B-2016-0388CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: D-2016-0388
20667 CRAIG CT CUPERTINO, CA 95014-2912 (359 15 017)
BAY AREA CUSTOM
BUILDERS INC
SAN JOSE, CA 95129
OWNER'S NAME: ZHOU XIAOFAN AND WANG YUMEI TRUSTEE
DATE ISSUED: 06/22/2016
OWNER'S PHONE: 408-306-8003
PHONE NO: (408) 446-1200
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class B Lic. #920644
Contractor BAY AREA CUSTOM BUILDERS INC Date08/3112016_BLDG
_ELECT _PLUMB
MECH X RESIDENTIAL COMMERCIAL
I hereby affirm that I' am licensedunder 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:
DEMO SFD (1300 S.F.)
I hereby affirm under penalty of perjury one of the following two 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
performance of the work for which this permit is issued.
v ..2. I have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of thelwork for which this
Sq. Ft Floor Area:
Valuation: $14000.00
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
APN Number:
Occupancy Type:
and state laws relating to building construction, and hereby authorize
359 15 017
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
PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit.
Additionally, the applicant understands and will comply with all non -point
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
source regulations per the Cupertino Municipal Code, Section 9.',l 8.
180 DAYS FROM LAST CALLED INSPECTION.
Signature i -i 41 / J Date 6/22 /2016
Issued by: Abby yende
Date: 06/22/2016
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
RE -ROOFS:
following two reasons:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
1. I, as owner of the property, or my employees with wages asCtheir sole
installed without first obtaining an inspection, I agree to remove all new materials for
compensation, will do the work, and the structure is not intended or offered for
inspection.
sale (Sec.7044, Business & Professions Code)
2. I, as owner of the property, am exclusively contracting with' licensed
Signature of Applicant:
contractors to construct the project (Sec.7044, Business & professions Code).
Date: 6/22/2016
I hereby affirm under penalty of perjury one of the following three declarations:
"A"
1. I have and will maintain a Certificate of Consent to self-insgre for Worker's
ALL ROOF COVERINGS TO BE CLASS OR BETTER
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued. i
HAZARDOUS MATERIALS DISCLOSURE
2. 1 have and will maintain Worker's Compensation Insurance as provided for by
I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code, for the performance of the work for which this
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
permit is issued,
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
s. I certify that in the performance of the work for which this permit is issued, I
Health &Safety Code, Section 25532(a) should I store or handle hazardous
shall not employ any person in any manner so as to becomsubject to the
material. Additionally, should I use equipment or devices which emit hazardous
I
air contaminants as defined by the Bay Area Air Quality Management District
Worker's Compensation laws of California. If, after maki. this certificate of
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
exemption, I become subject to the Worker's Cornpensatiorprovisions of the
the Health & Safety Code, Sections 25505, 25533, and 25534.
Labor Code, I must forthwith comply with such provisions 'or this permit shall
be deemed revoked.
Owner or authorized agent:_ /7
APPLICANT CERTIFICATION
Date: 6/22/2016
I certify that I have read this application and state that the above information is
CONSTRUCTION LENDING AGENCY
correct. I agree to comply with all city and county ordinances and state laws
I hereby affirm that there is a construction lending agency for the performance
relating to building construction, and hereby authorize representatives of this city
of work's for which this permit is issued (Sec. 3097, Civ C.)
to enter upon the above mentioned property for inspection purp�ses. (We) agree
Lender's Name
to save indemnify and keep harmless the City of Cupertino agai st liabilities,
judgments, costs, and expenses which may accrue against said City in
Lender's Address
consequence of the granting of this permit. Additionally, the ap licant understands
and will comply with all non -point source regulations per the Cu ertino Municipal
ARCHITECT'S DECLARATION
Code, Section 9.18.
1 understand my plans shall be used as public records.
Licensed
Signature Date 6/2 /2016
Professional
CUPERTINO
DEMOLITION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408)[777-3333 • buildingacupertino.Orcl
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DESCRIPTION OF WORK
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By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have provided is correct. 1 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 building construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applirant/Agent: Date:
SUPPLEMENTAL INFOPLMATION REQUIRED PRIOR TO ISSUANCE OF DEMOLITION PEiZMIT
� OFBICEIISE'Ut�I Y; i >'`
Provide Job Number from Bay Area Air Quality Management District-www.baa4md.org a4 4I5-749-4752.
Provide three copies Residential or six copies Commerical of a site plan showing protection for any trees 10"
diameter or more at 3' above grade.
Provdde Ietter from PG&E (408-725-3325) stating all and electric has been disconnected.
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gas
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Provide a letter of inspection, tests, and abatement of a y Hazardous Materials. Letter to be initiated by person(s)
certified in asbestos, mercury and/or hazardous materi1 examination.
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lanning Dept clearance to verify building is not const ered an historical landmark. Allow 10 business days.
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provide letter of clearance of all vermin from a licens pest control contractor.
Applioant shall call the Public Works Department at 4 8-777-3104 and schedule a "habitable dwelling' inspection.
Provide signed Debris Bin and Recyclable Materials f rm.
DemoApp_2013.doc reidsed 02/13/13