15010134W]
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10681 JOHNSON AVE
CONTRACTOR: BABEL CONSTRUCTION PERMIT NO: 15010134
OWNER'S NAME: TAN QI AND YU SHIFENG
3939 ARDEN FARMS PL DATE ISSUED: 01/23!2015
OWNER'S PHONE: 4083989841
SAN JOSE, CA 95111 PHONE NO: (408) 561-7041
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL EJ COMMERCIAL
License ClassLic. 4 sq _o !
DEMO SFDWL LIVING (1447 SQ FT); DETACHED GARAGE
(328 SQ FT); POOL (162 SQ FT)
Contractor Zn ilUVELte
I hereby affirm that 1 am licensed under the provisions of Ch Ater 9
(commencing with Section 7000) of Division 3 of the Business & Professions
Code and that my license is in full force and effect.
1 hereby affirm under penalty of perjury one of the following two declarations:
1 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
Sq. Ft Floor Area:
Valuation: $10000
performance of the work for which this permit is issued.
ave 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: 37531050.00
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. 1 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 FRO T 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
Issued by: Date:
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source egulatio s per the Cupertino Municipal Code, Section
9.18.
RE -ROOFS:
r
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
Signature of Applicant: Date:
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
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)
1, as owner of the property, am exclusively contracting with licensed contractors to
HAZARDOUS MATERIALS DISCLOSURE
construct the project (Sec.7044, Business & Professions Code).
1 have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 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
Section 3700 of the Labor Code, for the performance of the work for which this
the Health & Safety Code, Sections 25505 5 33, and 25534.
Owner or authorized agent: r Date: r3l
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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
ARCHITECT'S DECLARATION
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.
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
iaADDRESS: 10681 johnson ave
FEE
DATE: 01/22/2015
REVIEWED BY: Mendez
APN: BP#:
1-5()l 3
*VALUATION: j$10,000
,'PERMIT TYPE: Demolition Permit
PRIMARY SFD or Duplex
USE:
PENTAMATION 1 SFDWL-DE
PERMIT TYPE: i
WORK
demo sfdwl livin 1447 sq ft); detached garage 328 sq ft); Pool 162 sq ft
SCOPE
Suppl. Insp. Fee:Q Reg. 0 OT
0,0
FEE ID FLR AREA
s.f.
1DEMORES 1,500
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, eta). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'1 info.
FEE ITEMS (Fee Resolution II -053 E(f 7%I ,`l3)
FEE
QTY/FEE
MISC ITEMS
� `PG[s) I � 1'►t-O
I t�eM �PPtS 3Z�y, �
Permit Fee:
$574.00
Suppl. Insp. Fee:Q Reg. 0 OT
0,0
T hrs
$0.00
F-1
i
Strong Motion Fee: IBSEISMICR
$1.30
Select an Admi istrative item
1 q&6,-�v
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$576.30
$0.00 TOTAL FEE:
30
Revised: 01/06/2015
CUPERTINO
DEMOLITION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(d)cupertino.org 1� J
1U
PROJECT ADDRESS C7 r
APN #
OWNER NAME
v✓• `
PHONE 0 /i
j
E-MAIL
STREET ADDRESS
CITY, STATE, ZIP ,
FAX
CONTACT NAME
PHONE /
E-MAIL
STREET ADDRESS
G
CITY, STATE, ZIP 2_
FAX
2
eft r 1 S
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT AENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME f,
LICENSE N ER
LICE N YPE 7
BUS. LIC #
C�
COMPANY N
E-MAILFAX
e
STREET ADDRESS M (
_;-I :�q r kyl
CITY, STA.TE, ZIP
PHO E
DESCRIPTION OF WORK
RESIDENTIAL
# DWELLING
OFFICE USE ONLY'
USE
OCC. TYPE
S . Fr.
VALUATION
FLOOR AREA
UNITS
COMMERCIAL
FLOOR AREA
TYPE OF CONSTRUCTION
# STORIES
AQMD JOB NUMBER
-RECEIVED BY: -
TOTAL VALUATION:
J 4:
By my signature below, I certify to each of the following: I am the property owner or authorized agent to a roperty 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 buildin'r,fonstruc 'on. I authorize representatives of Cupertino to enter the above-identi5ed pro erty for inspection purposes.
Signature of Applicant/Agent: Date: 3
SUPPLEMENTAL INF ATION REQUIRED PRIOR TO ISSUANCE OF DEMOLITION P RMIT
OFFICE USE ONLY
PLAN cxEcx TYPE
Provide Job Number fro ay Area Air Quality Management District www.baaqr d.org @ 415-749-4762.
13 EXPRESS
_ Provide three copies (Residential) or six copies (Commerical) of a site plan showing protection for any trees 10"
in diameter or more at 3' above grade.
❑, STA NDARD
13 LnRcE
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)
MA?OR
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.
DemoApp_2013.doc revised 02/13/13
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 Department/Environmental 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. NAleight Tags of all material
recycled and disposed must he submitted with the final report in order to receive a Final Building
Inspection.
Recology,is the only debris bin service provider franchised to do business in Cupertino.
Debris from a project 3,000 square feet or more in Cupertino can be collected and
disposed by using:
Please check all that apply:
I 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 submittals 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:
✓ Submit a Construction and Demolition Waste Management Plan with your building permit
application, No fee for this plan. Forms are available at the BuildinglPublic tT76rks counter and online
at wwiv. cupertino. orglenvironmental. Report the tonnage recycled and disposed, by material type.
Recycling facilities must be selected fi-onz the City's approved list of Recycling Resources.
✓ Submit a Construction Recycling Reportform, The report is required before the Building
Department will schedule a final inspection. The report form is mailable at the BuildinglPzcblic
TE01-kS Counter alUi online ��-11�ra.cupertino.or �lenviroznne�ztal.
Signature:
Name: (printed)_
Title: _
Phone: _
Project Address:
k,
This form to remain in the project's building permit file for the duration of the project.
Revised 317112 1
Date:
City of Cupertino
Public works Department
m "
Environmental Programs Division
10300 Torre Ave
Cupertino, CA 95014
CUPERTJNO GREEN
Progrom
(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 Department/Environmental 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. NAleight Tags of all material
recycled and disposed must he submitted with the final report in order to receive a Final Building
Inspection.
Recology,is the only debris bin service provider franchised to do business in Cupertino.
Debris from a project 3,000 square feet or more in Cupertino can be collected and
disposed by using:
Please check all that apply:
I 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 submittals 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:
✓ Submit a Construction and Demolition Waste Management Plan with your building permit
application, No fee for this plan. Forms are available at the BuildinglPublic tT76rks counter and online
at wwiv. cupertino. orglenvironmental. Report the tonnage recycled and disposed, by material type.
Recycling facilities must be selected fi-onz the City's approved list of Recycling Resources.
✓ Submit a Construction Recycling Reportform, The report is required before the Building
Department will schedule a final inspection. The report form is mailable at the BuildinglPzcblic
TE01-kS Counter alUi online ��-11�ra.cupertino.or �lenviroznne�ztal.
Signature:
Name: (printed)_
Title: _
Phone: _
Project Address:
k,
This form to remain in the project's building permit file for the duration of the project.
Revised 317112 1
Date:
I' ,
I Ki((roy was here
December 17, 2014
To Whom It May Concern,
Killroy Pest Control has inspected the property at 10681 Johnson Ave,
Cupertino for pest infestation.
No infestations were found during the inspection.
If you have any questions please call me at (408) 378-0441 vm 105.
Sincerely,
Andrew Gibson
Pest Management Professional
Killroy Pest Control, Inc.
408-378-0441, ext. 105
Killroy Pest Control 1175 Dell Avenue, Campbell, CA 95008 408-378-0441
Pacific Gas and
Electric Company
DATE: I 1 q(5�
CITY OF CUPERTINO
10300 TORRE AVE
CUPERTINO CA 95014
10900 No. Blaney Avenue
Cupertino, CA 95014
SUBJECT: REMOVAL OF GAS SERVICES (CUT 9 MAIN IN THE STREET) ON:
SUBJECT: ELECTRIC SERVICES WAS CUT AT POLE ON:
O&V 17e�,iso., kve—
If you have any further questions, please contact me at (408) 725-3325
Sincerely,
kZ� o
Pacific Gas & Electric Company
DeAnza Service Planning
408/725-3325
goals som
111111111
ozod
"110-1-10
0
ul
3N.1 3NIJ