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14040056 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20840 MCCLELLAN RD CONTRACTOR:CHERRYLAND LLC PERMIT NO: 14040056 OWNER'S NAME: CHERRYLAND LLC 2[881 DOLORES AVE DATE ISSUED:04/09/2014 OWNER'S PHONE: 4085680616 CUPERTINO,CA 95014-2958 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL EJ COMMERCIAL E] DEMO(E) 1,008 S.F.SFD(NO BLDG PERMIT APP, SUB License.Class Lic.# DIVISION WITH PLANNING APPROVAL) Contractor Date 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 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 performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$14000 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:35920031.00 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 WO OT STARTED correct, I agree to comply with all city and county ordinances and state laws relating ,-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 sa LED INSPECTI N. indemnify and keep harmless the City of Cupertino against liabilities,judgments, ^ costs,and expenses which may accrue against said City in consequence of the 7 granting of this permit. Additionally,the applicant understands and will comply sue Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. 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,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 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, usiness&Professions Code) as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE 1 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 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 the Health&Safety Code,Sections 25505,25533,end 25534. l Section 3700 of the Labor Code,for the performance of the work for which this �! 1 rmit is issued. Owner or authorized agent: V Date:: �+ )� pJertif 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 4- 4- 1C.J DEMOLITION PERMIT APPLICATION O COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO,CA 95014-3255 CU PERI"INO (408)777-3228 •FAX(408)777-3333•building6ftupertino.org PROJECT ADDRESS � ^goo p n` e j APN# i OWN N�E LLC PHONES - (� -o6 / E-MAIL fa n 60 STREET ADDRE S CITY, STATE,ZIP FAX CONTACT NAMEPHONE E-MAIL e �L r� -06 l STREET ADDRESS CITY,S ATE, ZIP a FAX I OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONT CTOR N E LICENSE NUMBER LICENSE TYPE BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADD n/ ! CITY, TATE, IP cet / PHOE�_ ` ? _ ad4 DESCRIPTION OF WORK V (• RESIDENTIAL #DWELLING OFFICE USE ONLY FLOOR AREA UNITS USE OCC. TYPE SO.Fr. VALUATION COMMERCIAL FLOOR AREA TYPE OF CONSTRUCTION #STORIES _ S10 rV AQMD JOB NUMBER < D BY TOTAL VALUAT12p V J #: 4L42 By my signature below,I certify to each of the following: I am the prop67 owner or authorized agent to a property owner's behalf. I have rea this application and the information I have provided is correct. I have read the Description of Work and veri it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction. 1 juthorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: C Date: SUPPLEMENTAL INFORMATIO REQUIRED PR10R TO ISSUANCE OF DEMOLITION PERMIT OFFICE USE ONLY _Provide Job Number from Bay Area Air Quality Management District www.baaamd.org @ 415-749-4762. PLAN CHECK TYPE Provide three copies(Residential)or six copies(Commerical)of a site plan showing protection for any trees 10" ❑ EXPRESS in diameter or more at 3'above grade. ❑ STANDARD _Provide letter from PG&E(408-725-3325)stating all gas and electric has been disconnected. ❑ LARGE ❑ Provide a letter of inspection,tests,and abatement of any Hazardous Materials.Letter to be initiated by person(s) MAJOR 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 CITY OF CUPERTINO D F0FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 20840 MCCLELLAN RD DATE: 04/09/2014 REVIEWED BY: MELISSA APN: 359 20 031 BP#: - `VALUATION: 1$14,000 =PERMIT TYPE: Demolition Permit PRIMARY SFD or Duplex PENTAMATION 1 SFDWL-DEM USE: PERMIT TYPE: WORK DEMO E 1,008 S.F. SFD NO BLDG PERMIT APP SUB DIVISION WITH PLANNING APPROVAL SCOPE FEE ID FLR AREA s.f. 1 DEMORES 1,008 NOTE: This estimate does not include fees due to other Departments(i.e. Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . These ees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l info. FEE ITEMS (Fee Resolution 11-053 Efl.' 7,1%13) FEE QTY/FEE MISC ITEMS Permit Fee: $557.00 Suppl. Insp. Feer Reg. 0 OT F0,07hrs $0.00 i Strong.Motion Fee: 1BSEISMICR $1.40 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC j $1.00 SUBTOTALS: $559.40 $0.00 TOTAL FEE: $559.40 Revised: 04/01/2014 IN Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: -2 (o PERMIT# OWNER'S NAME: PHONE# 0 — — O- GENERAL CONTRACTO'RJ BUSINESS LICENSE# ADDRESS: CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please cbeck applicable subcontractors and complete the following information: &/ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring/Carpeting Linoleum/Wood Glass/Glazing Heating Insulation Landscaping Lathing Masonry Painting /Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile 4- � - z� ll-�- Owner/Contract Signature Date .r OWNER-BUILDER DISCLOSURE FORM s COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION 10300 TORRE AVENUE- CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408)777-3333- buildino(E)cuoertino.org CUPERTIND 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 ADD -ss� Ne lAPN 3 BF1 s -� - 2v-o 3 OWNER N E 0%VNER ADDRESS 2 e DESCRIPTIO OF\ ORK: e mu l t-- 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 of�icial 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 ACKNOWLEDGi►(ENT AND VERIFICATION OF INFORMATION (DIRECTIONS:Please read and initial each statement below to signify you understand or verity this information.) 5 v. 11. 1 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. " I understand as an "Owner-Builder" I am the responsible parry 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. V. I 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 mateeriafs, I may be considered an "employer"Linder state and federal law, I understand if I am considered an "employer' under state and federal law, I must register with the state and ederal 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 nsk. - I understand under California Contractors' State License Law, an Owner-Builderwho 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. A1YF -ancial I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. 0-14'71erBiiilde7-For,n ?010.doc revised 0�'/14/10 I understand I may obtain more information regarding my obligations as an "employer" from the Internal ie4vente Service,the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or vnnw.cslb.ca.gov for more information about licensed contractors. 7210.f 0. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the party legally and financially responsible for proposed construction activity at the site address listed above. . l agree that, as the party legally and financially responsible for this proposed construction activity, I will abide bytallippllcable laws and requirements that govern Owner-Builders as well as employers. 02. 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 phis orm. 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 Beard 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 LENDINIG AGENCY (DIRECTIONS:Please complete the following construction lending agency information.) 1 hereby a7rm 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 verify the property owner's signature. Property Owner's Signature: Date: -Lp� --------------------------------------------------------------------------------------------------------------------------------------------- (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 Ovmer-Builder Permit for my project. Scope of Construction Project(or Description of Work): Project Location or Address: Name of Authorized Agent: Tel No Address of Authorized Agent: 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, corm notarization, or other verification acceptable to the city may be required to be presented when the permit fs issued to verify the property owner's signature. Property Owner's Signature: Date: 0'fie 0ui;de�Fa�i ?OlO.doc revised 04/14/10 SOS PEST CONTROL 214 Christich Lane #103 Campbell, CA 95008 Rodent Inspection Clearance Date : March 7, 2014 Re: Property Address: 20840 McClellen Avenue, Cupertino, 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, f Mike Stadmiller Branch II Field Representative Pacific Gas and Electric Company 10900 No. Blaney Avenue 1 �' Cupertino, CA 95014 February 28, 2014 City of Cupertino 10300 Torre Avenue Cupertino , Ca. 95014 To Whom It May Concern: SUBJECT REMOVAL OF GAS AND/OR ELECTRIC FACILITIES The gas and electric facilities have been removed and/or abandoned at: - Gas service cut at main in street on: 4/24/2013 AT 20840 MCCLELLAN RD CUPERTINO CA 95014 - Electric service cut at pole on: 3/20/2013 AT 20840 MCCLELLAN RD CUPERTINO CA 95014 Sincerely, r Pacific Gas Electric Company DeAnza Service Planning y LEGEND ° AC ASPHALT CONCRETE BC BUILDING CORNER HAN BW BACK OF WALK CB CATCH BASIN CMP CORRUGATED METAL PIPE S IDENCE CO CLEAN OUT CRN CROWN EC EDGE OF CONCRETE re EM ELECTRIC METER EP EDGE OF PAVEMENT FC FENCE CORNER I FD FOUND 20840 MCCLELLAN RD FF FINISHED FLOOR PALO ALTO, CA 4 I , FL FLOW UNE APN: 359-20-031 FH FIRE HYDRANT ' G GROUND 1 GC GARAGE CORNER GFC GROUND AT FENCE GM GAS METER HC HOUSE CORNER ( ( HCR HANDICAP RAMP INV INVERT W E C iJP IP IRON PIPE & ASSOCIATES �eo16 I JP JOINT POLE } LG UP OF GUTTER I +101 1 0/H OVERHEAD 2625 MIDDLEFIELD RD#658 k$ o CO I PC PROPERTY CORNER PALO ALTO, CA 94306 IRW RETAINING WALL PALO 650 823-6466 SL STREET LIGHT I SSCO SANITARY SEWER CLEAN–OU FAX: (650) 887-0321 �— Z ' SSMH SANITARY SEWER MANHOLE 1 SDMH STORM DRAIN MANHOLE TBC TOP BACK OF CURB +neo°9� TC TOP OF CURB TOB TOP OF BANK (. v 6°I TOE TOE OF BANK Q ti `°�Q 5 Q°oke TP TOP OF PAVEMENT ti THZ,, F �, FG , � FG g FG , FG 419.75' (CL) 1O�FGr.ORTW TOP OF WALL 12" U/G UNDERGROUND IE8"0 K Q g � y � p VCP VITRIFIED CLAY PIPE "TREE 30 NE 22 EE 10 E "PINE 4"PI 24" e G4- CPWV WATER VALVE G6 G �° + 10° I oo°� O M WATER METER BOX g0 \ +g� +gg�0 +ggy0 G g ... ° 1005 ( ^ –CTV– CABLE TELEVISION UNE ' ° TBM SSMH F-1 °°` –E– ELECTRICAL LINE GFG6� G L G 01 G �1 +Gg55 0 6 0 <: •'a : 6• FQ °6 tQ { EL=100 00 e �Oo g1' +g0 +g0 +gg of +GgyS g°� ° SL –G– GAS UNE F?G&E. :FAEILF °tES . .. {�,g ' ® i -S- SANITARY SEWER LINE ' g g PA. • EAS1_ –D– STORM DRAIN N E O GROSS AREA 41 ,973.5fSQ.Ff. 0 " Pk <t: � –T– TELEPHONE LINENET AREA 39,973.5fSQ.FT. �Q:4o g % –W– WATER LINE p g1. 0 +gg �cn 6S 0G 0° o i LICENSE STAMPS AND SIGNATURE • . z W gg O i 1 k SIGNS BASIS OF BEARINGS L = o �Qg�.': a 0 REE " g , g E BEARING, N89 56 35 E, OF THE G 66 g kgs 1 R +G0�6 6 +gg O��L ��1' ° •'.• a' U ? �� ' tQ 6k gg I CENTERUNE LINE OF MCCLELLAN ROAD, AS ° SHOWN ON THAT CERTAIN MAP FILED IN LAND SG Q 1 GFGO� G 5� +G��� G� OHO+ g x `L G ti� ��. R Ig OFFICE OF THE RECORDER OF SANTA CLARA g� gAN �L gg: gg. W / 100. .a °+ (� G +AF, p 10°F 0G e 5�9 "T EE 0 (� COUNTY, STATE OF CALIFORNIA, IN BOOK v O k� / d- + 10° gg + 173 OF MAPS AT PAGE 54, WAS USED AS +g� J °°? +9 G �� SM THE BASIS OF BEARINGS SHOWN ON THIS 1 +eg 0.17 g MAP. Exp.00 1 1 0 �„� ( NO. L8235 JP g1 +9 0°1 +�9 L �-'—I ' f 0F CAV { CD I BASIS OF ELEVATION: $ 655 + +�06 + 98.6e <a, A. 1k p 1 ' g 40"OAK 6ti g��e hb ' G 6 �G og C .� . . �- g0. TBM ELEV = 100.00 (ASSUMED) 1 E 1 EE 1 R 8' R +G��Lg +g,'5 +9��g ge G �° g�+G g$�� .�qa•.. ;,a.' �oQa •-.a <1g�..� �� ' 1 g g + �. G 6 �. ,a. QQ 3 0' ' ° g g��Q ISSUED QG°16 FG FG ry 0�'FG FG L GFG j� <G00 F� 0 _ FG 0 FG p FG 1 GF 4%K11 NORTH g g g g g g g g ' (CL} G �� s.3° 419.72 I g$�� V I ILI I I NOTE' No. Description Date +0 0�`• g�'i I ' UNDERGROUND UTILITIES. SHOWN PER �Q SURFACE EVIDENCE AND RECORD MAPS. MAY BE DIFFERENT THAN AS SHOWN. SIG I BEFORE EXCAVATION, CALL UNDERGROUND �Q �$ SERVICE ALERT (USA) 1-800-642-2444. i g� 1 1 I ' JP c)- 1 � I e 1� COMMUNF Y J77VE QPMENT DEPARTMENT �rn,1y-C...�,.'`�L., ' g� BUILDING GiViSi v-CUERTINO `�•CJ 1 t ate, DATE: '4` F� A� m ��� E7D MARCH 30,2011 god This soft of plans and specifications MUST 5e kept at the SCALE: cis situ dUrin. c �' ! I 9 on ,r ruction. Itis unlawful ul to make any I"=20-011 . i anc•:;s or alterations on same,or to deviate DRAWN: til ru:rrom,without approval front the Building Official, $G Th.� npin x of this pian^F v ,��' .1 s SHALL NOT 1 $: OR 4 . 'a 10078 top . �3�^:i vai of the violation i of - ZN a ! ,; ance or State Law. r SHEET TITLE: I C3`Tw I PC?P01TlaO. lip ' ON j n TOPOGRAPHIC SURVEY SSMH 'r i SHEET NO. SSMH 9 IF +g�• © WEC