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B-2016-1366 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1366 10455 BANDLEY DR CUPERTINO,CA 95014-1912(326 33 102) (RDL CONSTRUCTION INC) SAN JOSE,CA 95113 OWNER'S NAME CHINESE CHURCH IN CHRIST-CUPERTINO DATE ISSUED:02/16/2016 OWNER'S PHONE:408-892-8754 PHONE NO:408-999-6633 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: Contractor ss B Lic.#510955 License Class RDL CONSTRUCTION INC)Date 02/16/2016 X BLDG _ELECT _PLUMB MECH T RESIDENTIAL X COMMERCIAL 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. JOB DESCRIPTION: Demolish indoor commercial swimming pool(1350 sq ft);Tenant I hereby affirm under penalty of perjury one of the following two declarations: Improvement prep(6094 sq ft). i. 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., Sq.Ft Floor Area: Valuation:$56500.00 APPLICANT CERTIFICATION I certify that I have read this application and state that the above APN Number: Occupancy Type: information is correct.I agree to comply with all city and county 32633 102 A(Tenant Improvements) 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 PERMIT EXPIRES IF WORK IS NOT STARTED expenses which may accrue aga• t said City in consequence of the WITHIN.180 DAYS OF PERMIT ISSUANCE OR granting of this perm'. Ily, applicant understands and will comply with all no -poi so r - lations per the Cupertino Municipal 180 DAYS FROM LAST CALLED INSPECTION.- Code,Section 9. 8Z Issued by:,11ft Signature Date 02/16/2016 Date:02/16/201MTrLZ ZECLARAIION 6 RF-ROOFS• I hereby affirm that I am exempt from the Contractor's License Law for one of the 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 following two reasons: inspection. 1. 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) Signature of Applicant: Z I,as owner of the property,am exclusively contracting with licensed Date:02/16/2016 contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: 1. 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 HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 34. of the performance of the work for which this permit is issued. 2. I have and will maintain Worker's Compensation Insurance,as provided for California Health&Safety Code,Sections 25505,25533,and 25534. I will by Section 3700 of the Labor Code,for the performance of the work for which maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&Safety Code,Section 25532(a)should I store or handle hazardous this permit is issued. material. Additionally,should I use equipment or de ices which emit hazardous 3. I certify that in the performance of the work for which this permit is issued,I air contaminants as defined by the Ba Management District I shall not employ any person in any manner so as to become subject to the will maintain compliance with the upe o i ' al Code,Chapter 9.1.2 and Worker's Compensation laws of California, If,after making this certificate of the Health&Safety C e,Sec' S,25533,and 25534. 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 :Owner or authorized agents _ be deemed revoked. Date:02/16/2016 APPLICANT CERTIFICATION NSTR NDIN ENCY I hereby affirm that there is a construction lending agency for the performance I certify that I have read this application and state that the above information is of work's for which this.permit is issued(Sec.3097,Civ C.) correct.I agree to comply with all city and county ordinances and state laws Lender's Name relating to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Address to save indemnify and keep harmless the City of Cupertino against liabilities, judgments,costs,and expenses which may accrue against said City in ARCHITECT'S DECLARATION consequence of the granting of this permit. Additionally,the applicant 1-understand my plans shall be used as public records. understands and will comply with all non-point source regulations per the Cupertino Municipal Code,'Section 9.18. Licensed Professional - Signature Date 02/16/2016 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 r (408) 777-3228-FAX(408)777-3333•buildinga(�cupertino.orq CUPERTINO ❑NEW CONSTRUCTION ❑ ADDITION LSI ALTERATION/Ti ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROIEC SS _ APN# f �1 OWNER NAM-_ ,A, �a wy f` E-MAIL 4 STREET ADDRESS. A A� CITY, STATE;ZFAX CONTACT NAME PE-MAIL !/�sL�®�'� STREET ADDRESS FAX ❑ OWNER ❑ OWNER-BUILDER LTJ -OWWNERRA/GENT ❑ CONTRACTOR ❑CONTRACTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONT CT NA E LICSE LICEATSE 'PE BUS:LIC# CO NAI a E_ FAX STREET ��' CITY STATE,ZIP � � ARCHITECT� ER NA ,e LICENSE NUMBER ry� BUS.LIC IV COM NY NAM E LA G_7 < dFAX STREET e CIT >STAT Z �� PH DESCRIPTION OF WORK EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES USE TYPE OCC. SQ.FT. VALUATION(S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NETAREA BATHROOM KITCHEN - OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECIr TORCH AREA GARAGE AREA: DETACH ATTACH #DWELLING UNTTS: IS A SECOND UNIT ❑YES SECOND STORY _ [J YES - BEIIGADDED? 01\'o ADDITION? [:]NO PRE-APPLICATION ❑YES IF YES:PROVIDE COPY OF IS THE BLDG AN E]YES RECEIVED _ - yz TJJrAL VALUAT PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? NOasF ` By my signature below,I certify to each of the fo oWi m th - roper[y owner or authorized agent to act on the property owner' behalf. I have read this application and the information I have provide 1 1 h ead the Description of Work and verify it is accurate. I gree t omply with all applicable local ordinances and state laws relating to buildi c Ion. thorize representatives of Cupertino to enter the above-i ratified roperty for inspection purposes. � Signature of Applicant/Agent: Date: lAo SUPPLEMENTAL INFO TION REQUIRED Q ,�,� _New SFD or Multifamily dwellings: Apply for demolition permit for IOj ER TxE cou�TE� BUIL�IcrC4i existing building(s). Demolition permit is required prior to issuance of buildina . r is I] PI ,cTLzEVIE ca permit for new building. s Commercial Bldgs: Provide a completed Hazardous Materials Disclosure l ' sT��nRD ❑z rosLicti�©RI.s f61m.if any Hazardous Materials are being used as part of this project. LARGE _ FIRE DEPT _Copy of Planning Approval Letter or Meeting with Planning prior to I] sA1i�z�sEs�ER DISTRICT { .NLA.IOR , submittal of Building Permit application. = s rte, Q ENS IRO\AZENTAL"HEALTH 31doApp_2011.doC revised 06131111 trr �E Fj A_a L.." € 1 t L 1V L t.11'I L fSANTAUNT Y CONTROL NUM. E s ! ^_7 0Q 4An,chcF: r.Bl_d, i_s C3------ 4 08 3 76-4010 p, on_ ` R� ?L4 q CHI_r.K too. 4&1 PLAN a `V 'tkf% �5 x tir ilre spurs lei �s ire Gl_, -, shall ^ ^ "n s, 4 i .; s !c I G „tG ,_i:0 ? 1:-C c��-�! C�bt! it cis o ;'T7 pm-r t!,i i_ppliC_t}O 1 ice_ t0h!, S:u_3 Ci_,a Count L li D _i,for _i' 0M. Ci C 901, =pur0\ prior LO alt 1,. All portions o! tht_buildin.- chall i e with in 5 fees OI a TT= - ?�gri � .L! >r 11aVi 1a a min'� i lli l Taiii!2 oI% Cn!�T- tI COCi�I j e0L ritC� �li2ll G( i Ol 1G 0 1'il7 2 Calc>nSG icil e L �. i'_r!�ll1sl7�i IOGcT o ,�1 .ii1 .-V !-tl C! Lhe CIu.IJrite„t Lnd ill the YL..1 Gl ''.x.t t.GYv1. C.FC 90 r.Er S.-doors shall be, £lily openable iso! l the ` �{it_hout Special lCnOwled:e or effo'��? s%_l-1:,Ot !quilr5 tight gr_spiiig, tight pii!Ching Cr il\'isir ! o?it -is r .� .� I 1'ti 1.LG LpelGw, Key Gp el._ed lock 1J.re\ti C:.s are rmind wlhe;n ,.,_duly distin ui hableas locked and sic77-, -en !r DOC 1R.TO R7-_Ivz1N UNLOC_C,D BUILDi;11iG Is OCCUPIED, CBC 1008,1:8 Mi-_G:ns or egress shall b 11lu,itir!2-,ed at a I I tim-.s with 90 rnInute back Lip F'.:`ie 2 or i ore exiu are required. CBC 1006,3 Exits shall be marked by illuminated exit signs. S1Eris shall be illuminated at_•II times and have 90 miriut�s of_-!er EMCy backup PO,We,, CBC'1015 Coin t!actor si'1_ll field 4 iii! tip i7`-slid of etiisting ra%`du,CO]SuuCT bl d 0!.Z�s m ies res ore or r= pair as i5cass y Panc;tmations til Iated wallskelliiigs shall be protecled by listed !ire rated _s_eml-lies(CG iip4rs, 6 oors,caulking, .i.estopping: etc,) CPC 703 v T--1l art shallro ioe- a l blei=d emerge y k=-'V l �"' p r!Caccess :orpaOcTer!tiniucbL'1ld .:!cr=cnCya c lila .,Ce_S k.=} bo-, CPC 506 A it T) pi>1 check qO s r!Gi perinti th8 L15 e, ciOi>c'or Cit i,s1'a of h unuous,7ciErlals, 07er_ii0 rcC ^nd COT nt. r_ CLC�STi�i�PFRh'I1 IS r 0 ir,cd Dilor i0 %iin_ti?�ih _iGic=C 0 %2__.�C1,3 u!_t=tial_ �q _g _Cil D mol' it v t Z C=i'1 t—i L� ,L .� r,Cil C rt t8� tt'i�si � ., a �i'�i� - � it. i �� „tat rialssh_11„ot!_ , iv.o\'e? prier t obia; :1-a- C0STj RE ?EIRN!I l, 1 PROV D: 0R A- o i s s u b11iIl'llI� Lt-!__1� c11�-'J.��.'L L0 C-0L_Ii.��lAllCv lYiih =.UCJ�'' Sli.!`"ij n - .�r;IJ �L��.S � =;..CaS h. !d -= GJ=L ,=.� CC:�i�ST. 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