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B-2016-0406 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:D-2016-0406 18964 TILSON AVE CUPERTINO,CA 95014-3655(375 09 012) ONSITE CONSTRUX HALF MOON BAY,CA 94019-4208 OWNER'S NAME: WONG MARY LI HUNG TRUSTEE DATE ISSUED:08/29/2016 OWNER'S PHONE:408-929-8827 ::::I��HO�NENO: 650)269-5560 LICENSED CON RACTOR!$DECLARATION ATION BUILDING`PERMIT INFO: License'Class B Lic.#905588 Contractor ONSITE CONSTRUX Date 10/31/201.7 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(E)SFD(t, 3LMF.), I hereby affirm under penalty of perjury one of the following two declarations: 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. `O/S�`c 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:$4850.00 APPLICANT CERTIFICATION 1 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 09 012 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. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally,the applicant understands and will comply with all ll non-point source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature Date 08/29/2016 Issued by:MEL ANAM Date:08/29/2016 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. 1,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. 1,as owner of the property,am exclusively contracting with licensed Signature of Applicant: contractors to construct the project(Sec.7044,Business&Professions Code). Date:08/29/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER m. 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 3. 1 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,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 APPLICANT CERTIFICATION Date:08/29/2016 C� I certify that I havereadthis 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 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 08/29/2016 Professional DEMOLITION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPERT'IINC 1 (408)777-3228•FAX(408)777-3333•buildinaCd-cupertino.org D- Zo 1� PROJECT ADDRESS i AYEAPN# 0 r _ 0 T OWNER NAME � Af ,�,�� (�`� _ �P (, V' 0"J l7' PHONE 110 �1 0 9 E-MAIL STREET ADDRESS CITY,. STATE,ZIP k- TT A FAX- CONTACT pyCONTACT NAME i PHONE CS-0 of. E-MAIL f STREET ADDRESS CTI'Y,STATE,ZIP - FA% .... `lam®N t l'� C l`f'Ol 1 ao- (-"t G 5 ❑OWNER ❑OWNER-BUILDER ❑ OWNER AGENT (CONTRACTOR ❑CONTRACTOR AGENT ❑: ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE COMPANY NAME t�.(-; /�tw�, _ Cl OOCS�i I� -2�1t G1fc .L 9 LS J is p FAX STREET ADDRESS ��//_ /" CITY,STATE,ZIP PHOS%'r- �G� LLt/+li f (�/�lL O � ©d7v DESCRIPTION OF WORK W6 C G S C3�n�L t- p r�cGs w � . RESIDENTIAL x: a #DWELLING /� (}PEICEIISE'ONLY FLOOR AREA UNITSa/{ U-fQYO`SL .USE OC'r -TP.E s '.ET VALUA1YOh7 1 COMMERCIAL FLOOR AREA TYPE OF CONSTRUE ON #STORIES 30!Z AQMD JOB NUMBER BF ; T ALV UATION: J#: � By my signature below,I certify to each of the following: I am the property owner or authorized age act on the property owner's behalf. I have rea 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-identified property for inspection purposes. Signature of Applicant/Agent: Date: 0 G SUPPLEMENTAL INFORMATION REQUIRED PRIOR TO ISSUANCE OF DEMOLITION PERMIT a> Custlly]GX, Al Provide Job Number from Bay Area Air Quality Management District www.baMmd.org @ 415-74911762. PLAIN CHECK TYPE Provide three copies of a site plan showing protection for any trees 10"in diameter or more at 3'above grade. C( xFss © sTAlYDARD. Provide letter from PG&E(408-725-3325)stating all gas and electric has been disconnected. Planning Dept clearance to verify building is not considered an historical landmark.Allow 10 business days. Provide letter of clearance;af all vermin from a licensed pest control contractor._ k > Applicant shall call the Public Works Department at 408-777-3104 and schedule a"habitable dwelling"inspection Provide signed 13ebns Bin.andRecyclable Materials form. _Commercial Buildings Only: Provide Fire Dept clearance for fire suppression/alarm system review. A Demo-4pp 2016.doc revised 03129116