13050063CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21087 GRENOLA DR I CONSTRUCTIONCONTRACTOR: 1 INHOMESTEAD I PERMIT NO: 13050063
OWNER'S NAME: TZE SU 110080 STERN AVE I DATE ISSUED: 05/08/2013
OWNER'S PHONE: 4083168708 I CUPERTINO, CA 95014 PHONE NO: (408) 255-8999
LICENSED CONTRACTOR'S DECLARATION
License ClassLie. # 6,6 3
Contracto> pyfmj 5�� Date �/x/ t j
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 frill force and effect.
I hereby affirm order 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.
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.
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 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
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, Sectio
9.18.
Signature C/ ./rte/ Date4x�
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
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.
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.
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
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked.
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 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
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
JOB DESCRIPTION: RESIDENTIAL
COMMERCIAL
DEMO (E) 1188 SQ FT SFD & 650 SQ FT DETACHED
GARAGE
Sq. Ft Floor Area: I Valuation: $6000
APN Number: 32628008.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FM LAST CABLED INSPECTION.
,bate:
4 RE -ROOFS:
All roofs shall be inspecte 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
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
CITY OF CUPERTINO
UUU Ucmrn4 A 9rfA-D — nYTTT ."INT _ 'nlVTCT()N
C
ialADDRESS:
21087 GRENOLA DR
DATE: 05/08/2013
REVIEWED BY: MELISSA
A -tech. Perwit Fee:
APN: 326 28 008
BP#: 1,3 0 51) 0069 3
*VALUATION: $6,000
*PERMIT TYPE: Demolition Permit
PLAN C11EC1. T) PE:
PRIMARY SFD or Duplex
P
Phimb. 11>sp. Fee:
PENTAMATION 1SFDWL-DEM
PERMIT TYPE:
USE:
Permit Fee:
$534.00
WORK
DEMO E 1188 SQ FT SFD & 650 SQ FT DETACHED GARAGE
hrs
$0.00
SCOPE
Plumb./tlleclt./Elee.
FEE ID FLR AREA
s.f.
1DEMORES 1,838
NOTE: this estimate does not mcltrae fees aue to omer ueparrn:ems (i.e. runnfung, mut,.. rr _ .• ,.........y ��... - •�•• • -•• --
-. `--.----`'--- _.. .r_Lr A. f:.,, .t Cn„fnnt /bo noni finr addn'1 info.
UlsLrl Cl, el(:. ineae eeo urc uua u, vr• .•,c .�......,...+
FEE ITEMS (Fee Resolution 11-053 Eff. 711112)
"I -leer. 1'1(711 Check
P/rrrub. Phar Cheel,
Elec, Pla/r Check
A -tech. Perwit Fee:
Maid), pee mit Eee:
—L-1
Dec. Permit Fee:
Other Alech. Inch.
Other Plumbhash,Li
Outer Elec. Lisp.
Mcch. Lisp, Fee:
Phimb. 11>sp. Fee:
Elec. Insp. Fce:
NOTE: this estimate does not mcltrae fees aue to omer ueparrn:ems (i.e. runnfung, mut,.. rr _ .• ,.........y ��... - •�•• • -•• --
-. `--.----`'--- _.. .r_Lr A. f:.,, .t Cn„fnnt /bo noni finr addn'1 info.
UlsLrl Cl, el(:. ineae eeo urc uua u, vr• .•,c .�......,...+
FEE ITEMS (Fee Resolution 11-053 Eff. 711112)
... .,,,...»..... ........'...-'.'---'---
FEE
QTY/FEE
-- ---- --
MISC ITEMS
Plan Check Fee.:
S'uppl. PC Fee
Plumb.lMech./Elec
Permit Fee:
$534.00
Suppl. Insp. Fee:Q Reg. Q OT
O,Q
hrs
$0.00
Plumb./tlleclt./Elee.
PhwibA1 fech.1Elec Permit Fee:
Conswiletion Tax:
Ad ministrolNe Fee:
ffork PVithout Permit?
Advaiwe l Plannhig Fees:
Tnwel Docmiwnlution Fees:
Strong Motion Fee: IBSEISMICR
$0.60
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$535.60
$0.00 TOTAL FEE:
$535.60
Kevisea: u4tzylzu i 3
e
dYPacific Gas ••0• No. Blaney Avenue
° Company'
I�� t if
b
95014
City of Cupertino
10300 Torre Avenue
Cupertino , Ca. 95014
To Whom It May Concern
SUBJECT REMOVAL OF GAS AND/OR ELECTRIC FACILITIES
The gas and electric facilities have been removed and/or abandoned at:
21087 GRENOLA DR, CUPERTINO on 05.06.2013
If you have any further questions, please contact me at (408) 725-
3325
Sincerely,
Cami Brown
Service Planning
PG&E