15100137CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10676 CARVER DR
CONTRACTOR:1 TQ CONSTRUCTION PERMIT NO: 15100137
OWNER'S NAME: GERALD LI
900 GOLDEN WHEEL PARK DR STE 204 DATE ISSUED: 10/19/2015
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O`WNER'S PHONE: 4082397888
SAN JOSE, CA 95112 PHONE NO: (408) 849-1715
LICENSED CONTRACTOR'S DECLARATION
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JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL
DEMO (E) I STORK SFD S.F.) WITH
p
License Class_ Lic. # n (J /—
(932 ATTACHED
GARAGE (324 S.F!)
Contractor Date 10 Ila
I hereby affirm that I am licensed under tire provisions of Cha ter 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:
Sq. Ft Floor Area,:
Valuation: $5000
1. 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
APN Number: 3732015.00
Occupancy Type:
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.
PERMIT, EXPIRES IF WORK IS NOT STARTED
APPLICANT CERTIFICATION
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
I certify that I have read this application and state that the above information is
180 DAYS F AS 7 ALLED INSPECTION.
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
Iss a e: ot
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 cc
all non-point source regulations per the Cupertino Municipal Code, Section 9.18.
RE-ROOFS:
All roofs shall be ihspect rior to any roofing inbeing installed. If a roof is
Signature Date r
installed without filrst obtaining an inspection, I agree to remove all new materials for
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inspection.
Signature of Applicant: Date;
® OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
ALL 1200F COVERINGS TO BE CLASS "A" OR BETTER
the following two reasons:
i. 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
HAZARDOUS MATERIALS DISCLOSURE
sale (Sec.7044, Business & Professions Code)
I have read the hazardous materials requirements under Chapter 6.95 of the
2. I, as owner of the property, am exclusively contracting with licensed contractors to
California Healt$ & Safety Code, Sections 25505, 25533, and 25534. I will maintain
construct the project (Sec.7044, Business & Professions Code).
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material.
I hereby affirm under penalty of perjury one of the following three declarations:
Additionally, should I use equipment or devices which emit hazardous air
t. I have and will maintain a Certificate of Consent to self-insure for Worker's
contaminants as defined by the Bay Area Air Quality Management District I will
Compensation, as provided for by Section 3700 of the Labor Code, for the
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
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
Owner or aut nt:
Date:,(.f/f
permit is issued.—
` L
s. I certify that in the performance of the work for which this permit is issued, I shall
CONSTRUCTION LENDING AGENCY
not employ any person in any manner so as to become subject to the Worker's
I
affirm thin there is a construction lending agency for the performance of work's
I hereby a
Compensation laws of California. If, after making this certificate of exemption, I
for which this perr lit. is issued (Sec.. 3097, Civ C.)
become subject to the Worker's Compensation provisions of the Labor Code, I
Lender's Name
must forthwith comply with such provisions or this permit shall be deemed
revoked.
Lender's Addres�
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APPLICANT CERTIFICATION
ARCHITECT'S DECLARATION
I certify that I have read this application and state that the above information is
I understand my plans shall be used as public records.
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
Licensed Professional
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
CLSPERTINO
DEMOLITION PERMIT APPLICATIC
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDI
10300 TORRE AVENUE CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • bu fdingCa)cuDertii
P1511 4[i
DIVISION
PROJECT ADDRESS (r�+
tL✓ C� RV E(. D,jVF
APN# 6, 7 5— 3 —6I
OWNER NAME
v a p t j� E g P
G J -P"4-68- 1„'fl 2.59 70e
-
E-MAIL
STREET ADDRESS a 1 F1+ s
CITY, STATE, ZIP � �G3�7 -
�� FAX
CONTACT NAME ¢� 3 2 / $
_ F- A� 1-1 PHONE 239- E-MAIL ��9'
STREET ADDRESS CITY, STATE, ZIP FAX
OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
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CONTRACTOR NAME
W. i
LICENSE NUMBER � 1,�7LICENSE
TYPE
BUS. LIC #
1
COMPANY NAME.
1_Q 4fn,1S-MUC-n0*AS
E-MAIL h� S� �+
CITY, STATE, ZIP
FAX
PHQ�E
STREET ADDRESS 3044 Kum i #Zt l&-ir AZ
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1166 (
,
DESCRIPTION OF WORK
!1M PL -61M R E LA
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RESIDENTIAL#
DWELLING
' OFFICE USE ONLY
- USE - d.
' OCC. TYPE so. Fr.
VALUATION
_FLOOR AREA
UNITS2576
COMMERCIAL
j
FLOOR AREA
{
_
TYPE OF CONSTRUCTION= # STORIESAQMD
JOB NUMBER 7 /� 6� RECENED BY= TO �A�I VApLUATI�I�
J 1Y'. 4md
By my signature below, I certify to each of the following: ' I am the property owner or authorized agent to b 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 relator onstructi I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
�T
Signature of ApplicandAgent: Date: _ 10
f SUPPLEMENTAL INFORMATION REQUIRED PRIOR TO ISSUANCE OF DEMOLITION PERMIT
OFFICE USE ONLY
Provide Job Number from Bay Area Air Quality Management District www.baaqmd.oru'1@ 415-749-4762.
PLAN CHECKTYPE
EXPRESS
Provide three copies of a site plan showing protection for any trees I U' in diameter or moire at 3' above grade.
$� Provide letter from PG&E (408-725-3325) 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)
El LARGE
c rtified in asbestos, mercury and/or hazardous material examination.
❑ MAJOR
p_ 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.
ypoica t sh 11 call the Public Works Department at 403-777-3104 and schedule a hablt�ble dwelling" inspection.
d0�zfl,
zPI-i-ovide signed Debris Bin and Recyclable Materials form.
Commercial Buildings Only: Provide Fire Dept clearance for fire suppression / alarm system review.
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DemoApp_2011.doc revised 03116/11
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CITY OF CUPERTII�j TO D
Nm -- N FEE ESTIMATOR - BUILDIN!G DIVISION
ADDRESS: 10676 Carver DriveDATE:
10%16/2015
REVIEWED BY: PAUL
APN: 375 32 015
BP#:
VALUATION: $5,000
*PERMIT TYPE: Demolition Permit
PL4N CHEC. J 7) I' is
PRIMARY
or Duplex
Other AlecC hisp.
PENTAMATION
USE:SFD
%".f€'C,. It?,Cp. I'eE'.
PERMIT TYPE: 1SFDWL-DE i
Permit Fee:
$574.00
Suppl. Insp. Feer Reg. 0 OT
WORK
Demo (EL1 Story SFD 932 S.f. with Attached) 34 S.f.
SCOPE
NOTE: This estimate does not include fees due to other Departments (ie. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.. These fees are based on the reliminar information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 E . 711113
FEE
NY?nib/ Nor,
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j-'7ee. Man
t Jc. <,it. l?E'r'ttZti f'f'E':
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Other AlecC hisp.
;rn
13,'flY32r`?. I/ZTf7. Fee:
%".f€'C,. It?,Cp. I'eE'.
NOTE: This estimate does not include fees due to other Departments (ie. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.. These fees are based on the reliminar information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 E . 711113
FEE
QTY/FEE
MISC ITEMS
h'"°h i Check ? ee .
j
l*ee
F7
Permit Fee:
$574.00
Suppl. Insp. Feer Reg. 0 OT
0.0
hrs
$0.00
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('011srrmclion TUX:
f
c.13 6iYXf'e'(,T . 3/c,T«E'iiing .L'E'es:
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Strong Motion Fee: 1BSEISMICR
$0.65
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
$1.00
SUBTOTALS -
$575.65
$0.0 -. -TO, FEE ,
$575.65
Revised: 10/01/2015
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