15100023 CITY OF CUPERTINO BUILDING PERMIT
IfI ILDING ADDRESS: 10405 MORETTI DR CONTRACTOR:WINGON PERMIT NO: 15100023
CONSTRUCTION CO
OWNER'S NAME: GOLDSILVERISLAND PRORTIES I.LC P O BOX 31983 DATE ISSUED: 10/05/2015
ONN NER'S PHONE: 4088963369 OAKLAND,CA 94604 PHONE NO:(510)228-6665
Q� LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
r r DEMO(E)1,034 S.F.SFD(NO GARAGE)
License Class /�
_ Lic.# L a-q
Contractor V)r V1 y (Jt49 �;,rN�tY�S'�t _Date
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.
Sq.Ft Floor Area: Valuation:$10000
1 hereby affirm under penalty of perjury one of the following two declarations:
t. 1 have and will maintain a certificate of consent to self-insure for Worker's APN Number:37514015.00 Occupancy Type:
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued.
\� z I have and will maintain Worker's Compensation Insurance,as provided for by
i Section 3700 of the Labor Code,for the performance of the work for which this PERMIT EXPIRES IF WORK IS NOT STARTED
permit is issued. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
APPLICANT CERTIFICATION 180 DAYS LLED INSPECTION.
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 relati
to building construction,and hereby authorize representatives of this city to —OAte: V
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 RE-ROOFS:
all non-point source regulations per the Cupertino Municipal Code,Section 9.18. All roofs shall ut 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
Sit nature Date inspection.
���� Signature of Applicant: Date:
❑ OWNER-BUILDER DECLARATION ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
t I,as owner of the property,or my employees with wages as their sole HAZARDOUS MATERIALS DISCLOSURE
compensation,will do the work,and the structure is not intended or offered for I have read the hazardous materials requirements under Chapter 6.95 of the
sale(Sec.7044,Business&Professions Code) California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
2 I,as owner of the property,am exclusively contracting with licensed contractors to compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
construct the project(Sec.7044,Business&Professions Code). Safety Code,Section 25532(a)should I store or handle hazardous material.
Additionally,should I use equipment or devices which emit hazardous air
I hereby affirm under penalty of perjury one of the following three declarations: contaminants as defined by the Bay Area Air Quality Management District I will
1 1 have and will maintain a Certificate of Consent to self-insure for Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Compensation,as provided for by Section 3700 of the Labor Code,for the I lealth&Safety Code,Sections 25505,25533,and 25534.
performance of the work for which this permit is issued. Owner or authori;%d agent -
2 1 have and will maintain Worker's Compensation Insurance,as provided for by vI Date: I � L c'l
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. CONSTRUCTION LENDING AGENCY
3. 1 certify that in the performance of the work for which this permit is issued,l shall
not employ any person in any manner so as to become subject to the Worker's I hereby affirm that there is a construction lending agency for the performance of work's
Compensation laws of California. If,after making this certificate of exemption,I for which this permit is issued(Sec.3097,Civ C.)
become subject to the Worker's Compensation provisions of the Labor Code,I Lender's Name
must forthwith comply with such provisions or this permit shall be deemed Lender's Address
revoked.
ARCHITECT'S DECLARATION
APPLICANT CERTIFICATION I understand my plans shall be used as public records.
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 Licensed Professional
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
DEMOLITION PERMIT APPLICATION
12 COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO, CA 95014-3255
CUPERTINO (408) 777-3228•FAX(408)777-3333•building(a)cupertino.org / (�/D oo 7
PROJECT ADDRESS. F7PN" t
O ERE \ O 1 PHONE E-MAIL
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STREET DRS CITY,S A�E ZIP, FAX
3 1�' 1 a
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CONTACT NAME \ PHONE �- 36 �\IL 1 I
j 11
ST ET ADDRESS CITY,S ATE ZIP\ L� FAX
Z S �t ? 1 S
❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE >.J BUS.LIC#
O
' S J
CO NY NAME E-kAFAX
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STREET ADDRESS CIT /STATE,ZIP
DESCRIPTION OF WORK
Tjyyt v, DLL
v '77/
RESIDENTIAL #DWELLING OFFICE USE ONLY
FLOOR AREA Yt UNITS USE OCC. TYPE SO.F1 VALUATION
COMMERCIAL
FLOOR AREA
TYPE OF CONSTRUCTION LO
STORIES
AQMD JOB NUMBER RECEIVED BY: TOTAL VALUATtoh
j #: 3 PW°
By my signature below,I certify to each of the following: I am the property owner or authorize agent to a the pro ner's behalf. I have rea t ss -
application and the information I have provided is correct. I have read the Description of Work and v e. 1 agree to comply with all applicable local
ordinances and state laws relating to 4uilding construction. 1 a orize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INF&kMATION REQUIRED PRIOR TO ISSUANCE OF DEMOLITION PERMIT OFFICE USE ONLY
_Provide Job Number from Bay Area Air Quality Management District www.baaamd.org @ 415-749-4762. PLAN CHECK I vPE
Provide three copies of a site plan showing protection for any trees 10"in diameter or more at 3'above grade. ❑ EXPRESS
_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) El 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 408-777-3104 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_201 Ldoc revised 03/16/11
CITY OF CUPERTINO D
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 10405 MORETTI DR DATE: 10/05/2015 REVIEWED BY: MELISSA
APN: 375 14 015 BP#: `VALUATION: j$10,000
*PERMIT TYPE: Demolition Permit I"CK
i>
PRIMARY PENTAMATION
USE: SFD or Duplex PERMIT TYPE: 1 SFDWL-DE
WORK DEMO E 1,034 S.F. SFD NO GARAGE
SCOPE
FEE ID FLR AREA
s.f.
1DEMORES 1,034
i
L Li
NOTE. This estimate does not include fees due to other Departments(i.e. Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc. . Thesefees are based on the preliminarl information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fce Resolution 11-053 Ef. 7%1/13) FEE QTY/FEE MISC ITEMS
"lint Check /',
,;up])/. PC FCC'
Plumb.!Ifech.'ElC,
Permit Fee: $574.00
Suppl. Insp. Fee:Q Reg. Q OT 0.0 lirs $0.00
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•Iclranc ed Planning Fees'
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Strong Motion Fee: IBSEISMICR $1.30 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $576.30 $0.00 TOTAL FEE:T $576.30
Revised: 07/02/2015
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-�Od Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
C U P E RT I N® Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS:to 09 j-10Y6t' EW, 7ert,avo PERMIT# l :2-3
OWNER'S NAME: 6 (`,�S e ''S 6a 41. mro PHONE# ;:-g �`� 3 Z
GENERAL CONTRACTOR: ��� EpA Czw&o
14 c - BUSINESS LICENSE# 3 r r-
. ADDRESS: Ra 9a CITY/ZIPCODE:
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTIONS) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
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
Edon - U . �-
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
Owner/Contractor Signature Date