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14090055 CITY OF CUPERTINO BUILDING PERNIIT BUILDING ADDRESS: 10576.JOHNSON AVE CONTRACTOR:HOMESTEAD PERMIT NO: 14090055 CONSTRUCTION INC OWNER'S NAME: ROSE 23 HAYWARD LLC 10080 STERN AVE DATE ISSUED:09/1112014 OWNER'S PHONE: 6502787300 CUPERTINO,CA 95014 PHONE NO:(408)255-8999 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL DEMOLITION OF 2 STORY HOUSE &GARAGE 2,652 SQFT License Class Lic.# (ey3 Contractor Nw«e J,.) C ..r1....ak, Date 11K qtr Z041 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: 1 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:$8000 !1' 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:37528032.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION 1 certify that l 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 WITHIN IgO DAYS OF PERMIT 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 FROM LAST CALLED 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 Issued by: Date: ���w � granting of this permit. Additionally,the applicant understands and will comply . s — / G � with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. ROOFS: Signature (i(/�.r,,. ��Date �j �e�. Z✓�(�/ All roofs shall be inspected prior to anyny 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: 1 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 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) 1,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. 1 will I hereby affirm under penalty or 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 performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and 1 have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25.505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date:/I'{S.a !v14/ 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,l 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 DEMOLITION PERMIT APPLICATION ^16 9 COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPBRTINQ 1 (408)777-3228• FAX(408)777-3333•buildinq(cilcurJertino.om PROJECT ADDRESS77 4�T�� se, A.v APN#, .4 f i­% -,,-1 1;)L, -7--? 41) q� LW I OWNERNAME t J J PHO E-MAIL lJ V 1 �o op STREET ADDRESS �'7�-�'# CrI'Y, STATE,ZIP �G �t n O C A FAX CONTACT NAME �n C�� ���li� PHONE E-MA/IL/ S 1 ff52 l7Ave C ,STATE, Zip o C, t YJV141 i ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME Q LICENSE ER ` LICENSE TYPE �B�US.LIC# Z COMPANY NAME uL / E MA C f� 3m,7>� Y V 0 Q oo�FA �) STREET ADDRESS/ ob Q r� 7 CITY,STATE,ZIP ® /� (7 i P P 9 o x/ Qr-9 DESCRIPTION OF WORK 7 LF j) j of Z hJr RESIDENTIAL #DWELLING / FLOOR AREA UNITS COMMERCIAL FLOOR AREA P0 AM92kl_ TYPE OF CO UCTION #STORIES / v AQMD JOB NUMBER j RECEIVED BY: TOTAL VALUATION: J#: S� Z Aft By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building constructio thorize r resentatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: �r - Date: ,- Y SUPPLEMENTAL INFORMATION REQUIRED PRIOR TO ISSUANCE OF DEMOLITION PERMIT OFFICE USE ONLY !/Provide Job Number from Bay Area Air Quality Management District www.baagmd.org @ 415-749-4762. PLAN CIIECK TYPE rovide three copies(Residential)or six copies(Commerical)of a site plan showing protection for any trees 10" d EXPRESS in diameter or more at 3'above grade. B-STINDARD 1 Provide letter from PG&E(408-725-3325)stating all gas and electric has been disconnected. Q LARGE Provide a letter of inspection,tests,and abatement of any Hazardous Materials.Letter to be initiated by person(s) © 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. rovide 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 FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 10576 johnson ave. DATE: 09/10/2014 REVIEWED BY: bobs. APN: BP#: VALUATION: 1$8,000 F.d 'PERMIT TYPE: Demolition Permit PRIMARY SFD or Duplex PENTAMATION 1 SFDWL-DEM USE: PERMIT TYPE: WORK demo 2 story sfd SCOPE FEE ID FLR AREA s.f. 1DEMORES 2,652 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 Eft" 7/1!131 FEE QTY/FEE MISC ITEMS Permit Fee: $574.00 Suppl. Insp. Feer Reg. ® OT 0.0 hrs $0.00 A Strong Motion Fee: IBSEISMICR $1.04 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.001 1 SUBTOTALS: $576.04 $0.00 TOTAL FEE: 1 $576.04 Revised: 08/20/2014 Pacific Gas and 11 a" Electric Company` 10900 No. Blaney Avenue Cupertino,CA 95014 DATE: 11 (o CITY OF CUPERTINO 10300 TORRE AVE CUPERTINO CA 95014 SUBJECT: REMOVAL OF GAS SERVICES (CUT @ MAIN IN THE STREET) ON: 1051a��Sc� . �� SUBJECT: ELECTRIC SERVICES WAS CUT AT POLE ON : If you have any further questions, please contact me at (408) 725-3325 Sincerely, 1 v� Pacific Gas & Electric Company DeAnza Service Planning 408/725-3325 < _ City of Cupertino Public works Department E Environmental Programs Division 10300 Torre Ave t� Cupertino,CA 95014 LUPERTINU GRFFN 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 square 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 only debris bin service provider franchised to do business in Cupertino. 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. ❑ I will use a Recology debris bin. By Agreement with the City,Recology will prepare my required Waste Management Plan&Recycling Report. Contact Recology: (408)725-4020. ❑ 1 am not using a Recology debris bin. I will provide the following submittals to the City's Public l Works Department,showing that I have recycled at least 60%of all construction demolition material E Ask for the Construction &Demolition Recycling Packet from the Building Department and r complete the following: £q ✓ Submit a Construction:and Demolition Waste Management Plan with your building permit application. No fee for this plan. Forms are available at the Building/Public Works counter and online at www.cupertina.oig/environmental. Report the tonnage recycled and disposed, by material type. Recychng,facilities must be selected from the City's approved list of Recycling Resources. ✓ Submit a Construction Recycling Report form. The report is required before the Building Department will schedule a fiiud inspection. The report form is available tit the Building/Public 4 Works Counter and online tltivt�.culaertiiio.orglenvironrneratal. Signature: Date: Name: (printed) Title: Phone: �— q Project Address: r/ 0, C' A This form to remain in the project's building pennit file for the duration of the project. Revised 3/7/12 1 � 2Q -6 221-4)) FE-Valohe By 07/29/'l 3 10576 J O H N S 0 N AVE. PRELIM. DESIGN REVIEW 10/29/'l 3 PRELIM. DESIGN REVIEW WALKWAY 12/13/'l 3 11'-6" o FLOOR PLAID AREA CALS: DESIGN REVIEW A I , „ 14 01/20/'l 4 N - BID & PERMIT SECTION DIMENSIONS AREA - - - ^i FRONT YARD PAV'G CALS: A 11.5X2 23.00 Front Yard Area: CNI (54.83+55.83) X 20 = 1,107 sf B 23.58X34.17 805.73 ^i I CONC. PAVERS Paving Area: 171-0 1$ 2nd FLOOR AREA 829 S.F. 400 s,f, 400+17+76= 493 sf C ,. .(D *c Paving ratio at Front Yard: f B C 20.5X26.5 543.25 r*,1 .` : = ' 493/ 1,107= 44.53% D 17X13.75 233.75 .:,': ,'' ; <"; . ��G� �%o o " Q NI E 6.5X4.33 28.15 Q U O W � 231-72) _ F 22.33X45.58 1017.80 FRONT YARD P AV' G CALS SI i. = 10'-0• ,�'°ti C;l,�P�`� ^i 1 st FLOOR AREA 1,823 S.F. � CL TOTAL FLOOR AREA 2,652 S.F. 10576 JOHNSON AVE. 2ND FLOOR AREA CATS• 1 ST FLOORAREA \ ALS a a% LU W W W W W W W W Z1 fr1 O •L W W W W W Y/ Y W .Y W VFeil ' W W W W W W W W .Y V• W W � I� CCI •Y Y �l• W •Y W W W y W W Z ^ ( c ) O ^I W W W W W W W W . 459 SIf I . W W 1 O W �6• W W W W W W W •Y W •Y F_t O1 Iw w w .Y W H• •Y •i• •Y •Y •Y W L o U 00G�I 1p 7.7 ^ I w w .v v v v v w , 14 E EL. 97.72 W W W W W W w W W ■ [� O SEWER M.H. 12 BARN AVENUE EL. 97.79 10 FT. a SEWER M.H. 13 �y � L 2 _101) o DATUM „ o a ADJACENT PROPERTY AT 10568 JOHNSON AVENUE o I EL. 100.00 zi N SEWER M.H. #1 % 0 o o , „ z RERENCE LINE BUSHES --- - 6 FT. REDWD. FENCE 102.53 PROPERTY LINE 103.83 FT. 100.88Fo-;-1-�sc;= UNE 101:78 SHRUBS 102.23 TKItm 100.74 100.47 100. OUT SLAB GUTTER CURB 1 102.10 102.15 I 1 CONC D/W BRICK PLANTER I SARUBS LANDSCAPE AREA CALS: 10076 i 10182 GAS METER 103.13 I � A. LAWN AREA: 459 SF CONC. WALKWAY OOq CONCRETE DRIVEWAY SL GL DR THRSHLD I P A N T' AREA A 1 1 � 101.95 ,U2.D4 B. L G E 9 + 400+ 1060+ 135 �Z sLAB EXISTING RESIDENCE �- i O = 1 7 8 7 I (� 103.08 10576 JOHNSON AVENUE � � �-- TOTAL LANDSCAPE AREA: A+ B- 2, 246 SF � �0 102.18 102.23 STEP ( W Li a W z i B K \-FACE OF CURB I FACE OF CURB-/ I ll1 WA CE LINE- J Cf}i$�ii't r 'PJ rC JF P�",rZTIMENT �1 Q 101.7 I m �- YC_J�r s;'" 100.64 101.0 / i l co f ZO GUTTER CURB i �Oti BRICK DRNEWAY 102.66 102.62 I y- +; N^Fr 1 RTtNp 12` HIGH oo WALKWAY •• p 101.79 I ' ^ WOOD WA �- -� 102.11 ", L l �^ T(??, cng l A = I RETAINING WALL M 8° FRUIT WATER GRASS Ift1S Il' S j'be k2 V PATIO SLAB LINES 02.27 \� �11` �J J P' n CO C� C f Com''' pt at the O LOT AREA = 102.59 A �� G C ! �n tr Icf 1 s t1lc�rt 'A 1 or G: ra c:ls arl �1 SMALL FRUIT TREE ItlE Un!a t0 ,� 102.59 102.28 � 5,921 tSQ.FT. '.- } 02.30 �- PG&E METER WITH\`% (J\ / thC' .Yviit i�'tr?Out rOv ► ' S mr i I_re r l 18` PALM a � SMALL FRUIT TREE , � t � � � r t0 0`:3 f'=;'- r n t,`ta Lti,d;r1 ©ictal. U a BRICK PATIO OMASTVERHEAD SERVICE \�y� ( v J T¢ q`'r rnt� L1t th IS DIO afl tono SHALL /y O ' ' 1-...rnit Or t0 30 c^3 u 3i �1 a, any s; Oval of the violation Z y�rovi =s Of an, It' Y 103.14 GRASS t ti �:1anC Q I �• or Sime Low. � 1 SL GL DR THRSHLD N ( r• � �' -___ _ � 0 ca BUSHES ® 24` PALM I \ 101.16102CONC. BLOCK WA 100.79 10i. 101.28 1 .fi0 102.0 WALKWAY 102.73 N') �SMALLUIT TREES FRUR Is JSHRUBS ' O102.33 \ 0 _BUSHES -- -- 6 FT. REDWD. INCE 102.33 /'� �•� I � � 1 (14 LINE 102 � 0 1� p �' 0 1 Ur r"=� 102.04 102.50 \ v A V \ / I U8`FRUIT �Y � �� ADJACENT PROPERTY AT 10584 JOHNSON AVENUE: j UTILITY SERVICE POLE DEMOLITION PLAN S: 1`a 10�-0` I FACE OF CURB 1. ALL EXIST. IMPROVEMENT SHAII BE REMOVED 2. DEMOLITION SHALL BE UNDER SEPARATED PERMIT. , Y 3. ALL EX. UTILITIES SHALL BE RELOCATED. 1 , 060 S S I EXISTING SITE PLAN W ^ I N iCIFIAWN i MC 00 rt a MC A DATE10 0 10 20 30 � AS NOTED AS NOTED ..UB nem. e"Ee, » T Z LANDSCAPE AREA CALS SI i- - i0°-0• 0F