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15050127 - DEMO ' ' • 10160 LEBANON DR 15050127 F/P ANSARI SUHAIL T AND MONICA SCAN N ED BOX #596 CITY OF CUPERTINO BLIILDING PERMIT BUILDING ADDRESS: 10160 LEBANON DR CONTRACTOR;VJINGON PERMIT NO: 15050127 CONSTRUCTION CO OWNER'S NAME: ANSARI SUHAIL T AND MONICA P O BOX 31983 DATE ISSUED:OS/21/2015 OWNER'S PHONE: 4082185906 OAKLAND,CA 94604 PHONE NO:(510)228-6665 T� LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL � COMMERCIAL � DEMO(E)1364 S.F.SFD WITH ATTACHED GARAGE 414 License Class� Lic.# ��Z-�� S.F. Contractor ��L�� (/�'�r� Date ^1 ?� 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 hvo 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:$12000 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:34214019.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that 1 have read this application and state that the above information is pERMIT EXPIRES IF WORK IS NOT STARTED corcect.1 agree to comply with all city and county ordinances and state laws relating wITHIN 180 DAYS OF PE 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 D 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 � � granting of this permit. Additionalty,the a plicant understands and will comply e � with all non-point source regulations per t Cupertino Municipal Code,Sectio 9.I 8. RE-ROOFS: Signature Date � � All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection,l agree to remove all new materials for inspection. ❑ OWNER-BUILDER DECLARATION Signature ofApplicant: 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 properry,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) l,as owner of the property,am exclusivety contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE 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 912 and the declarations: Health&Safety Code,Section 25532(a)should I srore 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 Munic' al Code,Chapter 9.12 and [have and will maintain Worker's Compensation Insurance,as provided for by thc Health&Safety Code,Section 25505,25533,a 25534. Sec[ion 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: C� Date:�� permit is issued. I certify that in the performance of the work for which this permit is issued,l shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of Califomia. If,after making this certificate of exemption,l CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,[must l 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 corcect. I agree to compty 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 l understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will compty with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.l 8. Signature Date DE�I�[OLIT[ON PERM[T APPLIGAT[QN O\ COMMUNITY DEVELOPI�iENT DEPARTMENT• BUILDING DIVISIOI� �1'� 10300 TORRE AVENUE�CUPERTINO, CA 95014-3255 �� (408) 777-3228• FAX(408}777-3333 • buildina�a cupertino.orp ` CUPERTINO PR07ECT ADDRESS t O l / � � AFN� � � �] / (�/ �J� 1 ( C�Q ,n 0�1 `I�' e L � C l ' v 0 WI�TER NAME f PHONE E-MAIL ✓�►n�C-ti��` a. STREETADDRESS �� ^ � CITY, STATE,ZIP ,y��l �� r FA7{ 1 �.� � CO?JTACT NAME � ��^�1`'� C.lnLT� PHor�.�r�u 6�_.. ) . E-1�4A'.�\1'h 1�"1 �✓'��:1 .�.y- STREET ADDRESS � �n � �� CITY,STATE, ZIP �� `r� C� � FA3C �"�C.' ti 0� ❑ OWI�TER ❑ Oli'NER-BUILDER ❑ OIiT'ERAGEt.'T �COt.'TR;4CTOR �CONTRACTORAGT? ❑ ARCHITECT ❑ENGIl�'EE `❑ DEVELOPER ❑ TEt��AI�? CONTRACTOR NAME �JN�� 11 7 A LICENSE NL"MBER ^� � a f LICENSE IYPE /� BUS.LIC� ) �r[s�v� `f �'o � COMPA1vYN?.1��fE �.,„�.. 1� 7�� E-��' ,\ p YV��i/` . CUr`V'� FAX W`J �Y\ C�'�Y��v vr� � Y✓�I30� STREET ADDRESS `I�A �'{ A� �D CITY,STATE,ZIP �� 4� PHO?�'E ra.��` y-� � v LL �� l!V b DESCRIPTION OF WORK ,m p L��1 W�'�- •��yc� � �� f� cfi_!� K�""wv 17� t 36 N� S � 'f 1 K � ��' RESIDENTIAL �.DVJELLING '} �. �OFFICE i15E OA'LY s r ` ' ��=s� � � �r �. FLOOR AREA • LNITS _ USE� ` � - CG +.TYPE .' S FT �� .< VALUAT70N COTvLMERCIAL �' � e r t. N r c �: � FLOOR AREA �' , t s TYPE OF CONSTRUCTION fi STORIES ^ - -, _ � � AQMD]OB NUMBER ; AL VALUATION: J#: N� 2t1� s - 1�a. � By my signature below,I certify to each of the following: I am the prope wner or th o act on the property owner's behalf. I have read this application and the infonnation I have provided is correct. I have read the Description of VJork and verify it is accurate. I ae ee to comply with all applicable local ordinances and state laws relating to buiid' g construction. I authoiiz representatives of Cupertino to enter the above-identified property for inspection pu�poses. Signature of Applicant/Agent: Date: c� SUPPLEMENTAL INFO ION UIRED PRIOR TO ISSUANCE OF DEMOLITION PERMIT -: oFFicE usE'onzY Provide Job Number from Bay Area Air Quality Management District u��anu.baaQmd.ors @ 415-749-4762. ' PLa�:�xEcxz�E ,. ,_ , _Provide ihree copies(Residential)or six copies(Commerical)of a site plan sho�a�ing protection for any trees 10 � E�r�ss ,- : , in diameter or more at 3'above grade. �':sTa.t.�var.o ,. Provide letter from PGZ..E(408-72�-3325)stating all gas and electric has been disconnected. � L'�tcE; Pro��ide a letter of inspection,tests,and abatement of any Hazardous A�Iaterial,s. Letter to be initiated by person(s) � n�JOR — �� : certified in asbestos,mercury and/or hazardous material exami-nation. � �, :� = _Planning Dept clearance to verify buildin�is not considered an historical landmark.Allow 10 business da��s. � � �,- " 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 dwellin�"inspection - Provide signed Debris Bin and Recyclable Materials fo;m. Den,oApp_2013.doc i-ei�ised OZ/13/13 CITY OF CUPERTINO D FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 10160 LEBANON DR DATE: 05/21/2015 REVIEWED BY: MELISSA APN: 342 14 019 BP#: °VALUATION: $12,000 xPER1H�'r TYPE: Demolition Permit � . :'� �� .,�'� �_. �E_'�;� PRIMARY SFD or Duplex PENTAMATION 1 SFDWL-DEM USE: PERMIT TYPE: WORK DEMO E 1364 S.F. SFD WITH ATTACHED GARAGE 414 S.F. SCOPE FEE ID FLR AREA s.f. 1 DEMORES �,364 ,� � . r, . . << , , �. {.' , �r <<r ., �.� NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer Dishict,School District,etc . These ees are based on the relimina in ormation available and are onl an estimat� Contact the De t or addn'l in o. FEE ITEMS (Fee Resolution 11-053 C�'/' i/1/13) FEE QTY/FEE MISC ITEMS r>fCFYt `5 . :t r ,.. t� 'i�;� r"( . .'<' �� r,��r, sx�,t°. > :�. Permit Fee: $574.00 Suppl. Insp. Fee:Q Reg. Q OT p,p hrs $0.00 ., , �. ..'��t�.. n_�.,. � ,f f � t : ;��: � _.a �.. '.iit ., i,....F?� .e I{i,'b' _i -`ii�,..Yi"63.i%�L', .... 1' , � �.. . t t�' ,<rri . .r�e .. .Fl J �i�S,Y ,i . ��'L t ., ��1,..,. . _... , Strong Motion Fee: 1BSEISMICR $1.56 Select an Administrative Item Bld�Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $576.56 $0.00 TOTAL FEEc $576.56 Revised: 05/07/2015