15010007 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10558 STERLING BLVD CONTRACTOR:PAB CONSTRUCTION PERMIT NO: 15010007
INC
OWNER'S NAME: JALILI MOHSEN H ET AL 21060 HOMESTEAD RD STE 216 DATE ISSUED:01/05/2015
OWNER'S PHONE: 4084996595 CUPERTINO,CA 95014 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL E]
Q ? DEMO(E)1300 S.F. SFD
License Class Lic.# � V (2 �j�
Contractor '? A J�, CCng Date ..0'5 -15
1 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.
1 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:$11000
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:37523030.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
t certify that I have read this application and state that the above information is PERMjT EXPIRES IF WORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 18�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 F 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 is ate:
granting of this permit. Additionally,the applicant understands and will comply
with all non-point sourc egu tions per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature Date Q -C _ 11 g 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.
F10ER-BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date:
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)
I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). 1 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(x)should l 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 1
performance of the work for which this permit is issued. will maintain complianee with the Cutin
unicipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25 2 3 and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Owner or authorized agent: Date:C J_06-15
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,I CONSTRUC ON 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 ARCHITECT'S DECLARATION
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 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
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 1
�O
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 O
CUPERTINO (408) 777-3228• FAX(408) 777-3333• building(a)cupertino.org \�
PROJECT ADDRESS ` Q G r � R 1 APN H 3 S '� Z3 a
OWNER NAME M e�TPf) )v,� 1 ') PHONE qC�'�lQ� CQn,Q E-MAIL 00.1 ^C�S i ��
STREET ADDRESS -c P!� VQ E-MAILCITY, STATE,ZIP(!V 9p (f)llFAX
CONTACT NAME 1 I PHONE
C J
C LIc$4Ctq_ 6S S PC -) I
STREET ADDRESS CITY,STATE, ZIP FAX
❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME 0�... Q Y LICENSE NUMBER LICENSE TYPE BUS.LIC 9
COMPANY NAME n n S viC �"e In E-MAIL ea.)D a"S t � /) m�' I 'nC FAX
01
STREET ADDRESS r1 CITY,STATE,ZIP l� ( PHONE
DESCRIPTION OF WORK fy�49 CP ;S , 1 C Us J C e -
RESIDENTIAL ^ 77.,
WELLING FFICE USE NLY
FLOOR AREA ITS USE OCC. TYPE Fr. VALUATION
COMMERCIAL
FLOOR AREA
TYPE OF CONSTRUCTION #STORIES
AQMD JOB NUMBER TOTAL VALUATION
l 0 d
By my signature below,I certify to each of the following: I am the property owner or authorizedact e property owner's behalf. I have read this
application and the information I have provided.isorrect. I have read the Description of Work and veri is accurate. I agree to comply with all applicable local
ordinances and state laws relating to buildi ns u ion. 1 authorize representatives of Cupertino to enter the above-Identified property for inspection purposes.
Signature of Applicant/Agent: Date: C1. o6 15
SUPPLEMENTAL INFO TION QUIRED PRIOR TO ISSUANCE OF DEMOLITION PERMIT OFFICE USE ONLY
_Provide Job Number from Bay Area Air Quality Management District w`,vw.baagmd.ora @ 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. El LARGE
_Provide a letter of inspection,tests, and abatement of any Hazardous Materials.Letter to be initiated by person(s) El 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.
1`f 1266 73
DemoApp 2013.doc revised 02/13/13
CITY OF CUPERTINO D
FEE ESTIMATOR— BUILDING DIVISION
FL ADDRESS: 10558 STERLING BLVD DATE: 01/05/2015 REVIEWED BY: MELISSA
APN: 375 23 030 BP#: S Q `VALUATION: $11,000
PERMIT TYPE: Demolition Permit
PRIMARY SFD or Duplex PENTAMATION
USE: PERMIT TYPE: 1 SFDWL-DE;
WORK DEMO E 1300 S.F. SFD
SCOPE
FEE ID FLR AREA
s.f.
1DEMORES 1,300
Ll -L- - L-1
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 preliminar information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (FeeResolartion ll-053 Eff 7i1i13) FEE QTY/FEE MISC ITEMS
Permit Fee: $574.00
Supp/. Insp. FeerQ Reg. Q OT 0.0 hrs $0.00
i
Strong Motion Fee: IBSEISMICR $1,43 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $576.43 $0.00 TOTAL FEE: 1 $576.43
Revised: 10/01/2014
Pacific Gas and
Electric Company 10900 No. Blaney Avenue
I, a" Cupertino, CA 95014
Date: December 9, 2014
City of Cupertino
10300 Torre Ave
Cupertino, Ca. 95014
SUBJECT: REMOVAL OF GAS SERVICES (CUT 0 MAIN IN THE STREET) ON:
10558 STERLING BLVD. CUPERTINO ON JUNE 2014
SUBJECT: ELECTRIC SERVICES WAS CUT AT POLE ON :
If you have any question contact us at (408) 725-3325
Sincer 1
acif'c Gas & Electric C pany
D nza Service Planni g
408/725-3325
ukst U31k 04430rists ,
Urban Tree Specialist
I.S.A CERTIFIED ARBORIST WE-7505A
Licensed • Bonded ° Insured
April 9, 2014
Re: Arborist Report
Property: 10558 Sterling Blvd.
Cupertino CA, 95014
To Whom It May Concern:
On March 8, 2014 a site visit was made to 10558 Sterling, Cupertino CA, 95014, to
catalog and evaluate the 2 trees located there.
Tree# 1- Prunus (Cherry Plum):This tree is healthy, the foliage color, dispersion and size
are correct and the trunk has one gall (crown gall) located at 311 height. The 3 co-dominant
trunks have circumferences of 15"-22"-22" at 4.5' DCH, the height is 12' and the crown spread
is 15'. This tree has structural problems as the co-dominant trunks are imbedded, and thus
subject to failure. This tree also is lifting the cement sidewalk and a tripping hazard exists at the
time of viewing.
Tree# 2- A Fraxinus (Evergreen Ash): A healthy young city tree with a circumference of
17", height of 12' and a crown spread of 7'.it is a city tagged tree and subject to all regulations.
Please feel free to contact our office contact us if you have any questions or concerns.
Sincerely,
_ '
Simon J. Tunnicliffe, Owner Operator
ISA Certified Arborist WE-7505A
PO Box 162 - Campbell, CA 95009 • 408-866-1148 ° CSL.#892956
i ell ) <
�r, �►r
City of Cupertino
Public works Department
Environmental Programs Division
, f10300 Torre Ave
CUPERTINO GREEN Cupertino, CA 95014
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/Envirormlental 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:
• .,:.3".U.zFS 'F.:.'il!GiY+nW 14tl4"'wFff. "� F,3...: d'»£4flff-2 »;. ., n.L„.;z«a k 'n'aaS&'.'s+Y"L fi`.: ;::;. .. •R• G:..aR2 "s',: rdL'33d4
Please check all that apply:
lq
�I am not using a Recology debris bin,however, the project is less than 3,000 s.f., e.g. buildings,patios, 1 14
sidewalks, driveways.
rE ❑ I will use a Recology debris bin. By Agreement with the City, Recology will prepare my required
l Waste Management Plan &Recycling Report. Contact Recology: (408) 725-4020.
t ❑ I am not using a Recology debris bin. I will provide the following submittals to the City's Public
Works Department, 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 (g
complete the following:
✓ 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 i37orks counter and online
at 1414-w.cl.ipertirto.org/environrnei?tal. Report the tonnage recycled a1d disposed, by material type.
Recycling_facilities must be selected f oni the City's approved list of Recycling Resources.
• d
✓ Submit a Construction Recycling Report_form. The report is required before the Building
Department will schedule a final inspection. The report form is available at the Building/Public
til/orks Cow7ter a71d of liw.cupertino,or(,r/environmental.
Signature:
d re: Date:__Z,�.2- �3 1__�
Name: (printed) � a l o q
Title: Q L"V)V
Phone: ilea'- q 6' i�
Project Address: Q5 5P V
'['his forni to remain in the project's building permit file for the duration of the project.
Revised 317112 1
T
i b �
NO ATTACHMENTS
RIPL.NE
4"■a" PL AN
4 SIDES (TYP.) TO BE KEPT
AN
4 0"
9i ♦ b. d'
EXISTING GROUND II e 2 O'
b' 'r
IWROCK OR EQUAL ♦:b
7 r
12"DIA,
TYR POST
ELEVATION
NOTES:
I. THE DEVELOPER SHALL INSTALL THE " TREE PROTECTION" DEVICES
PRIOR TO THE START OF GRADING OR CLEARING WORK.
2. THE CITY RESERVES THE RIGHT TD ISSUE A "STOP WORK" NOTICE IF
THE "TREE PROTECTION" DEVICES ARE NOT INSTALLED OR IF THE
DEVICES ARE NOT MAINTAINED PROPERLY.
3. SEE THE PROJECT GRADING PLAN FOR SPECIFIC TREES THAT REQUIRE
PROTECTION, ALL SPECIMEN TREES REQUIRE PROTECTION UNLESS
OTHERWISE NOTED,
4. NO EXCAVATIONS WITHIN THE "TREE PROTECTION AREA" ARE ALLOWED
UNLESS UNDER THE SUPERVISION OF A REGISTERED TREE SERVICE COMPANY.
5. ANY FILLING WITHIN THE "TREE PROTECTION AREA" SHALL BE DONE IN
ACCORDANCE WITH A DETAILED IMPROVEMENT PLAN APPROVED BY THE CITY.
G. NO TRIMMING, CUTTING,OR PRUNING OF DESIGNATED TREES CAN OCCUR
WITHOUT A REGISTERED TREE SERVICE CONIPAtM
7. CONSULT ORDINANCE 778 OF THE CITY OF CUPERTINO FOR PERMIT
REQUIREMENTS AND EKCEPTIONS.
8. TEMPORARY CHAIN LINK FENCING IS AN ACCEPTABLE SUBSTITUTE TO
THE WOOD CONSTRUCTION.
TREE PROTECTION STANDARDS
CITY ®� CUPERTINO^ APPROVED BY : DATE : !v S®4
STAFF®AR® DETAILS CI E !N e EA
R b
Ld
Q
LEGEND
EXISTING CONTOUR LINE
-- ®— NATURAL GRADE CONTOUR LINE
�. FOUND CITY MONUMENT BOX, OR AS NOTED 10
0 50
BOUNDARY OF PROPERTY SURVEYED
t
O RECORD INFORMATION I ^~ \ �;\ D 20 40 100
, , � GRAPHICSALE
-- CENTERLINE
IL
CURB INLET - �� 1 �, r+�c z
THE PAIR OF CITY MONUMENTS ALONG STERLING BLVD., BETWEEN CYNTHIA AVE.
CURB LINE AND BARNHART AVENUE WITH BEARING OF S11'03'18"W & DISTANCE OF 648.52' 2
DRIVEWAY APRON
,\ (648.46' CALCULATED PER R1)
` \ -
��y \ �� 90 yam-
-o ELECTROLIER \ \ �� S295J,~ \ ` �\ \\ �� `__�� �_ — \ _ — _ - •-
�, NOTES: `� Z z
,� \ 1S �\\ - -- - - — — -_ — -- - 1 0
�� QX. WATER W 45 8 , �� ` `18S _._ _
-- ---->: -----� ---- FENCE `< � � --._ 1--�`-- -- —_ ✓ r � ----- 1. DISTANCES AND DIMENSIONS ARE SHOWN IN FEET AND DECIMALS THEREOF. N � 0 0
SF 2. THE DISTINCTIVE BORDER LINE DENOTES THE BOUNDARY.
�b FIRE HYDRANT - - - - - - - - - - - - -
�;\\ \tet ✓ ,� \ \ �80 \ �_ - ___ r__ _ _._. __ _ ____ __ _ 3. THE AREA WITHIN THE DISTINCTIVE BORDER IS 8,623 S.F. OR 0.198 ACRES, MORE
e FLAT GRATE INLET �. - � - - -M--- - — _ OR LESS.
O.H. PWR OVERHEAD POWER LINE A� y y- A%>`� `
\ \\\ a�\\ _ \ _
� DRAINAGE
] EASEMENT
REFERENCES-
O.H, TEL OVERHEAD TELEPHONE LINE -Rrw
m
*\ a c�
Y
R1 TRACT 1183 44-M-13ss SANITARY SEWER LINE w
/7to 0 U
SANITARY SEWER MANHOLE BENCH MARK
COO
SANITARY SEWER CLEANOUT
DESCRIPTION: SANTA CLARA WATER DISTRICT BENCHMARK ID BM166; 5 CM
_ — — - - DIAMETER BRASS DISK, ON TOP OF EAST END OF SOUTHERN CONCRETE
SIGN — _
� � _a - -�� f y HEADWALL AT THE SOUTHEAST CORNER OF BOLLINGER ROAD AND SARATOGA
so STORM DRAIN LINE ( ) x�� _._ _ - _ - _ \ 1 M
TREE CANOPY TYP - "� - - ` f` CREEK. ELEV.: 202.78' (NAND 88)
lb
CD STORM DRAIN MANHOLE - Y
A �' ----=� ��- -_-` ABREVIATIONS
� � » -.
o UTILITY BOX � �A _-
�\ APN ASSESSOR'S PARCEL NUMBER
cr UTILITY POLE >14 _ _ — BM BENCH MARK
CAN CABLE TELEVISION OVERHEAD
w WATER LINEN-b.�* X " � � — D CURVE DELTA
� - v t}xt DRWY DRIVEWAY
WATER METER
2'X20' ANCHOR DS DOWNSPOUT
WATER VALVE CONC. lu EASEMENT D# DEED REFERENCE
FL FLOW LINE ELEVATION
C7 ELECTRIC METER 0��e, Ir'�� IP IRON PIPE
L CURVE LENGTH
1w:-1 WATER HEATER
00 M# MAP REFERENCE
C�
M-M MONUMENT TO MONUMENT
GAS 00 LO
rn EX. HOUSE O.H. PWR OVERHEAD POWER LINE
FF 188.5E w
O.H. TEL OVERHEAD TELEPHONE LINE
o PCL PARCELco
"4 P.M. PARCEL MAP
�
:G] � P.M.
PTN PORTION
X.N 'LOT 2 8 6 R RADIUS w
0 00SD STORM DRAIN
SS SANITARY SEWER \°SQL LgNO s
Iji
TC TOP OF CURB ELEVATION
�w PORFIRIO
TEMP. TEMPORARY A
Xq,� OSCAR OSUNL N
12 7REE �1 No. 8921
� Exp. 9-30-16, iJgT LLJ
& �5
{ x F of CAt�Fo
I
— — BASIS 0 BEARINGS
��
(S 11°03'18"W 648.46 CALCULATED PER R1)— - - ---- - - - - - -
`* S11°03'18"W 648.52' M-M
- .��_. L=51.05 R=1170,00--
—— — — — —— — — —— — ——— — — —— - -- �.:
A=2°30'00"
w
--- �`- -" --- SIDEWALK
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BUILDING DI'VlSIO-\I - c E RTINO
a' 7 h's set of plans and SpeCiflC�Itions MIST �e kep, ai i�c
i
to make an
��b site during ror structzon. (tis ��, t�ra i , JOB N0.
�o changes or aitc=rations on scnr,1,,e, or to deria e 5 2011
herefiom, wi;ncc-.i <,pproval from the Building 0 ficial. 11088
U
ohe Stamping s plan and saeci`ra' n
m �e held '.� SHA CT � SHEET
e d to perm f } rah cf the vi _.
.t,i.n
or State T.0.
0
Lave.
DATE --- OF
PERMIT# �-
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