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14120098F CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10292 S TANTAU AVE CONTRACTOR: MANA GENERAL PERMIT NO: 14120098 CONTRACTOR OWNER'S NAME: WANG CHENG -YI AND CHEN WAN JUNG 1839 TAMPA WAY DATE ISSUED: 12/1812014 OWNER'S PHONE: 4088882976 SAN JOSE, CA 95122 PHONE. NO: (408)375 -4288 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL License Class Lic. # 4 O 4- 3 DEMO GARAGE /SLAB (I HR INSP PER SEAN) Contraetoryna Y\K � '.ate _l 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 Sq. Ft Floor Area: Valuation: $500 performance of the work for which this permit is issued. 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 APN Number: 37508038.00 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 correct. 1 agree to comply with all city and county ordinances and state laws relating hereby WITHIN 180 DAYS. OF. PERMIT ISSUANCE OR to building construction, and authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 D` LA , ALLED 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. Additionally, the plicant understands and will co y with all non -p A t source regulatio per e Cupertino Municipal Code, Section Issue ,by' ate: RE- ROOFS: 9.18. 14 Signature Date 44-- All roofs shall be inspected prior to any roofing material being installed. if a roof is installed without first obtaining an inspection, 1 agree to remove all new materials for inspection, ❑ OWNER - BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that [ 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) I, as owner of the property, am exclusively 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 9.12 and the declarations: Health & Safety Code, Section 25532(a) should I store or handle hazardous 1 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 upertin Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, S do 5505, 3, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: Date .1 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, 1 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 0 CUPERTINO DEMOLITION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • buildinga)cupertino.org PROJECT ADDRESS `© l . 'i–At J APN # —0 � 0,36> OWNER NAME _ ` W PH : t)y CJ�y� E -MAIL STREET ADDRESS 10 CITY. TATS, Z i? I 'l G �i V FAX CON C NA to ^ PH NE E -MAIL ST 5'!U vx S CIT TpTE, ZIP c-_ r>, FAX ❑ OWNER ❑ OWNER- BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT C T CT,pR N Q 1� O AV Y r ( LICE " F LICEN YPE BUS. LIC # COMPANY NAME E -MAIL FAX S7jTj�E/D�ESS �� CI�y�TAT,I:, ZIP ( 7��j,J PHO DESCRIPTION OF WORK -De- Mo( -ibo� RESIDENTIAL # DW)rLLING OFFICE USE ONLY USE occ. TYPE SO. FT VALUATION FLOOR AMA UNITS COMMERCIAL FLOOR AREA TYPE OF CONST TION # ST ��� TOTAL VALUATION ' AQMD JOB NUMBER #: RECEIVED B J av By my signature below, I certify to each of the following: I am the property owner or au prized agent ct on t rty owner's behalf. I have rea s application and the information I have provided is correct. l have read the Description of Work an erif ' accurate. I agree to comply with all applicable local ordinances and state laws relating to buildi truction. I authorize rep sentatives of Cupertino o enter the above+- identi led prope for inspection purposes. Signature of Applicant/Agent: Date: 1 0 `-t— SUPPLEMENTAL INFORMATIO REQUIR ISSUANCE OF DEMOLITION PERMIT OFFICE USE ONLY PLAN CHECK TYPE Provide Job Number from Bay Ar a Air Quality Management District www.baagmd.ore CL 415- 749 -4762. Provide three copies (Residential s copies (Commerical) of a site plan showing protection for any trees 10" EXPRESS in diameter or more at 3' abov i a ❑ STANDARD Provide letter from PG &E (40 -72 32 ) stating all gas and electric has been disconnected. LARGE _ Provide a letter of insp c 'on, t sts, d abatement of any Hazardous Materials. Letter to be initiated by person(s) MAJOR certified in asbestos, m c a d/o hazardous material examination. / Planning Dept clearance o verify bu Iding is not considered an historical landmark. Allow 10 business days. _ Provide letter of clearanc of all ver in from a licensed pest control contractor. Applicant shall call the Public Works Department at 408 - 777 -3104 and schedule a "habitable dwelling" inspection. a Provide signed Debris Bin and Recyclable Materials form. DemoApp_2013.doc revised 02113113 I I/ F-MR7 CITY OF CUPERTINO D FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 10292 S TANTAU AVE DATE: 12/18/2014 REVIEWED BY: MELISSA APN: 375 08 038 BP #: 'VALUATION: $500 PERMIT TYPE: Demolition Permit PRIMARY USE: SFD or Duplex PENTAMATION PERMIT TYPE: 1 SFDWL -DEM WORK DEMO GARAGE /SLAB 1 HR INSP PER SEAN SCOPE Permit Fee: FEE ID FLR AREA s.f. 1DEMORES 0 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 Dept for addn'l info. FEE ITEMS (Fee Resolution 11 -053 Eft; 1,13) FEE QTY /FEE MISC ITEMS Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. Q OT 0.0 hrs $0.00 i Strong Motion Fee. IBSEISMICR $0.50 1.0 hrs Inspections $143.00 ISTIIVSP Inspection, Hourly Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $1.50 $143.00 TOTAL FEE-T $144.50 Revised: 10/01/2014