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15010099CITU OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 10260 JOHNSON AVE I CONTRAC TOION RC IG A ROGERS I PERMIT NO: 15010099 OWNER'S NAME: SAHA BRATIN& MULLICK AT; AVEE 13914 WELLINGTON SQ I DATE ISSUED: 01/16/2015 OWNER'S PHONE: 4085824661 1 1 SAN JOSE, CA 95136 PHONE NO: (408) 499-3354 > LICENSED CONTRACTOR'S DE LARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIALE] DEMO (E) 1011 S.F. SFD & ATTCH'D GARAGE (498 S.F.) License Class LL Lic.#. Contractor � 4 A. (2,,A . (A-11 Date I — - I hereby affirm thW( I am licensed under the provisi ns 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 th following two declarations: I have and will maintain a certificate of consent to sel insure for Worker's compensation, as provided for by Section 3700 of th Labor Code, for the Zeff'ormance of the work for which this permit is issu d. and will maintain Worker's Compensation Ins rance, 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 otdinances 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 ity in consequence of the granting of this permit. Additionally, the applican understands and will comply with all non -point source regulations per the Cupe ino Municipal Code, Section 9.18. Sienature �/� Date (� V — I S ❑ OWNER -BUILDER DECLAATION 1 hereby affirm that I am exempt from the Co ttractor's License Law for one of the following two reasons: 1, as owner of the property, or my employees wi wages as their sole compensation will do the work, and the structure is not intend d or offered for sale (Sec.7044, Business & Professions Code) I, as owner of the property, am exclusively con acting with licensed contractors to construct the project (Sec.7044, Business & Pr fessions Code). I hereby affirm under penalty of perjury on of the following three declarations: I have and will maintain a Certificate of Cons nt to self -insure for Worker's Compensation, as provided for by Section 37 0 of the Labor Code, for the performance of the work for which this permi is issued. I have and will maintain Worker's Compens ion Insurance, as provided for by Section 3700 of the Labor Code, for the perf rmance of the work for which this permit is issued. I certify that in the performance of the work or which this permit is issued, I shall not employ any person in any manner so as become subject to the Worker's Compensation laws of California. If, after aking this certificate of exemption, I become subject to the Worker's Compensat on provisions of the Labor Code, I must forthwith comply with such provisions or is permit shall be deemed revoked. I certify that I have read this application correct. I agree to comply with all city an to building construction, and hereby auth upon the above mentioned property for it indemnify and keep harmless the City of costs, and expenses which may accrue aE granting of this permit. Additionally, the with all non -point source regulations per 9.18. state that the above information is >unty ordinances and state laws relating e representatives of this city to enter ction purposes. (We) agree to save )ertino against liabilities, judgments, it said City in consequence of the licant understands and will comply Cupertino Municipal Code, Section Date Sq. Ft Floor Area: I Valuation: $10000 �I'\ Number: 37525060.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 LLED INSPECTION. 1. 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. I 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 authorized 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 CUPERTINO DEMOLITION PERMIT APPLICATION COMMUNITY D VELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE ENUE • CUPERTINO, CA 95014-3255 (408) 777-32281 � 228' qX641) 777-3333 • uildin cu ertino.or 41 ooZ PROJECT ADDRESS /0 260 APN # \/ Z OWNERNAME `�� S/, /� �JJ �j PHONE O, E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX CONTACT NAME 4i -' [��qq�-3,3,5vTE -MAIL r Sip l STREETADDRES&52//` J , // �// 7 `(%f�i� t CRY STATE, Ate•. I 6j r, i F � f ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER GENT W►CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACT?"/?, LICENSE NUMBELICENSE TYPE _ ) BUS. LIC # COMPANY NAMEZ.A'n • E Mp`� FAX STREETFS$� CrrY, 4MZIP /� A ` fn ,l V C•4( (�� G / F (Ja�C./�V9?-33511DESCRIPTION OF WORK RESIDENTIAL (��j # DWELLING OFFICE USE ONLY FLOOR AREA A / UNITS USL OCC TYPE SO, Fr VALUATION COMMERCIAL FLOOR AREA TYPE OF AW#W #STORIES AQMD JOB NUMBER J #: — ------ _t T11TAI � By my signature below, I certify to each o the following: lam the property owner or authorized agen on the property owner's behalf. I have rea is application and the information I have pro ided 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 uild ng construction. I rize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFO ATION REQUI PRIOR TO ISSUANCE OF DEMOLITION PERM OFFICE USE ONLY PLAN CHECK TYPE _ Provide Job Number from Bay ea Air Quality Management District www.baaamd.or� @ 415-749-4762. _ Provide three copies (Residen ial) or six copies (Commerical) of a site plan showing protection for any trees 10" ❑ EXPRESS in diameter or more at 3' above grade. ❑ STANDARD ❑ LARGE _ Provide letter from PG&E (40 -725-3325) stating all gas and electric has been disconnected. ❑ MAJOR Provide a letter of inspection, ests, and abatement of any Hazardous Materials. Letter to be initiated by person(s) / _ certified in asbestos, mercury d/or hazardous material examination. f Planning Dept clearance to v ify 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 Publ' Works Department at 408-777-3104 and schedule a "habitable dwelling" inspection. Provide signed Debris Bin d Recyclable Materials form. DemoApp_2013.doc revised 02/13/13 CITY OF CUPERTINO D F%�WAI FF.F. FCT11MATOR - R1JILDING DIVISION 0 FEE ID FLR AREA (s.f. 1DEMORES 1,500 ,her ; .,:rnb Insp Elec. Insp. Fey:_ NOTE: This estimate does ninc ude fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School no UISiTIC/, elG IRGSC eC� urc owc vn u•c •u .......... FEE ITEMS Fee Resolution 11-053 E . 7/1113 ADDRESS: 10260 JOHNSON AVE DATE: 01/16/2016 REVIEWED BY: MELISSA ---- ---- --- MISC ITEMS APN: 375 25 060 BP#: 14090020 *VALUATION: j$10,000 PERMIT TYPE: Demolition ermit I !'/.T\ r711,(K /) /T PRIMARY SFD or Duplex I I PENTAMATION 1SFDWL-DEM I PERMIT TYPE: i USE: WORK DEMO E 1011 S.F. S D & ATTCH'D GARAGE 498 S.F.) Suppl. Insp. Fee -0 Reg. 010T 0.0 SCOPE $0.00 0 FEE ID FLR AREA (s.f. 1DEMORES 1,500 ,her ; .,:rnb Insp Elec. Insp. Fey:_ NOTE: This estimate does ninc ude fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School no UISiTIC/, elG IRGSC eC� urc owc vn u•c •u .......... FEE ITEMS Fee Resolution 11-053 E . 7/1113 ...... ........... ......._..__ FEE _.__ _. _ QTY/FEE ---- ---- --- MISC ITEMS Plum Check Flee: ,Suppl. PC I c e 1'lunth. �::11��ch.7;l�c Permit Fee: $574.00 Suppl. Insp. Fee -0 Reg. 010T 0.0 1 lirs $0.00 T77- °lurnr ��li'c Permit F e: l r`Uvel Doculnewoliun 1, . Strong, Motion Fee: IBSEISMICR $1.30 Select an Administrative Item Bldg Stds Commission Fej: IBCBSC $1.00 SUBTOTALS: $576.30 $0.00 TOTAL FEE: $576.30 Revised: 01/06/2015 Pacific Gas and & Electric Cot +pany' DATE:IT( I CITY OF CUPERTINO 10300 TORRE AVE CUPERTINO CA 95014 10900 No. Blaney Avenue Cupertino, CA 95014 SUBJECT: REMOVAL OF GAS ON: l t I lZ I SUBJECT: ELECTRIC SERVICES WAS CUT AT POLE ON: t 0 i 160 s&' t 1 ctl I If you have any further questions, please contact me at (408) 725-3325 Sincerely, Pacific Gas & EI Ictric Company p Y DeAnza Service lanning 408/725-3325 JAN -16-2015 Pwamoft BA v Aa FA Ai K CjuA LATY M A N A G F M F N i' D i S T P I C r 10:43 BAY AREA AIR QUALITY MGNT COMPLIANCE & ENFORCEMENT DIVISION Galante Bros. P 0 Box 41490 San Jose, CA 95160 1 415 928 0338 P.01i01 Regulation 11, Rule 2 Acknowledgement of Notification and Payment of Fees 1/8/2015 ,I#: 4K878 Invoice No: 3MN10 The Bay Area Air Quality Management District (BAAQMD)acknowledges receipt or'your payment and your Asbestos Removal or Demolition flan described as: Demolition Site address 10260 Johnson Ave Cupertino, CA 95014 Strut Date January 19, 2015 Completion Date January 27, 2015 Removal amounts of friable ACM 0 linear feet 0 Square Leet 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. REGLiL.AnON 11-2 REVISION RA.AQMD A 4K878 _t REVISION # STAWF DATE COMPLETION DATE 1 r 2 1 ! I 3 I I I 4 I ! I 5 ---. .... NOTE. This form is not inlended aav a ver f k-ailvn of eliher ane err, pleleners of your original notification or ofils compliance with BAAUMn Reguhifi.'on 11-2. 1f you have any quesri"ons about this acknowledgment, please cal! our ��lice cal (413) 749-4762, TOTAL P.01