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15020043 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21030 GREENLEAF DR CONTRACTOR:HSU ALLEN K AND PERMIT NO: 15020043 CINDY S OWNER'S NAME: HSU ALLEN K AND CINDY S 10229 SCENIC BLVD DATE ISSUED:02/06/2015 OWNER'S PHONE: 4088938007 CUPERTINO,CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL SFDWL DEMO 1716 SQ FT License Class Lic.# 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 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 APN Number:32628084.00 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 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 AST 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 �. granting of this permit. Additionally,the applicant understands and will comply Issued by: Date: 09, 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. I❑•�� OWNER-BUILDER DECLARATION I 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, / AiN 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). 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(x)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,Sect's 25505,_25533,and 25534. ction 3700 of the Labor Code,for the performance of the work for which this vel Owner or authorized agen _ Date 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,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-poin4ource regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18, i Signature v t Cate DEMOLITION PERMIT APPLICATION 12 COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO (408) 777-3228• FAX(408)777-3333•building(a)cupertinLM �C PROJECT ADDRESS I I^ fJ` IS APN# 3_2U OWNER NAME , ` V ( � f PHON /\ ;C C�r G 3 y�rY E-MAIL 6/C (��" STREET ADDRESS J CITY, STATE,ZIP )ZIPIP (r FAX CONTACT NAME d�zPHONE E-MAIL STREET ADDRESS CITY,STATE, ZIP FAX ❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME � �A ('rl ICENSE NUMBER LICENSE TYPE BUS.LIC#td� •. COMPANY NAME f E-MAIL FAX f � STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK / n RESIDENTIAL #DWELLING OFFICE USE ONLY' FLOOR AREA fn1 UNITS USE OCC - TYPE S .FT. VALUA'TION' COMMERCIAL FLOOR AREA TYPE OF CONSTRUCTION #STORIES AQMD JOB NUMBER _ RECEIVED BY: - TOTAL VALUATION: By my signature below,I certify to each of the following: I am the property owner or authorized agent to act o owner's behalf. I have read this application and the information I have pr9y1ded is correct. I have read the Description of Work and verify it is accurate. 1 agree to comply with all applicable local ordinances and state laws relating to b)Afdinconstruction. I autho!je representatives of Cupertino to enter the above-identified property forr inspection purposes. Signature of Applicant/Agent: Date: 7Z 6 r S,FIPPLEMENTAL INFORMATION RP00IRED PRIOR TO ISSUANCE OF DEMOLITION PERMIT OFFICE USE ONLY Prov: Job Number from Bay Area Air Quality Management District ww\v.baagmd.or;@ 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 ' eter or more at 3'above grade. ❑ STANDARD - Pro etter from PG&E(408-725-3325)stating all gas and electric has been disconnected. L1 LARGE _Provide a letter of inspection,tests,and abatement of any Hazardous Materials.Letter to be initiated by person(s) El rIAJoR certti in asbestos,mercury and/or hazardous material examination. _P14alTing Dept clearance to verify building is not considered an historical landmark.Allow 10 business days. _P/� 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. rovide signed Debris Bin and Recyclable Materials form. Dem0pp_2013.doc revised 02/13/13 CITY OF CUPERTINO D FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 21030 greenleaf dr DATE: 02/06/2016 REVIEWED BY: Mendez APN: BP#: �© 3 *VALUATION: 1$14,000 *PERMIT TYPE: Demolition Permit CK !;N PRIMARY SFD or Duplex PENTAMATION 1 SFDWL-DEM USE: PERMIT TYPE: WORK demo sfdwl SCOPE FEE ID FLR AREA s.f. 1DEMORES E:F NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etG). Thesefees 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 Ef 71LI131 FEE QTY/FEE MISC ITEMS ' Permit Fee: $574.00 Suppl. Insp. Fee.E) Reg. OTQ,Q hrs $0.00 rrJj iJ: *.�. ..iiCC. Strong;Motion Fee: IBSEISMICR $1.82 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $576.82 $0.00 TOTAL FEE: $576.82 Revised: 01/06/2015