11020037COVER SHEET
11020037-D
10527 STERLING BLVD
PERMIT #
PROJECT
ADDRESS
APPLICANT
OUTSIDE
LANNING
PUBLIC
WORKS
FIRE
SANITARY
HOOD
HEALTH
IASSESSOR
DATE 2- � G/
APN# 2 . S— � � G1 G RES. (LVNG) (GARAM
COMM. SQ. FT. (NEW) T.I. SQ.FT. RDEL /2
CONTACT PHONE#
VALUATION (Cost of Project) REQD. PAID
NOTES: CONSTRUCTION TAX (Y) (N) _, G
SCHOOL FEES (Y) (N)
HOUSING bMG (Y) (N)
HEART OF THE CITY (Y) (I)
ISSUED BY DATE 3' TOTAL FEES
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10527 STERLING BLVD I CONTRACTOR: YOUNG'S CONSTRUCTION I PERMIT NO: 11020037
OWNER'S NAME: SEAN & AUDREY QI 11.4839 CONWAY AVE I DATE ISSUED: 03/03/2011 1
OWNER'S PHONE: 4085695288 1 SAN JOSE, CA 95124 1 PHONE NO: (408)377-6839 1
❑ LICENSED CONTRACTOR'S DECLARATION
License Class Lic. #
Contractor Date r i
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.
Signature Date��
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
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.
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. 1 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.
BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
MECH r RESIDENTIAL r COMMERCIAL r
JOB DESCRIPTION: DEMO SFDWL & DETACHED GARAGE (I 127SQ)
Sq. Ft Floor Area: I Valuation: $5000
APN Number: 37523016.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by:
Date:
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, Sections 25505, 25533, and 25534.
Owner or a� orized agent: ��� /
Date•
CONSTRUCTION LENDING AGENCY
I 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
CITY OF
CITY OF CUPERTINO
DEMO
CUPERTINO PERMIT APPLICATION FORM
APN# , r� T ,,� 1 I
J ,l�
Date:
Building Address:
C �- ? /1
om
Mailing Address (if different from building addr s):
e a� 7/--Q_--
Owner's Name:
Phone:
err - �'
s�ce
Contractor:
Phone 3 of g_vg /
Ke et
Fax:
Contractor License #: 9>67
/
Cupertino Business License #: /
Contact: Yo CA
Phone: �29�j9--ifs
Fax/e-mail: 61,f0x_0'
� D
Residential 54 Sq Footage _��Z�; Commercial ❑ Sq Footage
Job Description: — J�
N� ` v�l f.�
o ►''� �� � �J
Valuation:
v
Project Size: Counter ❑ Express ❑ Standard
Large ❑ Major ❑
Please complete relevant portions of the Green Building Checklist & attach it to the application
or if applicable, include on the plan set & the sheet index.
Quantity
Fee ID
Fee Description
Fee Group
Permit Type
1DEMORES
Demo -Residential
B
1SFDWL-DEM
1DEMOPRES
Pool Demo Residential
B
1SFP00L-DEM
1BCBSC
Cal Bldg Standards
Commission Fee
B
ALL PERMIT
TYPES
1BSEISMICRE
Seismic Residential
B
Revised 12/06/10
Building Department
CUPERTINO
CONTRACTOR / SUBCONTRACTOR LIST
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
JOB ADDRESS:
PERMIT # 2,007�
OWNER'S NAME:
HONE #fl
GENERAL CONTRACTOR- '
BUSINESS LICENSE #
ADDRESS:
CITY/ZIPCODE:
*Our municipal code rAs ri;all bus esses worGklin lthe city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE. �iJ�
I am not using any subcontractors: �
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring / Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
/ Contractor Signature
2, ,//
Date
REVISIONS BY
?ROPERTY LINE 50.00'
q I
n I I
5'-0' I
I r , REAR SETBACK_
�IS7 RAGEI � a,
L J T�4
r_—_______—_, (REMOVE) x...m..
(E) ELEC.
I EXISTING SINGLE SERVICE I I V
STORY RESIDENCE g
( I 1,130SF I I m 4E
,/�
dd99 0. Z N A�
� S Z
of
z m I U IA o�
I W <� 3
� I I
o J �
h
� I w
al � to Iw &
1
I I 13
COMPLETELY DEMOLISH I
(E) SINGLE SERCE ® AND GARAGEV RESIDENCE
DASHED LINES I l a
INDICATES PERIMETER I
OF EXISTING
STRUCTURES TO BE
^J I DEMOLISHED
::
REMOVE (E)
APRICOT TREE147-�
_i � -•
0
0
N
PROPERTY U—S.OS _
cL� J TFR` /NG l ��
Bp
\ VlF
APN 375 - 23 - Os6 oO, R. 0• W VAR ID
CL
\
ZONING R - 1
SITE AREA 5,663 SF
EXISTING FLOOR AREA (TO BE DEMOLISHED)
GARAGE 350 SF
RESIDENCE 1,130 SF
�1 SITE PLAN
WAW
NORTH
GRAPHIC SCALE
B' 2B' IV I B' XY
DO B
55
ec 81: S55
D—
SEPTEMBER 13. 2010
s AS NOTED
JOB •II�BEII
SAR - 0210
Bcr.
OF 1 9„BER
TERMINIX.
DATE OF INSPECTION
RESIDENTIAL PEST CONTROL ONE-TIME SERVICE AGREEMENT
PURCHASER
Name
Address a Z —7 SL R lac
City d
PREMISES
Name
Address —
City
State r 'A Zip L� State
Telephone
Terminix Office
Telephone (
Route
Telephone
Grid
TERMINIX WILL PROVIDE SERVICE FOR THE PESTS CHECKED BELOW:
❑ Indoor Tick Control
❑ Indoor Flea Control
❑ Clothes Moths
❑ Black Widow Spiders
❑ Brown
❑ Carpet Bed%"0`S, 2011
I �
SPECIAL INSTRUCTIONS:
Effective for a period of thirty (30) days from
❑ Wasps
❑ Yellow Jackets
❑ House Crickets
❑ Hornets
l)�
Zip
Same Day
SERVICE CHARGES FOR YOUR
TERMINIX PROTECTION ARE
SPECIFIED BELOW:
$ 36rD
regular charge
$
amount remitted with agreement
METHOD OF PAYMENT:
❑ Prebill
❑ Remit to Service Technician
Visa/Master Card
for the sum of $
(sub -total plus sales tax ), Terminix will service the identified property for the pests checked above.
This agreement terminates in thirty (30) days. If additional service is requested during the thirty (30) day period, service will be
performed at no additional cost to the Purchaser.
This agreement does not guarantee against present or future damage to the building or contents, nor provide for the repair or
compensation thereof. This agreement does not provide for the control of subterranean termites, dampwood termites, drywood termites,
fungus, wood boring beetles or other pests not checked above.
Upon request Terminix will provide the Purchaser with a copy of the manufacturer's specimen label of the pesticide(s) which will be
used to treat the premises.
NOTICE: YOU, THE PURCHASER, MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF
THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION. SEE THE ATTACHED NOTICE OF
CANCELLATION FOR AN EXPLANATION OF THIS RIGHT. THE TERMS AND CONDITIONS ON THE REVERSE
SIDE, INCLUDING THE MANDATORY ARBITRATION AGREEMENT, ARE PART OF THIS AGREEMENT.
In the event you have any questions or complaints, you may contact a Terminix Re7�1
tative by calling l ;800-ThRM N1X (1-800-837-6464)
� •- •- _ �/
Terminix Representative Signature Date ,Custotner Signature Date
www-tertninix rom
Key p 33218 Rev. 8/06 R/P 8/06
02006 The Tetminix International Company L. P. CUSTOMER COPY
TERMS AND CONDfflONS
and dean not gw—An q6mt prownt or h1wre dani�qw to �bk; or conl.Qnis, ox pmvia%.
or MOW M Agimaynt W"sqmNide No 11W CMUM CS MMW fmqw, Mum: oi. 'wny olhev not ivkojica[.-E'
IlAf.17ATION, OF 1JAB4.1-ITY. i Ei i:fi?€�{,:[.' zLitrF: `:.?;> V,))Es .,:d by an"•. nor a-1 ". Penalty. and
ANY CONTIRACT, TORT OR. OTHT'.KR 0'1;1lll9 TERMINIX SHALL 14AVIT M:.-FN NE(--.'1KjFNJ INTHE
FERIMMMANCE 0;'--'FfS DU-TiLS TO PURCHASI.--R. i,l) THE S(A.E Rl,�,PONSIBJIAF)r (.4; T1.,.'W)djNJX TO I -AR ANYONE
CI-AP,11N,'5 THWIUCIJ PlIRCHASM UNDIM THK PIAN M. 0,11 11HR"N." !SE i, Tt') PROFERI'o.' AND (11:) IIURC'viAsf�'-�R AND
ANYONE GMESSIN % FASUMMENIX
REMICTUI ANY OTHU? 10 PURCIMSER ME ANYONE MAIMM IMAM PURCHASER. QRS KAN
DOES VKH CUARANITAR.ANDIEMM TXWS NOTREMISli'Ni" `,, H ;\. f" STS NV, U.. I..
3, NOTIC' Ofi' (,I:ALVS� ACX'E'SS TO 1'R0P1,,RTY. Apy 66m.- ObAng ON d Fr i-�;latifl.g to th-is Aga-,*rn-mr nmst be. di-nng do", tern-, of 0--)i?
Agmenmut and in vTitin.g rig -.`i ( J'1.-E'kt-: Muir u"Mc swh wimp Jmni dwing dw, temn "bal! bk.a wailicy ofNa:(clain... '1-31v; only f;biigthrkol
of ];�Aminb, ort) Pvrc.k.,--r cm- ia{S<ow clairniv.I'MAMM asog env (A <w Ming a) His Apamw is U. ww=t xod di,:n only if a -valiid claim ii
rn,tde th.,- (e.rm Of JJs in the avent: of any (Alin by lkmhmer or wi)--m,, elaiyning ihmn'gll llor(basei: kx- ?tnytbing ihw.'Ior
ft>rronN to "ho r,;nd fa%.%,o11c (AiAimm,-- dihro?.Igb MR pay all of 00 Mao am! oximnws oflh&W
AdwNy bw Bor UnAwd uh ammmye AtcrOwAg ") or addug out pt%.%flas.n' must «zl; `,oyv 'Nnnin i's 'W`T1"4-0UW Tor
easy plirposa ihis Agivemew M fail iirE; to alli>w'):ermini.-- stAch ac,-c,s wil! flkoir+ Agrecmwoz wiilvxii fiirwernoli::2-
4,
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varhquAtq hunknums, nr amy nE. of flod or beyond ffi;:�q:iv(ot"Nm)inix,
R. Thi�', A.t.-rvt!mgntdovs nm cover and hnninx wM rEm he w9moN, Aw Amag YwMg 4"n or sv.q1;hnA -'or div
noti, kJonm A to pnonTdy Can at We, puchastr,." w) whj,-,-h ff,)jKj tjvt:;lijvoew o- il';Spection or is
EXCEVY AS 1%,01-11RITED BY LAW. '11,R i.k.11 NIX DISCLAtIVIS ANNY LIABILITY A. -ND SHALL N01"BE REKSPONSKRLE, FOR INDMEA:71.
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CUARAN"J EES AS GIVEN IN 1.:IFUT01, ANI. ;YMER (.,1.ARANTE1,, OR NVf1.RJ.,1;XNTY
4MA3T 1' ER REMINTIBRATV, EXPRE," OR MIMAED, INVCLIJDING:1NY IWARRANTV (IF OR FITNESS FOR 'k
I�NRTICIA,AR, PURPOSF
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01;.t fmtive 1he J),.Irht�s �En'd t;o or st;m.menv; will N� t6nding
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(Bind M a1l 6aly All 4 Akd al. uEi�, N;�J ol b" i 1-4 1 Eiwtl b,,
its :wn . ud expanse-O.-I'd ihowbimmion ohs as &5ginind hy to Me. Huwuwrjl�j-ra 1:�Vchas,r so 41
vvil' �xay arbil.ration. R-,e� dii;:: te: tbs.... NAFt-wE:,vxtxyn My exoend arn, i.,iling pw%;b&1er wowkl eply ?o Eifotirt
i1wisdicnoil.o.vor Elie powau, anOwlany cite athn qlall be. 1firift v as, fo'lfn�vs:
;,--t lx, xphwd vyiih i�ay Othe'" or
NOMY a, Pon pmpmy . !"Mon, ME WM am pomd a a coos amory 11C doxkwn �ti: 0E�, Qia'l bu a And! mnd Wnding mmolAka oI'
arihikmis ma r�Uitns1, lvinUnsww60 ewyMx.itatg,a,,-at.action i,g Aho i
M9 USE. whons 140 Mqwm uNn Hw =W any bu oiseived w aq son Neilux pony shall out the orhorpany x0h re4hyi
,i!:r T tbiin 1PE- vinkrement of AN dThjlnitil,�� or o� fliew mioo-,au)C�i 11-1E PARTIES
;o1w lwwwr sw pa-01.",
THEY %101. 111) 11-1."IF J1,1f) A RIGI-111 OR 0PP01fflJN-`1TYFO LITIGiVIl, DISPUTIE-S T1-11401,1(41 A CEOUla ANI)
TO 11AN-F A JI-1)(4: M JIM DECIM MEM CASE, UUT 1111EY (14+00SE -1-0 KVE ANY VISJATS DECIDED THROI.!GH
ARMTRMON,
UPON REQUF`il' IFRNHNtx VuLl, PIUMDE 11111 IMMIASta INYM A CMPN OF 1111' NJANUIACTUR�.E.R'S SVECINIFN
ITHI THE PEWMADEss) WHICH W113. 111K lnu:lmsus,
Pacific Gas and
I-V Electric Company'
City of Cupertino
10300 Torre Avenue
Cupertino, Ca. 95014
To Whom It May Concern:
10900 No. Blaney Avenue
Cupertino, CA 95014
SUBJECT REMOVAL OF GAS AND / OR ELECTRIC FACILITIES
The gas and electric facilities have been removed and / or abandoned at:
t 0 5 2- 15 541�(tn 0o2 1
If you have any further questions, please contact me at (4080725-3325
Sincerely,
Service Planning
Regulation 11, Rule 2
COMPLIANCE &
ENFORCEMENT
BAY AREA
AIRQUALITY DIVISION
MANAGEMENT
D 1 S T R I C T
Final Home Construction
13428 Christie Drive
Saratoga, CA 95070
Acknowledgement of
Notification and
Payment of Fees
1/25/2011
Job No: 3N496
Invoice No: 2QR50
The Bay Area Air Quality Management District (BAAQMD) acknowledges receipt of your payment and
your Asbestos Removal or Demolition Plan described as: Demolition
Site address
Start Date
Completion Date
10527 Sterling Ave
Cupertino, CA 95014
February 10, 2011
February 17, 2011
Removal amounts of friable ACM 0 linear feet 0 square feet 0 cubic feet
Should it become necessary to revise this plan, please do so in the spaces provided below and immediately
copy the District by fax or by mail.
REGULATION 11-2 REVISION BAAQMD J# 3N496
REVISION #
1
2
3
4
5
START DATE COMPLETION DATE
NOTE: This form is not intended as a verification of either the completeness of your original notification
or of its compliance with BAAQMD Regulation 11-2. Ifyou have any questions about this
acknowledgment, please call our office at (41 S) 749-4762.
p0--8jVR.i,
FEB 0 9 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
I a private truck 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
W I will use a bin and truck owned by the general contractor or the demolition contractor.
❑ I will use a private truck, and not drop a bin.
Recyclable Materials
Recyclable materials may be collected in private debris bins or containers leased
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.orQ.
..............................................................................................
-�
Signature: Date: -L-L-ZD I I
Name (printed): f -ft f) Y Q LA n4-
Title: /,- i
Phone: ( C, b 9 G% Q —(L 37� 1
Project address: f C)s Z �' f% q-�l IV
This form to remain in the project's building pennit file for the duration of the project
Revised 1/03 r
DEMOLITION
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 10527 sterling blvd
DATE:
REVIEWED BY: bobs.
APN:
BP#:
"VALUATION: 1$5,000
PERMIT TYPE: Demolition Permit
PL ] ,% CHECK T i'PE.
PRIMARY SFD or Duplex
USE:
PENTAMATION 1 SFDWL-DEM
PERMIT TYPE:
WORK
demo 1 story sfd and detached garage.
SCOPE
FEE ID FLR AREA
s.f.
1 DEMORES 1,127
Vv(,h. Plan C'h,r A
PL—)
Pig'- Nam Ch,!rk
)le,- h. Permit 1"cu.
1'h, ;l•, i'e' u. l r ...
t;i,r, Permi; ,` c::
Orher llc-ch. /risri,
Oth-r Piuu;h lrrst>Li
Oiber Flec. Insp.
alech. /n.,sp. hcc:
Phe ;l). fusp. Fey-::
Rec. Insp. Fca:
NOTE: These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 09-051 Eff. 7/1 /10)
FEE
QTYTEE
MISC ITEMS
Plan Check Fee'
Suppl. PC f ee
Plznnb./�IecJi.;lilec. flan Check:
Permit Fee:
$507.00
Suppl. Insp. Fee:0 Reg. 0 OT
0.0
hrs
$0.00
Plumb. /Mech./IElec Unit Fee:
Plumh./,Tech./E'lee Permit Fee:
%.onsowc,tlon Tax
Acoustical Review Fee:
Work With out.Permit,'
Plana , 111,ft" .
Travel Doctonentation Fees:
Strong Motion Fee: 1BSEISMICR
$0.50
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$508.50
$0.00 TOTAL FEE:
$508.50
Revised: 01115/2011