D-2016-0358 Permit ApplicationCUIPERTINO
DEMOLITION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333. buildina(Wcupertino.oro
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT % 6ONTRACTOR ❑ CONTRACTORAOENT ❑ ARCHTTECr ❑ ENGPIEER ❑ DEvELOPER ❑ TENANT
CONTRACTOR NAME 1 '•
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RESIDENTIAL #DWELLING
OFFICE USE
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�VAI UATION �s_•
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FLOORAREA" 61i(.J UNITS /
COMMERCIAL
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AQMD]OB NUMBP.R `/RECEIVP.D nY TO IL�yiAIUA'r1ON
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B m si -tore below, I .1 f to each of the following: - ltheproperty
y y gn y g: am p rn e p Ry owner or authorized agent to act on the property owner's behalf. 1 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 with all applicable local
ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
SignabneofApplicmOAgent; _- _ _ _ Date:
SUPPLEMENTAL INFORMATION REQUIRED PRIOR TO ISSUANCE OF DEMOLITION PERMIT
-ORFicni USEONLY
PLAN CHECKTYPE_
+✓Provide Job Number from Bay Area Air Quality Management District www.baagmd.ore @ 415-749-4762.
❑ EXPRESS
✓ Provide three copies of a site plan showing protection for any trees 10" in diameter or more at 3' above grade.
Provide letter from PG&E (408-725-3325) stating all gas and electric has been disconnected.
STANDARD
_✓
'✓Provide a letter of inspection, tests, and abatement of any Hazardous Materials. Letter to be initiated by person(s)
LARGE
certified in asbestos, mercury and/or hazardous material examination.
❑ MAJOR'
_ 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 408-777-3I04 and schedule a "habitable dwelling" inspection,
'✓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