14100031 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10291 JOHNSON AVE CONTRACTOR:BABEL CONSTRUCTION PERMIT NO: 14100031
OWNER'S NAME: FAN HAICHOU&KONG HAIYAN TRUSTEE 3939 ARDEN FARMS PL DATE ISSUED: 10/06/2014
OWNER'S PHONE: 4088918059 SAN.LOSE,CA 95111 PHONE NO:(408)561-7041
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL
DEMO(E)SFD(1,048 S.F.) q� 5ZS
License Class 1 Lic.# (� (,� `'1
ContractorCc!bGt�
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:$7000
l 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:37518032.00 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 WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 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 DAY ROM ST 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 Id
granting of this permit. Additionally,the applicant understands and will comply Issued by: Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature Date I' ? 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:
1 hereby affirm that 1 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 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 1 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 1
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 2573,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Owner or authorized agent:T2s Date: "
1 certify that in the performance of the work for which this permit is issued,1 shall d
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,1 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.
Date
DEMOLITION PERMIT APPLICATION 1
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 r V
CUPERTINO 1 (408)777-3228• FAX(408)777-3333• 4
PROJECT ADDRESS APN# _ /8 0
OWNER NAME O E-MAIL ( (�
Tosr
STREETADDRESS �-�� CI Y j STAT � FAX S o uA' E,ZIP y
CONTACT NAME.• ,I
- A PFI O E Q LI E-MAIL i - '\ \
STREET ADDRESSr r CITY STATE, ZIP FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME e LICE S- UMBE LICENSE TYPE BUS LIC#
COMPANY NAME ` E- AIL FAX
STREET ADDRESS CITY,STATE,ZIP . PHOI� r l
YCIQV
YMS,
DESCRIPTION OF WORK De L�,Ac
RESIDENTIAL R t!DWELLING OFFICE USE ONLY
FLOOR AREA ✓ UNITS USE E YPE SO.FT. VALUATION
COMMERCIAL
FLOOR AREA
TYPE OF CONSTRUCTION #STORIES
AQMD JOB NUMBER � REC D T yA[.UiAT-IOI��
J #: G//7�U
By my signature below,I certify to each of the following: I am the property owner or author ed t to n the property owner's behalf. I have d this
application and the information I have provided is correct. I have read the Description of Work.n verify itis accurate. 1 agree to comply with all appl able local
ordinances and state laws relating to building cons action- I aut ri resentatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: 1G� Date: v ` -
SUPPLEMENTAL I`NFM4ATION'R_E#6IREfjj1FR TO ISSUANCE OF DEMOLITION PERMIT OFFICE USE ONLY
i
Provide.lob Number fr/Bay Area Air Quality Management District ,vvvw.baacitnd.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.doe revised 02/13/13
CITY OF CUPERTINO D
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 10291 JOHNSON AVE DATE: 10/06/2014 REVIEWED BY: MELISSA
APN: 375 18 032 BP#: 14070007 'VALUATION: 1$7,000
PERMIT TYPE: Demolition Permit
PRIMARY SFD or Duplex PENTAMATION 1SFDWL-DEM
USE: PERMIT TYPE:
WORK DEMO E SFD (1,048 S.F.
SCOPE
FEE 1D FLR AREA
s.f.
1 DEMORES 1,048
F-1 Ll Lj
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 prelimina information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 11-055 Eff ?1%15) FEE QTY/FEE MISC ITEMS
Permit Fee: $574.00
Suppl. Insp. Fee:Q Reg. Q OT 0.0 hrs $0.00
i
Strong,Motion Fee: IBSEISMICR $0.91 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: 1 $575.91 $0.00 TOTAL FEE: 1 $575.91
Revised: 08/20/2014
Pacific Gas and
11"Z,- Electric Company 10900 No. Blaney Avenue
Cupertino,CA 95014
DATE: September 5, 2014
CITY OF CUPERTINO
10300 TORRE AVE
CUPERTINO CA 95014
SUBJECT: REMOVAL OF GAS SERVICES (CUT @ MAIN IN THE STREET) ON:
September 4, 2014 @ 10291 JOHNSON AVE CUPERTINO CA
SUBJECT: ELECTRIC SERVICES WAS CUT AT POLE 0114 :
August 20, 2014 @ 10291 JOHNSON AVE CUPERTINO CA
If you have any question contact us at (408) 725-2153
Sincerely,
John Gambucci
Pacific Gas & Electric Company
DeAnza Service Planning Dept.
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SCOPE OF WORK DRAWN BY: SS
DEMOLISH EXISTING STRUCTURES ON SITE CHECKED BY: sss
AND BUILD A NEW TWO STORY RESIDENCE. DATE
OCTOBER 01 2014
SCALE:
AS NOTE®
JOB NUMBER:
HKR - 0914
SHEET:
OF 1 SHEETS