11070221 (2)COV E RS H E ET
11070221-D
21150 GRENOLA DR
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CITY OF CUPERTINO BUILDING PERMIT I
BUILDING ADDRESS: 21 150 GRENOLA DR
OWNER'S NAME: SUBIR SENGUPTA
OWNER'S PHONE:
❑ LICENSED CONTRACTOR'S DECLARATION
License Class Lic. # 20 0`%
Contr r Date 7 ZP///
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.
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
permit is issued.
APPLICANT CERTIFICATION
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,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Signat Date 7 �/
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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,
Business & Professions Code)
1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
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.
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
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
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
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,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
CONTRACTOR:' -aE I PERMITNO: 11070221
�0(n1N �UI I�er'S DATE ISSUED:07/28/2011
PHONE NO:
BUILDING PERMIT INFO: BLDG r ELECT PLUMB
MECH RESIDENTIAL COMMERCIAL
JOB DESCRIPTION: SFDWL DEMO 1,204 SQ FT
Sq. Ft Floor Area: I Valuation: $10000
APN Number: 32628059.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAY FRO AST CALLED INECTION.
Issued by: Date: P/
RE -ROOFS:
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.
Signature of Applicant:
Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, S 505, 25533, and 25534.
Owner or authorized a nt: Date:
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for the performance of
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
Signature Date
CUPERTINO
DEMOLITION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(acupertin0.0rg
//0 --7- d22/
PROJECT ADDRESS 2"I I SO '4PZ 6(A'R.- 7APN#
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OWNERNAME SV%X L S-efjo �4 d Cl r�l
PHO -lti6) D I..-6704)
E-MAIL
STREET ADDRESS V ISO e'��A �-
SS
CITY, STATE,
FAX
CONTACT NAME ,ULOA
�
PHONE
Ua $42- 6700
E-MAIL
STREET ADDRESS
CIT Y, SPATE, ZIP
FAx
��
44�❑ OWNER -BUILDER ❑ OWNER AGENT a<0-NTR c-roP, ❑ coNTRAcTOR AGENT ❑ ARCHrrECT ❑ ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTO�I�� ME
NORb1ti1 $VIIWL
LICENSE NUMBER
Q
LICENSE TYPE
BUS. LIC N
COMPANY NAME
E-MAILb� 0- _ ,w"(ag Jt LAOS . �
W
F ` bq' r , 7"
STREET ADDRESS
I-KI ALSAUA �-•
crry, STATE, ZIP
S*P-) 70SE- CA 1 45,1 S2
PHONE
-6Sa -516, 77V
DESCRIPTION OF WORK
W40%Z -14015C E'h0U` ?4MJ
q DWLRESIDENTIAL LING �
53
� w�INF0 ¢�
-•��M K_
-
I lJiI�
FLOOR AREA W4
COMMERCIAL
FLOOR AREA
TYPE OF CONSTRUCTION
N STORMS
z
I
U
AQMD JOB NUMBER
_
TOTAL VALUATION:
J #:
�k..r>
4 l0 (900
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 withal] applicable local
ordinances and state laws relaqng construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature ofApplicant/Ag t: -J>. AJI:9�1Date: 7 11
SUPPLEMENTAL INFORMATION REQUIRED PRIOR TO ISSUANCE OF DEMOLITION PERMIT
e'�irfSE;t
vide Job Number from Bay Area Air Quality Management District ww^v.baagmd.ors @ 415-749-4762.
_C_.PrbViTe three copies of a site plan showing protection for any trees 10" in diameter or more at T above grade.-
y
6 Provide letter from PG&E (408-725-3325) stating all gas and electric has been disconnected.
,4A'fo—vide 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.r''='=T
1--frovide letter of clearance of all vermin from a licensed pest control contractor.
Applicant the Public Works Department 408-777-3104 "habitable dwelling" inspection.,-
-_
s� shall call at and schedule a
Provide signed Debris Bin and Recyclable Materials form.
Commercial Buildings Only: Provide Fire Dept clearance for fire suppression / alarm system review.
DemoApp_2011.doc revised 03116111
CITY OF CUPERTINO
ww D
FEE ESTIMATOR - BUILDING DIVISION
191
ADDRESS: 21150 grenola dr.
DATE: 07/28/2011
REVIEWED BY: bobs.
APN:
BP#:
"VALUATION: j$10,000
`PERMIT TYPE: Demolition Permit
PRIMARY SFD or Duplex
USE:
PENTAMATION 1SFDWL-DEM
PERMIT TYPE:
WORK
demo 1 story sfd and detached garage.
SCOPE
FEE ID FLR AREA
s.f.
1 DEMORES 1,204
ET
Ll
MOM- The.Qe fee.0 tire haved an the nleliminnry infnrma/inn avnilnhie and are nniv an evtima/e_ C antnr/ the Dent fnl nddn �l infn_
FEE ITEMS (Fee Resolution 11-053 F.. 711111)
FEE
QTY/FEE
MISC ITEMS
„.
Permit Fee:
$523.00
Suppl. Insp. Fee.10 Reg. 0 OT
0.0
hrs
$0.00
I'lrt;nl=. • r11::rr..:1�;1Lt l'e:r•rar! f�r�< .
Work N'ithou! f«i"1'niGl'
i
'l�rt: ti=trl L)t:< rrrret'r?��7t.rz�a ��t"G,::
Strong; Motion Fee: IBSEISMICR
$1.00
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$525.00
$0.00 TOTAL FEE:
$525.00
Revised: 07/04/2011
City of Cupertino
Public Works Department
10300 Torre Ave.
Cupertino CA 95014
(408) 777-3354
Debris Bins
Debris from a project in Cupertino can be collected and disposed of in either:
1. a Los Altos Garbage Co. bin (call 725-4020 to order), OR
2. a bin owned by the project's general contractor or demolition contractor, and hauled by a vehicle
owned and registered to that contractor (contractor should be prepared to prove. ownership), OR
3. a private track with a bed, but no bin
The Los Altos Garbage Company is the only debris bin service provider
franchised to do business in Cupertino.
Bins from other leasing companies may not be used in Cupertino.
Please check all that apply:
❑ I will use a Los Altos Garbage Company bin
I will use a bin and truck owned by the general contractor or the demolition contra r.
I will use a private truck, and not drop a bin. (I,
ee
Recyclable Materials.
Recyclable materials may be collected in private debris bins or containers ased
from ANY company, as long as the materials are both:
1. separated by type of material into separate containers, AND
2. are not contaminated by garbage.
Separated recyclable materials are materials that are separated into individual containers, each
containing just one type of recyclable material. Typical examples of recyclable materials
include: metal, wood, concrete, steel -reinforced concrete, asphalt, tree trimmings, white goods,
toilets (hardware removed), rocks and clean fill dirt. Separated recyclables must ultimately be
recycled or otherwise reused, and not disposed of in a landfill.
Contractor should be prepared to provide the name and phone number of any recycling companies being
used on the project. A list of local recycling companies can be found at: www.recyclestuff.org_
........................................................................... 0.................
Signature: Date: -728 h
Name (printed): 49a b id
Title: ccv, ,c)&at>I,y-60/Lzms , /lic-.
Phone: CQ�u } 6Ta • 387 , V36
Project address: 2-050 6-! Nb-A bQL ,
This form to remain in the project's building permit file for the duration of the project.
Revised 1103
000
O 20" WESTERN
RED CEDAR
EXISTING SCREENING
ON NEIGHBORS
PROPERTY:
ITALIAN CYPRESS
SPACED AT 5'-0"f
EAST 00.0'
016- WESTERN
Z RED CEDAR
• u,
OH
I Uj
O�
N �
TREE DRIP LINE w
(TYPICAL) w
0 30" PINE
_____ _____________ _________
\ TREE PROTECTION
\ FENCING LOCATED AT
\ O ASMODEST DRIP LINE WHEREVER POSSIBLE YPICA )
EXISTING SCREENING
ON NEIGHBORS
PROPERTY:
ARBUTUS MARINA
SPACED AT 15'-0"t
APPROXIMATE
LOCATION OF
ADJACENT
RESIDENCE
EXISTING
GARAGE
(TO BE REMOVED)
e
�
�
DEMOLITION PLAN
�0
NORTH
APPROXIMATE
LOCATION OF
ADJACENT
RESIDENCE
NOTES:
1. THE DEVELOPER SHALL INSTALL "THE PROTECTION DEVICE "
PRIOR TO THE START OF GRADING OR CLEARING WORK.
2. THE CITY RESERVES THE RIGHT TO ISSUE A "STOP WORK"
NOTICE IF THE " PROTECTIVE DEVICE " IS NOT INSTALLED.
3. ROLLED CHAIN LINK FENCE ON DRIVEN POST.
4. PLACE WOOD CHIP AROUND TREE AND ALONG DRIP LINE
CONSTRUCT FENCE
ALONG DRIP LINE
THE PRYMCwflON DETAIL
N.T.S.
a l?�INL DIVISlom � �UPEF�iJId
` a z , t wYb and specifications MUST be ltept at "I
ab si'tc do�elr c oon traaotl an. 6t i`3 L9nlavjfui to make any
;;iterations on sarnc�, or to deviate
��ora�eom3 e1�itiZ � approval from the Building Of,icial.
dua t r ��ir� r `�hjc plan and specifications SHALL N0T
ho hold, to pc rrn�i or to be an approval of the vioia'(icn
eq any rrovisicno od ally city Ordinance or State Law-
ASSOCIATES
ARCHITECTS
22867 SUNSET RIDGE DR.
AUBURN, CA 95602
530-268-3055
RONAL0 H. HARRIS
DARYL V. HARRIS A.I.A.
rhaarchitects.com
rhassocLasbcgloba1.net
awings
revisions
Pa
oject number
1900
e
JULY 2011
sheet number
VICINITY MAP
of sheets