D-2016-0392CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: D-2016-0392
10760 JOHNSON AVE CUPERTINO, CA 95014-3818 (375 31 005)
PAB CONSTRUCTION
INC
CUPERTINO, CA 95014
OWNER'S NAME: YU HENRY
DATE ISSUED: 07/11/2016
OWNER'S PHONE: 408-616-9957
PHONE NO: (408) 499-6595
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class GENERAL BUILDING CONTRACTOR Lic. #980537
Contractor PAB CONSTRUCTION INC Date 01/31/2017
—BLDG —ELECT —PLUMB
MECH X RESIDENTIAL 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 EXISTING HOME (1000 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.
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
Sq. Ft Floor Area:
Valuation: $8500.00
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
375 31 005
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.
WITIiIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally, the applicant understands and will comply with all non-point
source regulations p r th Cupertino Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 7/11/2016
Issued by: Abby vende
Date: 07/11/2016 I�JVV V1)
OWNER-BUIL R ECLARATIO
I hereby affirm tha 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 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 (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: 7/11/2016
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR 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 DISCLOSURE
2. I 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 become subject to the
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If, after making this certificate of
will maintain compliance with the Cuper 'no Municipal Code, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety Code SeconJ25505, 25533, and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
Owner or authorized agent:rAl,
APPLICANT CERTIFICATION
Date: 7/11/2016 vp
I certify that I have read this application and state that the above information is
CONSTRU I N LENDING AGENCY
correct. I agree to comply with all city and county ordinances and state laws
I hereby affirm that there is a co&4ruction 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 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.
I understand my plans shall be used as public records.
Licensed
Signature Date 7/11/2016
Professional
DEMOLITION PERMIT APPLICATION
COrvAllAUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TCRRE AVENUE CUPERTINO, CA 95014.3255
G i) ' E l i" E i t (408) 777-3228• FAX (408) 777-3333 • buHdji q(C-pctr#apTmo.earg
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By Puy sipattire below, I. certify to tach cfthe followit.ig: I ant.th. l ropcily owner or autho6yed a„erit to act curl ( Ie propeity c lmwr `s behalf. t 13m e ,cati this
applicatim and the it brinatiml I hav%' hitt )d "g is correct. I ha-ve read 111c Descriptiora of 3,','ork aiid verify it is acctrtate. 1 agrC e to comply with all applicable 'local
or diiazwce and state laws ic1"q-ti 011. 1 taitholiz- represelitaxives of Cuper ilio to ejrter tine abovc-iticmificd pro, porty for iiispactionr pulpa' s.
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SUPPLEMENTAL, l 1 CIR r1 TION* f; EQ lR,UjD.Pfl fOR TO ISSt)ANCE OF DEMC3LYfION i'L12M1'"I rt �tfi� test: ty:I k
,T'rcrlc{c Job ``axnt7ti iromBay Area Air Quality 4,' ia;cstrict,Vwn'bataaamd„it,@4j5-749-4711,2, �awk�t,trt.t� xit�r; 4
rrovide three opics l�a ; ito pltrtrees
U” ii} tiiatm�:er ea ttY x'c at 3` It>tyt e �r�tEe.
L� 5'1'�1a4llr�r2i1
Provide letter fi-om PG&E (408-725-:3325) , to ing all.,g; s andelectric has been disconnected.
i'12tat1itl Dept clearance to verify building is not misidcred an historical landmark -,,Allow 10 business days.
0 MAJOR—
_t/Tawide letter of tki <ar;tl7 -t. of al l vermin fro n a lit` Tkii }rest control coiitrat:tcrr.
Applicant shall' call the Public Works Department at 408-777-3104 and schedule a "babi€able dwelling," irispecrion,
T Provide Constrtactiori aand Demolition Recycling lDiv -sion si8"'Imture form,
Commercial Buildings Chrly: Provide. Fire'Dept clba ratn;c for fire supp'ressicata i alama sy; tem review.
C?c:ri,tr. PAIL., 016doc rcitaed 0580/76