15080160P,
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10685 CUL-BERTSON DR
CONTRACTOR: HILL VALLEY
PERMIT NO: 15080160
LANDSCAPE
OWNER'S NAME: LIAO CHIEN C AND MA CHUN
1085 EASY ST
DATE ISSUED: 08/21/2015
OWNER'S PHONE: 4084643618
MORGAN HILL, CA 95037
PHONE NO: (408) 718-3326
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
C
License CI s Lic. # J
DEMO (E) 932 S.F. SFD
Contractor Date
I hereby affirm that I am licensed tinder 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
Sq. Ft Floor Area:
Valuation: $8500
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.
APN Number: 37536033.00
Occupancy Type:
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
to building construction, and hereby authorize representatives of this city to enter
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
upon the above mentioned property for inspection purposes. (We) agree to save
180 DAY 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-�
Z f
granting of this permit. Additionally, the applicant understands and will comply
ssueA bq� Date: !
with all non oint source regulations pgr he Cupertino Munici al Cod , 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. .
13OWNER-BUILDERDECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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)
I, as owner of the property, am exclusively contracting with licensed contractors to
HAZARDOUS MATERIALS DISCLOSURE
construct the project (See.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(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 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 wA 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, lections 25 0 5 3, a 5 34
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agentl 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
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.
Signature Date
C
:�1u_a"t 11a][44)
DEMOLITION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT o BUILDING DIVISION
10300 TORRE AVENUE o CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 ^ buildingp_cupertino.org
C ._090/ 60
PROJECT ADDRESS L ®v QE C j ej 1��}"y L o&) m `/p CuPR ,
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I(A-0 V /m +✓PHONE
APN # �— 3 � —03-3 03 2
c`Y1-IJjL
OWNER NAME /(fit W
.36� �
E-MAIL �l) � I I l � /ii' � I d 1 1ol
STREET ADDRESS q /,�D 11
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CITY, STATE, ZIP 5,€y. TC&) i CA �7�� r\
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FAX
CONTACT NAME
Y 1 t n I �I
PHONE
E-MAIL
V 1
STREET ADDRESS
®'Chen
CITY, STATE, ZIPtVfi . �I /
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FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT uoICONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑r1TENANT
CONTRACTOR NAME
LICENSE NUMBE
LICENSE TYPE
BUS. LIC
a
COMPANY NAME 1
i
E-MAIL
FAX
STREET ADDRESS •
CITY, STATE, ZIP
PHONE �O T��
'1
DESCRIPTION OF WORK
r
RESIDENTIAL /} 2
# DWELLING
OFFICE USE ONLY'
FLOOR AREA 7
UNITS
USE
OCC. TYPE S . FT.
VALUATION
COMMERCIAL
FLOOR AREA
TYPE OF CONSTRUCTION
# STORIES
E -- BY: -
TOTAL VALUATION:
AQMD JOB NUMBER
By my -signature below, I certify to each of the following: I am the property owner or autho ' gent I the prope wner's behalf. I have read this
the information I have is correct. I have read the Description of Work and verify it is acc agree to comply with all applicable local
application and provided
ordinances and state laws relating to 1 iilding cons tion. I a e presentatives of Cupertino to enter v -identi d ro erty for inspection purposes.
Signature of Applicant/Agent: M, W Date:
SUPPLEMENTAL INFORMATION REQUIRED PRIOR TO ISSUANCE OF DEMOLITION PERMIT
OFFICE USE ONLY
Provide Job Number from Bay Area Air Quality Management District www.baaamd.orQ; @ 415-749-4762.
PLAN CHECK TYPE
_
Provide three copies of a site plan showing protection for any trees 10" in diameter or more at 3' above grade.
❑ EXPRESS
_
❑ 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)
❑ MAaoR
certified in asbestos, mercury and/or hazardous material examination.
lanning 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.
vide signed Debris Bin and Recyclable Materials form.
N mmercial Buildings Only: Provide Fire Dept clearance for fire suppression /alarm system review.
DemoApp_2011.doc revised 03116111
�,,CITY OF CUPERTINO
Imo,`7 FEE ESTIMATOR - BUILDING DIVISION
FEE ID FLR AREA
s.f.
1DEMORES 932
10685 CULBERTSON DR
DATE: 08/21/2015
REVIEWED BY: MELISSA
JimADDRESS:
APN: 375 36 033
BP#:/ C5
*VALUATION: $8,500
*PERMIT TYPE: Demolition Permit
PL:.,V CHECK
PRIMARY SFD or Duplex
USE: P
Plumb, lisp. Fee:
PENTAMATION 1 SFDWL-DEM
PERMIT TYPE: i
WORK
DEMO E 932 S.F. SFD
SCOPE
Suppl. Insp. Fee:Q Reg. Q OT
FEE ID FLR AREA
s.f.
1DEMORES 932
NOTE: This estimate does not include fees due to other Departments (i. e. Planning, PUDILc works, fire, Junuary aewc.
d h !' n ation available and are onlyan estimate. Contact the Dept or addn'I info.
District, etc. . These ees are base on t e re /Oona
FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13)
Afech. Plan Check
Plumb. Plan Check
Elec—Plan Check
;L9eclr. Pet mif Fee:
Plumb. Permit Fee:
Elerc. Permit Fee:
Other rllech. IYap.EI-L--
Other Plumb Insp.
other Elec. Insp.
ilec•h.Insp. Fe ..
Plumb, lisp. Fee:
Elec. Insp, Fee:
Permit Fee:
$574.00
NOTE: This estimate does not include fees due to other Departments (i. e. Planning, PUDILc works, fire, Junuary aewc.
d h !' n ation available and are onlyan estimate. Contact the Dept or addn'I info.
District, etc. . These ees are base on t e re /Oona
FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13)
/orm
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
Suppl..PC Fee
Plziznf�./r1 teclz.il�lec
Permit Fee:
$574.00
Suppl. Insp. Fee:Q Reg. Q OT
0,0
hrs
$0.00
1'l ztzrz b. i.9%c•h.;'Fl oc
1'lz�mh.i:9fec1�.!Elec Perrnii Fee:
Construction Tax:
.4dininisirative Fee:
),Vork 11`ithout Permit?
Advanced Planning Fees:
Trrn,el Documenloticn9 Fees:
Strong Motion. Fee: IBSEISMICR
$1.11
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBT4TALS;.;n
$576.11
$0.00 TOTAL FEE ,
$576.11
Revised: 07/02/2015