16010016-DP . ,
� .
10334 S TANTAU AVE
16010016
F/P
LI ANSHAN ET AL
SCAIVNED B�X # 684
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10334 S TANTAU AVE CONTRACTOR:LI ANSHAN ET AL PERMIT NO: 16010016
OWNER'S NAME: LI ANSHAN ET AL 10334 S TANTAU AVE DATE ISSUED:01/04/2016
OWNER'S PHONC: 4084645030 CUPERTINO,CA 95014 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL � COMM�RCIAL �
DEMO (E) 1 STORY SFD(1785 S.F.)WITH DETACHED
License Class Lic.# GARAGE(616 S.F.)
Contractor Date
I hcreby 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 u»der 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: Valuatio»:$10000
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work for wliich this APN Number:37508035.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I cartify that I have read this application and state that the above information is pER1dIIT EXP�S IF WORK IS NOT STAItTED
correct.I agree to comply with all city and county ordinances and state laws relating wITHIN 180 I)AYS OF PERIVIIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 1$� S FROM I.AST CALI.ED INSP CT �.
indemnify and keep harmless the City of Cupertino against fiabifities,judgments, �� ( ' �'
costs,and expenses which may accrue against said City in consequence of the I/�,��
grantmg of tltis perm�t. Addttionally,the applicant understands and will comply Issued by. ��'� `� Date: � �
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
R�-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,I agree to remove all new materials for
��" inspection.
����� OWNER-BUILDER DECLARATION '
Signature of Applicant: Date:
I h reby�ffirm that I am exempt from the Contractor's Liccnsc Law for one of
thc following nvo rcasm�s: ALL ROOF COVERINGS TO B�CLASS"A"OR BET"TER
I,as owner of the property,or my employees with wages as their sole compensation, •
will do the work,a��d the structure is not intended or offered for sale(Sec.7044, ,, �
Business&Professions Code) `' �
��as owner of the property,am excfusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSUR�
onstruct die project(Sec.7044,Business&Professions Code). I have re�d the hazardous materials requirements under Chapter G.95 of the
California Health&Safety Code,Seetions 25505,25533,and 25534. I will
I hercby affirm under pcnalty of perjury one of the following three maintain compliancc with thc Cupertino Muuicipal Code,Chaptcr 9.12 and the
declarations: Hcalth&Safcty.Codc,Section 25532(a)should I storc or handle hazardous •��
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use cquipmcnt or dcviccs which cmit hazardous
Coinpensation,as provided for by Section 3700 of the Labor Code,for the air contamivants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliancc with the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safcty Code ..�e,f;f ns 25505,255 nd 25534.
Section 3700 of the Labor Code,for the performance of the work for which this � �� �
rmit is issued. Owner or authorized agen : Datc:_����T f(�
certify that in the performance of the work for which this permit is issued,I shall
ot employ any person in any manner so as to become subject to tlte Worker's
Compensation laws of California. If,after making this certificate of exemption,1 CONSTRUCT ON LENDING AGENCY
become subject to tlie 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.)
Lendcr's Name
APPLICANT CERTIFICATION Lcnder's Address
I certify that I have read this application and state tliat the above information is •
conect.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 ARCHITECT'S D�CLARATION
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the I understand my plans shal(be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with all�point source regulations per he Cupertino Municipal Code,Section Licensed Professional
9.18. f •
Signature Date `7 �
�EEIIfOLIT[0�1 PERM[T /�PPL[CAT[ON ��Or�I�
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CURERTfNO (408) 777-3228• FAX(408)777-3333•buildinq(c�cupertino.orq
PROJECT ADDRESS /D � � �1 � ��� APN# 7, (� /-- �Q Q �h ��
( (G � o �:
OV✓NERNAME —� PHOT'E�,_.(?I � � :� l E-MAIL /
:�i ��� �t/� � ' ��� ��zZG�..��1 S�(�°Cil't,t.�l�� �.7n'
STREETADDRESS � ��� ���,� ���` � CITY, STATE,Z�P 1 _i_ ,� ; C,(�-GIC��� F`—f'V —C� '
�c/'(Y 1�.� /'�
CONTACT NAME - ' PHOT'E . E-MAIL q
12°�-i:" ✓'�vt- – -��U '�Gd-��� S(.i:. �'L G�!'►C�� C�
STREET ADDRESS � CITY,S E, ZTP �s .A�
� O L � G _E�. � �.O C'� � '�� Z�
1 .
�IS�,1 OWNER � OR'NER-BUILDER ❑ OWNERAGENT ❑ CONIRACTOR ❑CONfRACTORAGEA'T ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENPNT
CONTRACTORNAME LICENSE NUMBER LICENSE TYPE BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZTP PHONE
DESCI2IPTION OF WORK /� �
(1�/?/(/c��� f1'L1.
RESIDENfIAL ' #D�WELLING ��� �-Y.3"�� j`�'� �? { OFFICEU�EONLY "r: 3e •,��.} 4{ �j ���'#``F`
FIAORAREA • � UNITS � �° = USE..::;'-'.>,r_'},�OCC.�,.*r:��TYPE•• �hS �.Ft�yi ` „..,�»,�UALUA°TI N.,�...���.��
COhIIvIERCIAL ��zt t s�.�d�x{`k� � �'� ��yi �� ��?9�j?� ��z�S'w �a�� i,r�y •,lidY M�{y
r.f�t k St . i. �� � y� i�s,�i�� �, � iS<:�.,..�'c,i :. 'a..�2 ��-
FLOORAREA � � <.� . :�'- .x Y." `' � .ia�-.,._.. rx.`x:..r .f..t; ',��
TYPE OF CONSTRUCTION�\ �STORIES 1 S� �`t' '�.�`� `' �;�q ;' . + `` J� � ,, t"� e h i`-y 3 �,1;'
e
�j .�'?,a. �':T.1� .. d���_ r ts..'r �3r� s .:{' T t,�....,.�
{ � �-: r .t��, � y s „ F F.. x{ � ,... ,,....�..
AQNID JOB NUMBER RECE _ � � t 5 r� ; TOTAL VALUATION:
J#: ` ��� ' �,s. 5 � Dap
By my signature below;I certify to each of the following: I am the pmperty owner or authorize�d agent to act on the property owner's behalf.rtI have read this
application and the infonnation I have provided is correct. I have read the Description of VJork and verify it is accuiate. I agree to coinply with all applicable local
ordinances and state laws relating to building cons tion. I authoriz resentatives of Cupertino to enter the above-identified property for inspecrion pwposes.
Si�ature of Applicant/Agent: Date:
' SUPPLEMENTAL INFO TION REQ D PRIOR TO ISSUANCE OF DEMOLI"TION P RMIT � ��oFFicE usE on�,Y` #
� �; ,�}«., 3 • K
Provide Job Number from Bay Area Air Quality Management District wt;nv.baac�md.or;@ 415-749-4762. -.-.P�.cxECKZY'rE.;,,,:.;::
c� Provide three co ies .Residential or six co ies Commerical of a site lan showinQ rotection for an trees 10 ; �
❑{•ExrxEss} ° .
— P � ) P � ) P oP Y K "t �
,� ' ..r4 ��.. ,�
i diameter or more at 3'above grade. sT�u.D�:n `
� � ;
❑�LARCE� r _.
P vide letter from PG&E(408-725-3325)stating all gas and electric has been disconnected. , � ,
V Provide a letter of inspection,tests,and abatement of any Hazardous A2aterials.Letter to be initiated by person(s) w� �JOR� :, �
certified in asbestos,mercury and/or hazardous material examination. M - � J ' , 4 :.
:� k:s t
�anning Dept clearance to verify building is not considered an historical]andmark.Allow 10 business days. 4 s r
�' Provide letter of clearance of all vermin from a licensed pest control contractor. `
�A licant shall call the Public Works Departrnent at 408-777-3104 and schedule a"habitable dwelling"inspection ' °` f -:
�t :>: ( �e �. �
Provide signed Debris Bin and Recyclable Materials form. , ;
DemoApp_2013.doc reinsed 0�/13/13
. �
����1�
CITY OF CUPEItTINO
�
FEE ESTIMATOIt-BUILDING DIVISION
` ADDRESS: 10334 S Tantau DATE: 01/04/2016 REVIEWED SY: PAUL
APN: 375 08 035 BP#: '"VALUATION: $10,000
��PERMTT TYPE: Demolition Permit 1�I::,�;t t:'fC1�:�:��"'7�3��)1:':
PRIMARY PENTAMATTON
USE: SFD or Duplex PERMITTYPE: 1SFDWL-DE�
WORK Demo E 1 sto SFD 1785 S.f. with Detached Gara e 616 S.f.
SCOPE
FEE ID FLR AREA
s.f.
1 DEMORES 2,401
:Fe°s,=. t'l:art C'tzc�� Pr':��,�n,I'�caar t,"?:e�c'k L=Ttrc;. 1'I��ra C';-rr;1:
f�I1:1;�F.�"�a';'iiT<'1".,�.. �"�iiNY%.7.�"�c't'rF7t`i`�{�n, ?:J. �d,:
..t'L:. I��P:?Y17; �:c:
i��a%2... �';'s::%.. �i7;f.�. t�t��r:"t:r:�rh Irs�; t;�;,crt�tii��i�.tr.S��.
1418i;�1. ii7S7:.t'e.'<': %'1l7;19FiJ.i,"t.�J; �`'�a.u, i'��CL;. . 1,'t.;� (��(;(!;
NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Se►ver District,Sc/tool
District,eta . These ees nre based on the relinzinn in ormation availnble and are onl nn estimate. Contact the De t for addn'1 i�z o.
FEE ITEl!'IS (Fee Re,solutiorr.1.1-053 Fff. %;'1/.13,� FEE QTY/FEE 1!'IISC ITEl!'IS
f`'.'L�Yi C;ltc'��t�f���E��,':
:�i1.���f.`Jl', .I'�:�%'is,r
''.
' r±P31).�::`�t�..'t1 t.:"...I';f.;
Permit Fee: $574.00
Suppl. Insp.Fee:Q Reg. Q OT p.p hrs $0.00
,r't rria.l%..!;:i�l:;.r,;'7.-'i°sdr��
�IttPYJ•'''..'.'�:�;�{;iT?.;"f:I:;C;I�;,:"id2;i f"�t't';
�.�C)iiSPi'd!C'ldliii �CZ.ti:
�3c,irr�i�tit'f;-clf;w'�'�'t'�':
l�z�rlc I-I'Li:f?Od.iJ''�(:Y9�?Ir`.�
.�.i:l�k�'sfP1�;�;f�.#'�l:Cd17i'ZT3t�.�"�C't'S:
j7"!X'dE;�t�.�::1C:Z(7)'ic,'FftCd�Ic>7'f�`�P�':5:
I
Stron�M.otion Fee: IBSEISMICR $1.30 Select an Administrative Item
Bld�7 Stds Commission Fee: 1BCBSC $1.00
°� 5� ;,.,. -- _ SUBTqTALS;, $576.30 $0.00 =� � ° TO'IzAv F���::: $576.30
Revise . 010112015
I
Building Depart�raent
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
C U P E ItT 1 N O - Fax: 408-777-3333
CONTRACTOl�/ SUBCONTRACTOl� LIST �
JOB ADDRESS: /(� PERMIT# I
OWNER'S NAIVIE: PHONE# -' -� � i
GENERAL.CONTRACTOR: BUSINESS LICENSE#
ADDRES S: CITY/ZIPCODE: �
_ XOur municipal code requires all businesses working in the city to have a City of Cupertino business license. �
NO BUILDING FINAL OR FINAL OCCLTPANCY INSPECTION(S) WILL B� SCHEDLTI.,ED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors: I
Signature Date -
Please check applicable'subcontractors and coYnplete the following information: j
_ �
✓ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE#
Cabinets &Millwork � � �
I
Cement Finishing ,
Electrical �
Excavation f 2�z�L �ii i��Y.� l�7.2S'� � � 8 �
Fencing �
Flooring/Carpeting -
Linoleum/Wood
Glass /Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting/Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tanlc _ _
- Sheet Metal �
Sheet Rock
Tile
�� �� � / --/�
O ner/Contrac Si nature ate �