15060167CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10657 LARRY WAY CONTrRAt TORHiq: " de/MN PERMIT NO: 15060167
OWNER'S NAME: KASAMSETTY KISHORE AND POTTURI SUDH �-5 I J' DATE ISSUED: 06/25/2015
OWNER'S PHONE: 4088321627 p� (.� � PHONE NO:
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL ❑
(� C� C ` DEMO EXISTING STRUCTURE AND REMOVE EXISTING
License Class Y� Lie. # "� s l r � � FOUNDATION
Contractor \– t 1\\ V�N �_L tk-< Date CO �)— 5 k
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: $15000
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: 31602011.00 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 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 D YS FROM LAST CALLED INSP CT ON.
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: `� N V Date:
granting of this e i . Additionally, the applicant understands and will comply
with all non -poi t ou a regul 'ons per the Cupertino Municipal Code, Section
9.18.
)-!Signature Date (o 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 Date:
Signature of Applicant:
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)
HAZARDOUS MATERIALS DISCLOSURE
I, as owner of the property, am exclusively contracting with licensed contractors to
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 t e netino nicipal Code, Chapter 9.12 and
the Health & Safety Code, Sectio 2255 an 534.
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 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 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
CUPERTINO
DEMOLITION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building0cupertino.ong 1506016':
.
PROJECT ADDRESS t �� ��� �y �� �6
`
APN # 31 & n� O i I
OWNER NAME
^ S �� ` (
PHO ��
E-MAIL �j( !Lg (,,,, C
l`I V
STREET A D S �_ % /0 /'. A
�
CITY, STAT ZIP /
A" � _O
FLAX'`
5 I
' L e C� l
CONTACT NAME
PHONE
E-MAIL
STREET ADDRESS
CITY, STATE, ZIP 7
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONT NA E c
��
LICE E N MBE
LICENS SE
BUS. LIC #
COMPANY NA (�
E-MAIL
FAX
STREET ADDRESSLj( 5-(
CITY. T�TU7� � It I
� 'l ,(/ \
PHONE
n-5 `` L G
FJ
DESCRIPTION OF WORK
civ P CCS I
RESIDENTIAL Z.q� �L��
# DWELLING
OFFICE USE ONLY
USE
OCC.
TYPE
S . FT.
VALUATION
FLOOR AREA
LTN
COMMERCIAL
FLOOR AREA
TYPE OF CONSTRUCTION
# STORIES
JOB NUMBER �1 ' j '�
RECEIVED BY:L
t� !
TOTAL VALUATION:
jnAQMD
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 . t
ordinances and state laws relating to uilding cons ction. I uthorize representatives of Cupertino to enter the above -identified property for inspection purposes. 1
Signature of Applicanf/Agent: r Date:
SUPPLEMENTAL INFORMATION REQUIRED PRIOR TO ISSUANCE OF DEMOLITION PERMIT
OFFICE USE ONLY
Job Number from Bay Area Air Quality Management District www.baagmd.org @ 415-749-4762.
PLAN CHECK TYPE
❑ EXPRESS
-y%Provide
Y Provide of a site plan showing protection for any trees 10" in diameter or more at 3' above grade.
X Provide letter from08-725-3325) stating all gas and electric has been disconnected.
STANDARD
Provide a letter of inspection, tests, and abatement of any Hazardous Materials. Letter to be initiated by person(s)
E-1 LARGE
certified in asbestos, mercury and/or hazardous material examination.
El MAJOR
��//
XPlanning Dept clearance to verify building is not considered an historical landmark. Allow 10 business days.
XProvide letter of clearance of all vermin from a licensed pest control contractor.
l Applicant shall call the Public Works Department at 408-777-3104 and schedule a " h pection.
Provide s'
Commercial Buildings Only: Provide Fire Dept clearance for fire suppression / alarm system review.
DemoApp_2011.doe revised 03/16/11
DAM
l`+"t-`L
CITY OF CUPERTINO `30&/I67. D
FEE ESTIMATOR -BUILDING DIVISION
FEE ID FLR AREA
s.f.
1DEMORES 2,321
ADDRESS: 10657 LARRY WAY
DATE: 06/25/2015
REVIEWED BY: PAUL
P111-1/1. P'cr io:, f e
APN: 316 02 011
BP#:
`VALUATION: 1$15,000
*PERMIT TYPE: Demolition Permit
PIAN CHECK ITPE.
PRIMARY SFD or Duplex
USE:
1'lItuth. Irsf�. I ; c
PENTAMATION 1SFDWL-DEM
PERMIT TYPE: 19
woRK
DEMO EXISTING STRUCTURE AND REMOVE EXISTING FOUNDATION
SCOPE
Suppl. Insp. Fee:Q Reg. Q OT
FEE ID FLR AREA
s.f.
1DEMORES 2,321
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc). These fees are based on the preliminary information available and are only an estimate. Contact the Deptfor addn'1 info.
FEE ITEMS (Fee Resolution 11-053 Eff. 711113)
Mech. Plan Check
Plumb. Plan Check
E1ec, Plan Check
P111-1/1. P'cr io:, f e
Plumb. Permit Fee
lilec•. Permit Fee-
Other• AAc•h. Insp,
her• Plumb Insp.
Usher Lkx- Insp. Li
hh>clz. hrs��. l a r
1'lItuth. Irsf�. I ; c
li4tc'. Gulp>. FCC.
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc). These fees are based on the preliminary information available and are only an estimate. Contact the Deptfor addn'1 info.
FEE ITEMS (Fee Resolution 11-053 Eff. 711113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
suppl. PC.' Fee
1'1111716.:1.1ech.Il lec
Permit Fee:
$574.00
Suppl. Insp. Fee:Q Reg. Q OT
0--01
hrs
$0.00
Plzu7lb..!Alec•i1.; F.lec
1'Irsrrth.ilLfacll./Flee Pern7ii ]-ee:
Construction T cry:
-l,''1ininistrWive Fee:
1 "ork G6`i£Jrc'�ztt E'vrnzit
Advanced Planning Fees:
7i<11'el D(wumewaiior1 F,:,cs:
Strong Motion Fee: IBSEISMICR
$1.95
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$576.95
$0.00 TOTAL FEE:
$576.95
Revised: 05/07/2015
GUPERTINOOkEEN
Program
City of Cupertino
Public works Department
Environmental Programs Division
10300 Torre Ave
Cupertino, CA 95014
(408) 777-3354
Construction and Demolition Recycling Diversion
Requirements and' Instructions
Covered projects, or all construction, demolition and renovation projects that are 3,000 square feet or more
are required to complete a Waste Management Plan for the City of Cupertino demonstrating that 60% of the
material generated is recycled, in compliance with ordinance CMC 16.72.050.. At the conclusion of the project
a Construction Recycling Report must be filed with the Public Works DepartmentlEnviroiumental Division
showing the tons recycled and disposed by material type. Use. tonnage information from. weight tags provided
by facilities to quantify total estimated waste and percentages for materials. Weight Tags of all material
recycled and disposed inust be submitted with the final report in order to receive a Final Building
Inspection.
Reeologyristie only debris bin service provider franchised to do Uusiness'in Cupertino.`
Debris from a project 3,000 square feet or more in Cupertino can be collected and
disposed by using:
Please c ck all that apply:
am not using a Recology debris bin, however, the project is less than 3,000 s.£, e.g. buildings, patios,
sidewalks, driveways.
❑ I will use a Recology debris bin. By Agreement with the City, Recology will. prepare my required
Waste Management Plan & Recycling Report, Contact Recology: (408) 725-4020.
❑ I am not using a Recology debris bin. I will provide the following subinittals to the City's Public
Works Department, showing that I have recycled at least 60% of all construction demolition material:
Ask for the Construction & Demolition Recycling Packet from the Building Department and
complete the following:
✓ Subnzit a Construction anal Dentoli.tion Waste Management Plan with your building permit
application. No fee for this plan. Forms are available at the. Building/Public ld`orks counter and online
at wwiai.cupertino.org/environmental. Report the tonnage recycled and disposed, by material type.
Recycling facilities nucst be selected from the City's approved list of Recycling Resources.
✓ Stebnzit a Construction Recycling Report form.. The report is required before the Building
Department will schedule a final inspection. The report form is available at the Building/Public
Works Counter and online titsvw.cupertino.orIZ/environmental.
Signature:
Name:
Title:
Date: 1 A V -e 2S 2a�
t
(printed) - C S �—\ O R C .Sf\ f`1 S �.r... 1 y
Phone:
Project Addres
This forma to remain in the project's building permit file for the duration of the project.
Revised 317112
4 Si
TYP, POST
ELEVATION
NOTES
1. THE DEVELOPER SHALL INSTALL THE " TREE PROTECTION" DEVICES
PRIOR TO THE START OF GRADING OR CLEARING WORK.
2, THE CITY RESERVES THE RIGHT TD ISSUE A "STOP WORK" NOTICE IF
THE "TREE PROTECTION" DEVICES ARE NOT INSTALLED OR IF THE
DEVICES ARE NOT MAINTAINED PROPERLY,
3. SEE THE PROJECT GRADING PLAN FOR SPECIFIC TREES THAT REQUIRE
PROTECTION. ALL SPECIMEN TREES REQUIRE PROTECTION UNLESS
OTHERWISE NOTED.
4, NO EXCAVATIONS WITHIN THE "TREE PROTECTION AREA" ARE ALLOWED
UNLESS UNDER THE SUPERVISION OF A REGISTERED TREE SERVICE COMPANY.
5. ANY FILLING WITHIN THE "TREE PROTECTION AREA" SHALL BE DONE IN
ACCORDANCE WITH A DETAILED IMPROVEMENT PLAN APPROVED BY THE CITY.
G. NO TRIMMING, CUTTING,OR PRUNING OF DESIGNATED TREES CAN OCCUR
WITHOUT A REGISTERED TREE SERVICE COMPANY.
7. CONSULT ORDINANCE 778 OF THE CITY OF CUPERTINO FOR PERMIT
REQUIREMENTS AND EXCEPTIONS.
S. TEMPORARY CHAIN LINK FENCING IS AN ACCEPTABLE SUBSTITUTE TO
THE WOOD CONSTRUCTIOK �v
TREE PROTECTION STANDARDS
CITY OF CUPERTINO',
JAPPROVEDSTANDARD DETAILS BY : r:IY F 1N .� DATE : [!� 64
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INDEX
t Rar✓�aWWWnu,sEuam, EE&Tv RwwaaaeExuorn� waE�»"a°��em.:mmw..emd« mm»Rawan.
' IP R 41�ICJ A REMGVR WAtIFRAR11t�.
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" .,4 - SAN ,�v:e a �Gr.. wlaouremnmea 4)uaaa`dvya«n»w« LAN/ NOTES
a tots
Al SITE P
mueeEvmx aJEGRB RW a MW'(W Mmem OMm+mxa%mp«P \—_
�J:AY bw+r,I•in s ,., N:.. rr. �acawmr Rwaxtwa. s zz
2
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a ° p�/��y aRNmraG.X� 3 ELEVATIONS
w �ICE �4.�5� c.nv. acemarc.a. m m �«:asm«. X«:..mw«Ra a:ea«wm Po,, �I�
a, 1 masnW«M.E»mrc,a. +�E % �Raa "::" �'e«» EXISTING F R PLANJDEMO W ��;
14
gRMGrAeel.NdM MNpACotlx «e»wm ww+
A5,� PROPOSED IRST FLOOR PLAN
0 Maq sly m »xR«
» RxxEm„« m
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�', CO NIT L EtO ENT DE ARTME TMONT YNroi'ORCX PoS'.1D' ( A() PROPOSEOCI,F PLAN
' f U N IS f,UP RTINO paMtYARGf �anA° � (ij
� I � :T hPPROVED Sro[rARGu WMNTERRGPIRGWAuaP � • ' _
A7 BUILDIN SECTIONS C
w'vP I e ry xx nn o'
® l LECTRIL/ MECHANICAL PLAN F
Dsue EN E ERG Iz
C
y LL
)61N a, ,iTu �` , f
GB GR Nf BUILDING
F
NS GEN RAL NOT
F�a � z oPEaT I to
9{uProRa M twa
92M", — GN2 GENE LNOTE aoPFR
DA.
N"' LANMNG DEPT 7 �. O
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L1 LA�7DSMPE PLAN,,,--',,
_ M
« C
51.1 S1jRUCTI!iliAL NOTES i
P8�
_.5cF'F'nl.
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