15100032I CITY OF CUPERTINO BUILDING PERMIT I
BUILDING ADDRESS: 18600 BARNHART AVE CONTRACTOR: WINGON PERMIT NO: 15100032
CONSTRUCTION CO
OWNER'S NAME: GOLDSILVERISLAND HOME LLC P O BOX 31983 DATE ISSUED: 10/05/2015
OWNER'S PHONE: 4088963369 OAKLAND, CA 94604 PHONE NO: (510) 228-6665
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL M COMMERCIAL ❑.
DEMO (E) I STORY SFD (1,127 S.F.) WITH DETACHED
License Classlt_ Lie. # ZU GARAGE (864 S.F.)
Contractot�lr®Vl ( u� 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. 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.
2. 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
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 permit. Additionally, the applicant understands and will comply with
all non -point source regulations per the Cupertino Municipal Code, Section 9.18.
Date n
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
t. 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)
2. 1, 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. I have and will maintain aCertificate 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.
2. 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.
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
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 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 permit. Additionally, the applicant understands and will comply with
all non -point source regulations per the Cupertino Municipal Code, Section 9.18.
Signature Date
Ft Floor Area: I Valuation: $10000
APN Number: 37523014.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 YS FROM LAST CALLED INSP C ION.
Issued by: Date:
RE -ROOFS:
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. twill 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 25505, 25533, and 25534.
Owner o authorized agentk-11: e
,
1/ 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
N
5
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CUPERTINO
DEMOLITION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE a CUPERTINO, CA 95014-3255
(408) 777-3228 a FAX (408) 777-3333 s building9cupertino.org
PROJECT ADDRESS
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APN #
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❑ OWNER ❑ OWNER-BUH.DER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
LICENSE NUMB R
LICENSE TYPE
BUS. LIC #
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DESCRIPTION OF WORK
aa, (SWIRESIDENTIAL
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# DWELLING
OFFICE USE ONLY:
USE
OCC. TYPE s . FT.
VALUATION
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FLOOR AREA �/ v
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COMMERCIAL /
FLOOR AREA A10
TYPE OF CONSTRUCTION
T# STORIES
AQMD JOB NUMBER
RECENED $Y� / p
LOU
TIALP� IIATION:
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 building construction I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORYAATI&q REQUIRED PRIOR TO ISSUANCE OF DEMOLITION PERMIT
OFFICE USE ONLY
PLAN CRECKTYPE
Provide Job Number from Bay Area Air Quality Management District www.baagmd.org @ 415-749-4762.
Provide three copies of a site plan showing protection for any trees 10" in diameter or more at 3' above grade.
❑ ExPREss
---Provide letter from PG&E (408-725-3325) stating all gas and electric has been disconnected.
STANDARD
El LARGE
Provide a letter of inspection, tests, and abatement of any Hazardous Materials. Letter to be initiated by person(s)
certified in asbestos, mercury and/or hazardous material examination.
❑ MAJOR
Planning Dept clearance to verify building is not considered an historical landmark. Allow 10 business days.
C,-'-'P_rovide 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.
`Commercial Buildings Only: Provide Fire Dept clearance for fire suppression / alarm system review.
DemoApp_201 ].doe revised 03116111
CITY OF CUPERTINO i i t D
FF,F, FgT1MATn1D _ 72TTTT T1TNft nTXrrcTnisT
it ci�..Plcf,r t.'iuck f',urnf;. Nan t,:"IaecA Elec. Plan Check
ti le%fZ. Perrnif Fee: Afffibnb, Permit Fee: T*Iec. Per rurfi l=ee:
Other, t:iech. 1n41. 7— L),{rc:r1'!arrti?bap,El
01he,•E?ec'. frrsp.
Llech. Insp. Fee: Pl,.rmb. Inset. Fen: Elea fray. Fee:
1vvl P,: z nzs estimate does not include fees due to other Departments (i. e. Planning, Public Works, Fire, Sanitary Sewer District, School
District Pfl'_ )_ Thow FOPv arP havad Ala flap nrvliaaaisanru i»fna•wan}inaa m .ailnhln na..d a.l„ ..H OL... 71n..1 f . "d,4..aH
FEE ITEMS (Fee Resolution 11-053 E . 7/1/13,
1AJ1V1
\
t ADDRESS: 18600 Barnhart Ave
DATE: 10/05/2015
REVIEWED BY: PAUL
APN: 375 23 014
BP#:
VALUATION: j$10,000
*PERMIT TYPE: Demolition Permit
.t 1 A;r CHECK Ilia.:
Permit Fee:
PRIMARY SFD or Duplex
PENTAMATION
F-00
PERMIT TYPE: 1 SFDWL-DE
WORK Demo E 1 Sto SFD 1 127 S.f. with Detached Gara a 864 S.f.
SCOPE.
I�I1f1?"/�. !: eC{i.11 /E?C' 1�Sritllt P'ee.
it ci�..Plcf,r t.'iuck f',urnf;. Nan t,:"IaecA Elec. Plan Check
ti le%fZ. Perrnif Fee: Afffibnb, Permit Fee: T*Iec. Per rurfi l=ee:
Other, t:iech. 1n41. 7— L),{rc:r1'!arrti?bap,El
01he,•E?ec'. frrsp.
Llech. Insp. Fee: Pl,.rmb. Inset. Fen: Elea fray. Fee:
1vvl P,: z nzs estimate does not include fees due to other Departments (i. e. Planning, Public Works, Fire, Sanitary Sewer District, School
District Pfl'_ )_ Thow FOPv arP havad Ala flap nrvliaaaisanru i»fna•wan}inaa m .ailnhln na..d a.l„ ..H OL... 71n..1 f . "d,4..aH
FEE ITEMS (Fee Resolution 11-053 E . 7/1/13,
FEE
QTY/FEE
MISC ITEMS
Phm (Beck./*ee>:
A
x51111pl. PC:' Fee
Permit Fee:
$574.00
Suppl. Insp. Fee -(F) Reg. 0 OT
F-00
hrs
$0.00
I'Iumb.I Zech-,,Vee
I�I1f1?"/�. !: eC{i.11 /E?C' 1�Sritllt P'ee.
Construcllon T/-zx:
Administrtifiv? Fee:
T fork Without Permit?
11el:=cxrtced Plcrnnin.g.Fees:
Truvel.Doemneniadon l=ees:
Strom Motion Fee: 1BSEISMICR
$1.30
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
- ;-SUBTOTALS*
$576.30
$576.30
Revised: 07/02/2015
CUPERTINO
CONTRACTOR / SUBCONTRACTOR LIST
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
JOB Y(Lhaa_____ �- _.
u
OWNER'S AME C>
�"�,� -----
PHONPERIE # ` P
,e� ��„, .
GENERAL CONTRACTOR: � � �.
LICENSE #,,,.
BUSINESS�����
ADDRESS; � � d _ m
CITY"ZIPCODE:
*Our inunicipal 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 ONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS 1-,lCENSE.
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
V
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cerneht Finishing
Electrical
Excavation
Fencing
Flooting / Carpeting
Linoleum / Wood
Glass ( Glazing
Heati g
Insulation
Landscaping
Lathing
Masonry
Painting /'Wallpaper
Paving
Plastering,
Plumbing
Roofing
Septic Tank
Sheet, Metal
Sheet Rock
Tile
Lo
r / Contractor Signature
Date
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