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D-2016-0395 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:D-2016-0395 18836 LOREE AVE CUPERTINO,CA 95014-3635(375 15 019) DIANLI CHEN CONSTRUCTION CUPERTINO,CA 95014 OWNER'S NAME: WANG JENNY JINLING DATE ISSUED:07/15/2016 OWNER'S PHONE:408-263-8225 PHONE NO:(408)888-2898 LICENSED CONTRACT DE LARA PION BUILDING PERMIT INFO: License Class B Lic.#856154 Contractor DIANLI CHEN CONSTRUCTION Date 03/31/2017 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:. I hereby affirm under penalty of perjury one of the following two declarations: DEMO 1 STORY SFD(814 S.F.)WITH ATTACHED GARAGE(225 S.F.) 1. 1 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. jhave and will maintain Worker's Compensation Insurance,as provided for by . Ua "Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuations$8500.00 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 15 019 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 all this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Mu icipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature - Date 07/15/2016 Issued by:PAUL O'SULLIVAN p Date:07/15/2016 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 roofmg 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:07/15/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER r. 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 Cupertino Municipal Code,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Se tions 25505,25533,a d 25534. Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. [� Owner or authorized agent: APPLICANT CERTIFICATION Date:07/15/2016 1 certify that I have read this application and state that the above information is CONSTRUCTION4NDING 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 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 nor-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 07/15/2016 Professional DEMOLITION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228•FAX(408)777-3333•build ihg(abcupertino.org PROJECT ADDRESS j� '3,15 ee 4-ve APN# -1,S M� C jq OWNER NAME '�" PHONE E-MAIL Ay jtqL,_M _ STREET ADDRESS y 1 '/, 6�L � CITY, STATE,ZIP �1 ,,I -t 64 FAX, CONTACT NAME yCj Y Y!d yy/y 'Cal ourls� IsYG eln PHONE �I fy�® EMAIL STREET ADDRESS ' CITY,STATE;'(ZIIP��_ �" Ile �r� ff � � qo 11� _FAX ❑.OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT v`❑EENGiNEER ❑ DEVELOPER ❑ TENANT CONTRACTORNAME Dlan , LCNSENUMBER p � �.,J�,,��L�� Z� � l� LICENSE TYPE BUS.LIC# (i, (f(� W G/� s. COMPANY NAME E-MAIL o FAX STREET ADDRESSdd 3 7 CITY,STATE, Q /01 .dL7 �®l.✓ s V v el „�(�f PHONE � [� DESCRIPTION OF WORK , <D omo � AK6?jt!��_1 (6L",' ,e gke Px,)Ier AN 40 1H -vNi5f 14 SIDENTIAL #DWELLING OFFICE USE ONLY FLOOR AREA ' UNITS USE Ft NAJA ATt(S27 COMMERCIAL FLOORAREA s TYPE OF CONSTRUCTION #STORIES AQMD JOB NUMBER RECEIVED EY �r 7#° qvE� Y n By Iny 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 real 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 applicable local ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above-identipead.�property for inspection purposes. Signature of Applicant/Agent: Date: r V/PSUPPLEMENTAL INFORMATION REQUIRED PRIOR TO ISSUANCE OF DEMOLITION PEPAIT o C Us> otvLy rovide Job Number from Bay Area Air Quality Management District www.baagmd.org @ 415-749-4762. p ANCPEC T Provide three copies of a site plan showing protection for any trees 10"in diameter or more at 3'above grade. ❑ �xress / ❑ sTA vnAan- V Provide letter from PG&E(408-725-3325)stating all gas and electric has been disconnected. ❑ LARGE Planning Dept clearance to verify building is not considered an historical landmark.Allow 10 business days. x / ❑ IYIA,TOR '41Provide letter of clearance of all vermin from a licensed pest control contractor. 7 Applicant shall call the Public Works Department at 408-777-3104 and schedule a"habitable dwelling"inspection. Provide Construction and Demolition Recycling Diversion signature form. _Commercial Buildings Only: Provide Fire Dept clearance for fire suppression%alarm system review. DemoApp_2016.doc revised 051..10116