13080088 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 18985 BARNHART AVE CONTRACTOR:ALPS CONSTRUCTION& PERMIT NO: 13080088
REMODELING
OWNER'S NAME: PRASHANT TOMAR 681 E BROKAW RD DATE ISSUED:08/13/2013
OWNER'S PHONE: 4085837288 SAN JOSE,CA 95112 PHONE NO:(408)898-6474
0 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIALS
License Class_ LIC.# SFDWL DEMO 814 SQ FT
Contractor AL Date
I hereby affirm that I am licensed under the provisio o Chapter 9
(commencing with Section 7000)of Division 3 of the B mess&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:$5000
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:37509029.00 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 D ROM LAST CALLED I CTION.
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 sour regulations per the Cupertino Municipal Code,Section
9.18. 1
RE-ROOFS:
Signature Date 11.7 /7 All roofs shall be inspected prior to any roofing material being installed.If a roof is
3 installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
❑ O -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 a d
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 5 5,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: ate:
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. It after making this certificate of exemption,I CONSTRUC I LENDING AGENCY
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
9.18.
Signature - Date
DEMOLITION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINO (408)777-3228•FAX(408)777-3333•building(cDcupertino.org
PROJECT ADDRESS !89
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OWNERNAME ONE v-E-MAAIIL V
STREET ADDRESS CITY, STATE,ZIP FAX
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❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME Ll' LIC INSE NUM O LICENSE TYPE BUS.LIC#
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COMPANY NAME 1 4✓ E-MAIL FAX
STREET ADDRESS / CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK / IL
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RESIDENTIAL #DWELLING OFFICE USE ONLY
FLOOR AREA UNITS ,''USE< :TYPE SO,Fr. VALUATION
COMMERCIAL
FLOOR AREA
TYPE OF CONSTRUCTION #STORIES
Of
AQMD JOB NUMBER EECE, TOTAL V N.
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By my signature below,I certify to each of the foll ing: I am the property owner or autho ' ed t to act on the property owner's behalf. I have read this
application and the information I have provi i rrect. I have read the Description of Work verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to c ction. I authorize representatives of Cupertino to enter the above-id tified pr erty for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORMATIO UIRED PRIOR TO ISSUANCE OF DEMOLIT O ERMIT OFFICE USE ONLY
_Provide Job Number from Bay Are uality Management District www.baagmd.org @ 41 -749-4762. PLAN CHECK TYPE
_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. El STANDARD
_Provide letter from PG&E(408-725-3325)stating all gas and electric has been disconnected. El LARGE
El
_Provide a letter of inspection,tests,and abatement of any Hazardous Materials.Letter to be initiated by person(s) M4JOR
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