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D-2016-0389CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: D-2016-0389 18734 LOREE AVE CUPERTINO, CA 95014-3839 (375 18 025) NEW WORLD CONSTRUCTION CUPERTINO, CA 95014 OWNER'S NAME; XINGYUETAL DATE ISSUED: 06/28/2016 OWNER'S PHONE: 408-636-8881 PHONE NO: (408) 253-0888 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lie. #895018 Contractor NEW WORLD CONSTRUCTION Date 04/30/2017 —BLDG _ELECT _ PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing ' MECH X RESIDENTIAL _ COMMERCIAL with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: DEMO 1 -STORY SFD (1048 S.F.); DEMO GARAGE (264 S.F.) I hereby affirm under penalty of perjury one of the following two declarations: t. 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 i i1performance 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: $12000.00 APPLICANT CERTIFICATION 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 375 18 025 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 N T 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 PERM ISSUANCE OR source regulations per the Clpertino Municipal Code, Section 9.18. 180 DAYS FROM LAS C L D NSPECTION. mn.. Signature ��'-- Date26/ 8/2016 Issued by: Alex Vallelunga ` OWNER -BUILDER DECLARATION Date: 06/28/2016 I hereby affirm that I am exempt from the Contractor's License Law for one of the RE -ROOFS: following two reasons: Ali roofs shall be inspected prior to any roofing material be' ag installed, If a roof is t. I, as owner of the property, or my employees with wages as their 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 (See.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: 6/28/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" DR BETTER 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. HAZARDOUS MATERIALS DISCLO URE 2. I have and will maintain Worker's Compensation Insurance, as provided for by I have read the hazardous materials requirements undf r 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 3. 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 ir handle hazardous shall not employ any person in any manner so as to become subject to the material. Additionally, should I use equipment or device which emit hazardous air contaminants as defined by the Bay Area Air Quality Wanagement District I Worker's Compensation laws of California. If, after making this certificate of will maintain compliance with the Cupertii unicipal ode, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Code, Sections 2 505, 2553 , and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. - Owner or authorized agent: – .. APPLICANT CERTIFICATION Date: /� 28/2016 I certify that I have read this application and state that the above information is N TR N LEND AEN Y 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 -.) to enter upon the above mentioned property for inspection purposes. (We) agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code, Section 9.18. 1 understand my plans shall be used as public records. Licensed Signature Date 6/28/2016 Professional UMMULI II 1v1V rCKIYI'I 1 RrrLIt+H 1 IUM COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION 10300 TORRE AVENUE • ,CUPERTINO, CA 95014-3255 (408) 777-3228 . FAX (408) 777-3333 buildin4(a)-cupertino.org r 2f f)�� C1 PROJECT ADDRESS b �] /==:?.,,Ave • APN# OWNERNAME Y-• y PHONE to 63 6k� C r E-MAII,��1 el STREET ADDRESS A V s CITY, STATE, ZIP C ` �h v i C4 � f �./". (i( FAX CONTACT NAME n a PHONE L�L��%k' Nj (7 o IEMMq!!jAWU STREET ADDRESS / I CITY, STATE; ZIl' ♦ Qd / FAX CA 01 OWNER ❑ OWNIERBUILDER 0 OWNERAGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑- ARCHITECT 13 ENGINEER ❑ DEvE LOPER ❑ TENANT GONTRACTORNAMEy; ' LICENSENUMBER5 P � / LICENSE TYPE $ BUS. LIC # COMPANYNAME E-MAIL FAX STREET ADDRESS p CITY, STATE, ZIP DESCRIPTION OF WORK d d� RESIDENTIAL % �; # DWELLING a7Y 17y /%�% bFNTGE USE ONLY . 'USE OCC. TYPE 80,1M VALUATION FLOORAREA � t UNITS S/ COMMERCIAL FLOORAREA 1' TYPE OF CONSTRUCTION # STORIES , AQMD JOB NUMBER a RECEIVED BY. ' d TC T VALUATI N By my signature below, I certify to each of the following: I am the property owner or authorized Qent-("ct on th erty owner's behalf.' I have tea this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all a)plicable local ordinances and state laws relating to building constructi I authorize representatives of Cupertino to enter the above -identified property for inspect n purposes. Signature ofApplicant/Agent: Date. — - i-- - SUPPLEMENTAL INFORMATION REQUIRED PRIOR TO ISSUANCE OF DEMOLITION PERMIT off CE Usk ONLY F1.MrCHECKnTF Provide Job Number from Bay Area Air Quality Management District www:baagmd.org @ 415-749-4762. FX PPJSS Provide three copies (Residential) or six copies (Commerical) of a site plan showing protection for any trees 10" in diameter or more at 3' above grade. sT ARD Provide letter from PG&E (408-725-3325) stating all gas and electric has been disconnected. F1 LAItG _ Provide a letter of inspection, tests, and abatement of any Hazardous Materials. Letter to be initiated by person(s) certified in asbestos, mercury and/or hazardous` material examination. 00 Planning Dept clearance to verify building is not considered an historical landmark. Allow 10 business days. `v°� rovide letter of clearance of all vermin from a licensed pest control contractor. _VA 'c shall call the Public Works Department at 408-777-3104 and schedule a "habitable dwelling" inspection. p, — ��r 6 WLf Provide signed Debris Bin and Recyclable Materials form. M PLOT PUNS CHECKED BY p _ - DATE KUH 9 � o , PLANNING DEPT o d 0np o C-11 IPE TINO C�Mp[�Q�D�109 C�Qo g�Q �l EXIST. SIDEWALK LOREE AVE. EXIST. ROLLED CURB TO STAY. EXIST. DRIVEWAY TO _ BE ...R EMQVEQ c EXIST. NONPROTECTED D TREE TO BE REMOVED IST. TREES 16• TO STAY. 9e I I I I w o•UPARTMENT I Q i= gt o to€VIS CUPER INO DEMOLISHED z p7p,rf IS �y TR ES EXIST. ONE _ TO" STAB. This sit of nipns and sic�r�.,m°�a.icar, n ��5; �sE §The NONPROTECTED STORY HOUSE I o lob M d��s y svuctlon. tis unla ..'q to m,TRSE yJO BE REMOVED roi'I"e ge; o altorat9�ns aii e r c dowime EXIST. ROL EC thO, arom, %.ifthout ai prov-, from .�"�usi iIng Official. CUR$ R' IDEW LN ti its 3 T F 9�leL � a G °dir bi z+� t i_or� r — — — — — — — GH�•h.A�t�'U6�?�°� be ice; ¢ r�"dila €Ji ic8 i� ; cSI �?�ave?I of the vid on {r� -j Ll IC)dffLTt� ��Y�erit cgf a P �ns o a y City Ordinance or Beate �cfv. L A N v -�R CJI' `"E �� t/ 1 � � �� ;'• i.,e l�^' GOIDE PERMIT NO. GiOPL fAC