U glROS 6tI0I aurog wolsnD �¢ z w H aauapzsag L'AONJadUS 21 M m 0 ci ON -IF...... LL I n"i t 3 s� ff O G6 w Q. H � og Z e 0 f ZD w, i m X h nm = N LU�> 'a ° .r..... uj b � � �Z N< QJ i U i i i ff