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15060129 (2) CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10095 BRET AVE CONTRACTOR:HORIZON PERMIT NO: 15060129 CONSTRUCTION OWNER'S NAME: HSIAO SUTSEN D AND TSERNG HUAH YEU 35506 ORLEANS DR DATE ISSUED:06/18/2015 OWNER'S PHONE: 4087723138 NEWARK,CA 94560 PHONE NO:(510)673-4769 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL � ' DEMOLISH(E)RESIDENCE(1544 SQ FT)AND ATTACHED License Class Lic.# GARAGE(625 SQ FT). Contractor �_ Date t �� 9 I hereby affirmI_ haa 1 ee snsnctm d 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:$6000 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:37511023.00 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 FROM LAST 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: with all non-point source regulations per the Cup' ino Municipal Code,Section 918. ff p RE-ROOFS: Signature ' ®Date l<i ( ®� 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. ❑ OWNER-BUILDER DECLARATION 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(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(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 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,Sections 2 50 , 5533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized age-w- Date: it �) 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 CONSTRUCTION LENDING AGENCY 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 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 918. Signature Date DEMOLITION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CdJFERTiNO (408) 777-3228^ FAX(408)777-3333•building(Qcupertino.org �.' �� PROJECT ADDRESS ) ®0 5- Gy-et CIA e •� ®/ 7 f `� fl ! l�` G/ OWNERNAME �a_t6e� all/2. 6iow PHO�6 /y/2-31_39 EMAIIOJCLbe t.5 @ ` c(Aao, STREET ADDRESS /OO/+,57- CITY, STATE,ZIPn e-ce �O 6A / FAX CONTACT NAME �� r PH or 1 J� d� EMAIL j ' F1 STREET ADDRESS OA Uf-;A�NS7CITY,STATE, ZIP FAX f ❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ISJ/ONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAM,S LICENSE N E LICENS&YPE BUS.LIC# E P� V-t 7 COMPANYNAMEFAX ( C4 A/ EMAIL r(. fit 7rti STREET ADDRESS G� CITY,STATE, l PIJONE 9 3 TO DESCRIPTION OF WORK ' P"► C i 6,J RESIDENTIAL / #DWELLING OFFICE USE ONLY FLOOR AREA u��7 UNITS "y r _ :USE.- •.-^dCC.. ..,TYPE, .. .''S .FT. ,=: �r .•:,:VALUA'T'ION COMMERCIAL v +` FLOOR AREA { TYPE OF CONSTRUCTION #STORIES AQMD JOB NUMBER : A, _RECEIVED BY TOT VALUATTJON_,� I v YL �/v(17J1 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 with all applicable local ordinances and state laws relating to building construction.A authorize representatives of Cupertino to enter the above-identified property for inspection purposes. ��Z=Signature of Applicant/Agent:. Date: [ '� 1 & SUPPLEMENTAL INFORMA 6N REQUIRED PRIOR TO ISSUANCE OF DEMOLITION PERMITOFFICE usE oi\iY V Provide Job Number from Bay Area Air Quality Management District www.baaomd.org @ 415-749-4762. 'PLAA cH`ECKTYPE V Provide three copies(Residential)or six copies(Commerical)of a site plan showing protection for any trees 10" ExPREss in diameter or more at 3'above grade. {sSA1\DARD Provide letter from PG&E(408-725-3325)stating all gas and electric has been disconnected. I Arcs Provide a letter of inspection,tests,and abatement of any Hazardous Materials.Letter to be initiated by person(s) MAJOR 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. 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. Provide signed Debris Bin and Recyclable Materials form. DemoApp_2013.doc revised 02/13/13 CITY OF CUPERTINO D FEE ESTIMATOR—BUILDING DIVISION �ADD7RWESS: 10095 Bret Ave DATE: 06/18/2015 REVIEWED BY: sean N: BP#: O o77 Z *VALUATION: $6,000 *PERMIT TYPE: Demolition Permit PIAN,Cl PRIMARY SFD or Duplex PENTAMATION 1 SFDWL-DEM USE: P PERMIT TYPE: i WORK Demolish E residence 1544 s ft and attached garage 625 s ft . SCOPE FEE ID FLR AREA s.f. 1 DEMORES 2,169 Elec.Plan a9ech. Plan Check 11hu;tb. flan Check Check teclr. Perrrzit Fee: Plum!). Permit Fee: Flec. Permit hips: Other ;tlech. Insp. El 011ier Plumb lrar,. Urher E'lec.Insp. E3--L- .Wech.Insp.Pic: P/ztrnb, huh. hies: Elec.Imp. Fee: NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,eta). These fees are based on the prelimina information available and are only an estimate. Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolution 11-053 Eff. 711113) FEE QTY/FEE MISC ITEMS Plan Suppl. .PC Fee 1'ltrrsab.-'r1leclz.il'lec Permit Fee: $574.00 Suppl. Insp.Feer Reg. Q OT 0,0 hrs $0.00 1'hrtrr l;.i':llecla.;'Isl ec PJt;nth.;r�1 cFt.;li'lec Permit Fee: Construction ?ax: T-71- Administrative Fere: ii''or-k 14,ithout Pertnil? zldvanced 11h.-inning Fees: TrUvel Documeniation Fees: Strong Motion Fee: IBSEISMICR $0.78 Select an Administrative Item BldgStds Commission Fee IBCBSC $1.00 L SUBTOTALS $575.78 $575.78 Revised: 05/07/2015