D-2017-0013CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: D-2017-0013
10356 MENHART LN CUPERTINO, CA 95014-3631 (375 16 015)
OWNER/BUILDER
10356 MENHART IN
OWNER'S NAME: WEIHUAXIONG
DATE ISSUED: 04/11/2017
OWNER'S PHONE: 408-866-4039
PHONE NO: OWNER
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class Lic. #
Contractor OWNER/BUILDER Date
— BLDG _ELECT —PLUMB
MECH XRESIDENTIAL —COMMERCIAL
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.
JOB DESCRIPTION:
DEMO SFD (1081 S.F.), DETACHED GARAGE (293 S.F.) & DECK
I hereby affirm under penalty of perjury one of the following two declarations:
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
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
permit is issued.
Sq. Ft Floor Area: Valuation: $10000.00
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above
APN Number: Occupancy Type:
information is correct. I agree to comply with all city and county ordinances
375 16,015
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, costs, and expenses which
PERMIT EXPIRES.IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit.
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally, the applicant understands and will comply with all non -point
source regulations per the Cupertino Municipal Code, Section 9.18.
180 DAYS FROM PECTION.
Signature Date 04/11/2017
Issued by: MELIS
Date: 04/11/2017
OWNER B 1Ii DER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
RF ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
following two reasons:
I, as owner of the property, or my employees with wages as their sole
installed without first obtaining an inspection, I agree to remove all new materials for
i.
compensation, will do the work, and the structure is not intended or offered for
inspection.
sale (Sec.7044, Business & Professions Code)
2. t\ J, as owner of the property, am exclusively contracting with licensed
Signature of Applicant:
contractors to construct the project (Sec.7044, Business & Professions Code).
Date: 04/11/2017
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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
HAZARDOUS MATERIALS DISCLOSURE
performance of the work for which this permit is issued.
have Worker's Compensation Insurance, as provided for by
I have read the hazardous materials requirements under Chapter 6.95 of the
2. I and will maintain
Section 3700 of the Labor Code, for the performance of the work for which this
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
permit is issued.
Health & Safety Code, Section 25532(a) should I store or handle hazardous
��. X 3. (- I certify that in the performance of the work for which this permit is issued, I
material. Additionally, should I use equipment or devices which emit hazardous
I
shall not employ any person in any manner so as to become subject to the
air contaminants as defined by the Bay Area Air Quality Management District
Worker's Compensation laws of California. If, after making this certificate of
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety Code, Sections 25505, 25533, and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
f'
be deemed revoked.
Owner or authorized agent:
Date: 04/11/2017
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
correct. I agree to comply with all city and county ordinances and state laws
of work's for which this permit is issued (Sec. 3097, Civ C.)
relating to building construction, and hereby authorize representatives of this city
Lender's Name
to enter upon the above mentioned property for inspection purposes. (We) agree
to save indemnify and keep harmless the City of Cupertino against liabilities,
Lender's Address
judgments, costs, and expenses which may accrue against said City in
consequence of the granting of this permit. Additionally, the applicant understands
ARCHITECT'S DECLARATION
and will comply with all non -point source regulations per the Cupertino Municipal
I understand my plans shall be used as public records,
Code, Section 9.18.
Signature ' J M' Date 04/11/2017
Licensed
Professional
EAMNIVE72ne
DEMOLITION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333 - build ingC&-cuperti no.org
I) -7-,o (4— e)01
R
PRIOJECT ADDRESS
�naob Neakav+ LIA Capfytho, CA V014-
APN #
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WNEWA E-MAIL
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STREET AD% V
I ore CITY, STZ, jZ_ FAX
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CONTACT NAME HONE E-MAIL
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-0-el � 1A 0 )(101 t7e— 693�-137 �
STREET ADDRESS CITY, SIE, ZIP FAX
(I T-0 Mpit U021 Ilk 17TV /4
OWNER El OWNER -BUILDER D OWNERAGENT I-] CONTRACTOR El CONTRACTOR AGENT 1:1 ARCHITECT El ENGLNrER L1 DEVELOPER ❑ TENAN1
CONTRACTOR NAME
1,14CE NUfER
LI SEP E
BUS.LIC #
4.660
COMPANY N E-MAIL "1140tl� tom
e6tsfisut .1 C
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ST ADDRESSY, STATE, 7�
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PHONE
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DES [tOF WORK
49 deotc, 1,Ad to pew L
mp
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RESIDENTLkLft
073
DWELLING
OFFICE USE I ONLY
FLOOR AREA
UNITS
USE occ,
TYPE
SQ. FT.
VAtUATION
COMMERCIAL
7
FLOOR AREA
TYPE. OF COISTRUCTION
tip
AQMD JOB NUMBERTOTAL
4874
VALT) J�TION:
By my signature below, I certify to each of the following: I am the property owner or authorize c�t on the property owner's be.. I have read this
application and the information I have provided is correct. I have read the Description of Wo verify itis accurate. I agree to comply wlffi all applicable local
ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORMA-fiON REQUIRED PRIOR TO ISSUANCE OF DEMOLITION PERMIT
OMCE USE ONLY
-PLAN CHECK TYPE
—.Provide Job Number from Bay Area Air Quality Management District vrww.baag d.or @415-749-4762.
0 ss
ExPRE1.
Provide three copies of a site plan showing protection for any trees 10" in diameter or more at 3' above grade.
El STANDARD
Provide letter from PG&E (408-725-3325) stating all gas and electric has been disconnected.
LARGE
Planning Dept clearance to verify building is not considered an historical landmark. Allow 10 business days.
MAJOR
Provide letter of clearance of all vermin from a licensed pest control contractor.
kpplic nt shall c the Public Wor Department at 408-777-3104 and schedule a "habitable dwelling" inspection.
Provide signed Debhs Bin and E ecycl7le Materials form.
Commercial Buildings Only: Provide Fire Dept clearance for fire suppression alarm system review.
DemoApp_2016.doc revised 03129116
CUPERTINO
OWNER -BUILDER DISCLOSURE FORM
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building cDcupertino.ora
Dear Property Owner(s):
An application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified at:
SITE ADDRESS
v3K6 1"'feif ltcw- L,it -P,7to.
APN
BP#
-ZD 1 —0 01
OWNER NAME
�i��ff �; I pp e !t j
U4 3(v X i G 1O(Al l t e 1 ° p
OWNERADDRESS f , y
1,>31,6 1 �'Pf�I.�� Cu Lm
DESCRIPTION OF WORK:
k h L,-Jd &�, sfi3t�? fi,ivve
We are providing you with an Owner -Builder Acknowledgment and Information Verification Form to make you aware of
your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder. We
will not issue a building permit until you have read, initialed your understanding of each provision, signed, and
returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless
you, the property owner, obtain the prior approval of the permitting authority.
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
(DIRECTIONS: Please read and initial each statement below to signify you understand or verify this information.)
(ALL1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -
Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material
personally. I, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by
an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not
provide coverage for those injuries. I am willfully acting as an -Owner-Builder and am aware of the limits of my
insurance coverage for injuries to workers on my property.
2. 1 understand building permits are not required to be signed by property owners unless they are responsible for
the construction and are not hiring a licensed Contractor to assume this responsibility.
IrU K 3. 1 understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may
protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her
name instead of my own.
4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license
numbers on permits and contracts.
�5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the
total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be
considered an "employer" under state and federal law.
6. 1 understand if I am considered an "employer" under state and federal law, I must register with the state and
federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to
unemployment compensation for each ``employee." I also understand my failure to abide by these laws may subject
me to serious financial risk.
UIX 7. 1 understand under California Contractors' State License Law, an Owner -Builder who builds single-family
residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by
licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work
is performed under contract with a licensed general building Contractor.
Vt 4 8.'1 understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for
any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction
defects in the workmanship or materials.
O71'71e7BZfilde7F07711 2010.doc revised 04/14/10
9. 1 understand I may obtain more information regarding my obligations as an "employer" from the Internal
i Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments,
t and the California Division of Industrial Accidents. I also understand 1 may contact the California Contractors' State
License Board (CSLB) at 1-800-321-CSLB (2752) or www.csib.ca.gov for more information about licensed
�! contractors.
K 10. 1 am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that
�.t am the party legally and financially responsible for proposed construction activity at the site address listed above.
W � 11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide
by all applicable laws and requirements that govern Owner -Builders as well as employers.
Y
'��12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the
information I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If
you contract with someone who does not have a license, the Contractors' State License Board may be unable to
assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed
Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or
employee of that individual or firm is injured while working on your property, you may be held liable for damages. If
you obtain a permit as Owner -Builder and wish to hire Contractors, you will be responsible for verifying whether or not
.those Contractors are properly licensed and the status of their workers' compensation insurance coverage.
CONSTRUCTION LENDING AGENCY
(DIRECTIONS: Please complete the following construction lending agency information.)
I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued
(Sec 3097 Civ.)
Lender Name: Lender Address:
Before a building permit can be issued, this form must be completed and signed by the property owner and
returned to the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license,
form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued
to verifythe propertyowner's,si� nature.. /
Property Owner's Signatupre, Date: // , a It. 2!v,7
C/
---------------------------------------------------------------------------------------------------------------------------------------------
(NOTE. The following Authorization Form is required to be completed by the property owner only when designating an
agent of the property owner to apply for a construction permit for the Owner -Builder).
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby
authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an
Owner -Builder Permit for my project.
Scope of Construction Project (or Description of Work):,
Project Location or Address:
Name of Authorized Agent:
Address of Authorized Agent:
Tel No
I declare under penalty of perjury that I am the property owner for the address listed above and i personally filled out the
above information and certify its accuracy. Note: A copy of the property owner's driver's license, form notarization, or other
verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's
signature.
Property Owner's Signature: Date:
Ois77e7Builde7Fo77772010.doc7•evised04114110
CUPERTIINO
PURPOSE
PROCEDURE CHECKLIST FOR DEMOLITION PERMITS
COMMUNITY DCVELCPM NT DEPARTMENT - BUILDING DIVISION
ALBERT SALVADOR, P .E., C.B.O., BUILDING OFFICIAL
90304 TORRE AVENUE • CUPERTINO, CA 05094-3255
(408) 777-3228 - FAX (448) 777-3333 - bqlldlncjgcupertlgo.orcj
The demolition application should be applied for before or at the same time as the neve construction
permit application (these are separate permit applications and fees). Permit fees are due at the time of
the application/plan submittal. The new construction pen -nit will not be issued until the demolition
permit is issued, unless a letter obtained froin the Building Department is submitted stating that "The
existing house will not be demolished until the new construction permit is issued". The letter needs to
be signed by both the property owner and general contractor.
REQUIREMENTS
To obtain a demolition permit in the City of Cupertino, please complete a Demolition permit
a lication alo with each of the following requirements as it applies to your specific project.
7, Three (3) copies of a Site (Demolition) plait for Residential or six (6) copies for
Commercial -% I be required showing any trees is inches in diameter at 3 feet
above grade on the subject property, and what nneans will be taken. to protect
these trees.
PG&E most be contacted AS EARLY AS POSSIBLE priox to demolition to
schodule the abandonment. Contact PG&E at (408) 725-3325. A later fforn.
PG&X shall be provided to the City, stathig that all gas and aloctrie has boo i
diseomwetod. (7 118 step can be time consuming, so it is 11'nportmit to beighl the
process 1"nedlately)
Provide job Number framrt Bay Area Air Quality Management District
www. "aa @ 415-749-4762,
Cheek to see if the building is considered art historical lwidniark. Obtain Clearance
from the Community Development Plaiiniii.g Department. Allow 10 workingy
days—.
Provide a letter of clearance of all vermin from a licensed best control contractor.
I (Z b. Important: Prior to the issuance of the demolition permit, the applicant rniut call
the Public Works Department at (4018) 777-31,04 and arrange a "habitable dwelling"
inspection.
7. Debris bin and Recycling sheet: read, sign and date. The sheet will remain in the
project's building permit file for the duration of the project.
E& S. Commercial only -prior to issuance of the demolitions permit, the .Fire Department
must review the plans for fire stippression/alarm systems that shall remain in
service
be. g Mkt ff, t shall be replaced with. the new
service or be mod! � s r D t,
constr
1'I°iedi°hung II)eIDarl inein't
�IEVHEWQED FOUL CO[A-. CUM[I[JNellCE
T.1e»roProcnrli.rr�.rloC r'eWserf 2/13/13
Pacific Gas and
Electric Company.
WE DELIVER ENERGY:
APRIL 1OT", 2017
ZHAOHUIMENG
10356 MENHART LN.
CUPERTINO, CA 95014
RE: 10356 MENHART L.N. CUPE TINO CA 9501.4
Order Number: 112506901
To whom it may concern,
The gas meter at the above referenced address has been removed and the gas service
was cut off at main on (04103117).
The electric service & meter at the above referenced address has been disconnected and
removed on (02127117).
Sincerely,
14-4 611 FR9
Justin Pigg
Project Coordinator.] Pacific Gas & Electric Co I
DeAnza Division] 10900 N Taney Ave. Cupertino, CA 95014
J2PY-@D.ge.com 10ffice: 408.725.2165
M -I" 7:OOAM — 3:30PM
**AVAILABLE BY APP01NTMENT ONLY**
"Safety is a full time job; don't make it a part time practice"
AwWoOmmid
IIII'') E 1I1 11140
1I°tuflIdPiiing 1'teirertirrieurst
EVHI:�°:MED FOR CODE CONA['sI[JANCE
Revuewed l y:! Melhssa Ilw°i&m e
Lute: D V°E?I
SOS PEST CONTROL
214 Christich Lane #103
Campbell, CA. 95008
Rodent Inspection Clearance
Date: October 08, 2015
Re: Property Address: 10721 Santa Lucia, Cupealno, CA 95014
To whom it may concern:
The property at the above location was inspected today for any infestation of rodents. No
active infestation was found, If you have any further questions, please call our office at
(408) 866-6609.
Thank you,
Mike Stadmiller
Branch II Field Representative
IIII°°') SII 11140
1I°tedi°ii:p I1)ep ariineiint
ILWIME'D FOR CODE CONA['[JANCE
Revuewed By:! Melhssa `,James
Data: D VE?I
City of Cupertino
F T Public works Department
tt Environmental Programs Division
j` 10300 Torre Ave
Cupertino, CA 95014
2iiP�RFlNd Cak4 Ek Fi
Program (408) 777-3354
Construction and Demolition Recycling Diversion
Requirements and Instructions
Covered projects, or all construction, demolition and renovation projects that are 3,000 s care 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. Weight Tags of all material
recycled and disposed must be submitted with the final report in order to receive a Final Building
Inspection.
"Recology.is the nnldebris bin service provider franchised to do '' u
Y p busixaess in (pe'1ino.
T
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.f,, e.g, buildings, .patios,
sidewalks, driveways.
Cl 1 will use a Recology debris bin. By Agreement with the City, Recology will prepare my required
Waste Management flan & Recycling Report. Contact Recology: (408) 725-4020.
Cl 1 ani not using a Recology debris bin. I will provide the following submittals to the City's Public
Works Departrrrent, 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 Mcanogement Plan with ,your building permit
application. No feo for this plan. Forms are available at the BuildinglPttblic Wor:14 counter eared online
at wK w.ctaper-£ino.orgfeanvironrrt.ental. Report the tonnage recycled and disposed, by material. type.
Recycling facilities roust be selected f om the City's approved list ofRecyeling .Resour'ces.
✓ Submit a Construction Recycling Pepart form. The report is required before the Building
Department will schgaide aflutal inspec 071. .The report farnr is available tai the BuildinglPublic
Works �ounte dline xw� cr.a aaea°into.rrlaravie�ar€raentcrl.
Signature:
Name: (printed)
Title:
Phone: 2-
Project Address:
This form to reanain in the project's building
.Revised 31711.2
io of the roject,
I iii dli ID elpat meat
FREVH.�.=..D FDR CODE COWI[JANCE
Revwed a yd\46llissa Ilw°J&m e
DME0,1E?I F
Date:
4 -10`
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P.U.E.
EXISTING GARAGE
RIDGE=!113.12
2935.F.
O BE DEMOLISHE
Wj
W
e
Eh
4TREE
4 TREE T
c
0356 MENHART LANE/
EXISTING HOUSE
FF = ±101.25
RIDGE --±111.12
J
WTD
/ 1,080 S.F.
/ TO BE OEMOL15HE0
.a
--
8'TRE
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>
3
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REE n
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EDEMOLISH
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AREA = 5,057±SQ.
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- e
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-
--��
HEEP (E)
IGNT OF WAV
?
KEEP (E)
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Ti�1Do.Do
LANE
12 -
10360 MENHART LANE
EXISTING HOUSE
RIDGE -1111.48
OWNER NAME: MR. WEIHA XIONG
/ SITE ADDRESS: 103% MENHART LANE
/ SCOPE OF WORK:
DEMO. I STORY SINGLE FAMILY HOME
WITH EXISTING PATION (89.S.F.) TO BE
SCO PE OF WORK IN THE FUTURE:
NEW ISTORY SINGLE FAMILY HOME.(
h
Z
22"TREE
TO EEMAIN
'60'R/W)
DEMOLITION SITE PLAN
SCALE 118"=1'-0"
Gopl
WITH AN DETACHED GARAGE (293.5.F.)
ATT-UGG GARAGE (440.S.F.)
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION - CUPERTINO
This set of APPROVED
plans and specifications MUST be kept at the
job Site during conslruction. It is unfavful to make any
changes or alterations un Safne, or (o deviate
therefrom, without approval fro"' 'he 30ilding Official.
o �nls p;an and s eLI` .) ;YIS SHALL NOT
be held to perrnit or t
of
an '01a =' of Ire violation
c1� ce or State Law.
DATE
(N)GAS LINE PERMIT# -
-
ZU�_ QUI