B-2016-0375 i
CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS: CONTRACTOR: PERMIT'NO:D-2016-0375
10406 S FOOTHILL BLVD CUPERTINO,CA 95014-2604(357 03 078) KUBRO
CONSTRUCTION
CUPERTINO,CA 95014
OWNER'S NAME: LEE KENNETH M AND DAISY W C TRUSTEE DATE ISSUED:09/01/2016
OWNER'S PHONE:408-832-3073 PHONE NO:(408)839-5800
LICENSED D ONT A TOR' DECLARATION ATION BUILDING PERMIT INFO:
License Class B Lic.#960307
Contractor KUBRO 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 Diviiion 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
DEMO 605 S.F.(E)GRANNY UNIT.
{ 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
P
of the work for which this permit is issued.
,wave and will maintain Worker's Compensation Insurance,as provided for by I
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$5000.00
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 357 03 078
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 Municipal Code,Section 9.18. 180 DAYS FROM LAST C CTION.
Signatu _ pate 09/01/2016 Issued by:MELI
_D1— Date:09/01/2016
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the RF.ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
i. 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)
z. 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:09/01/2016
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
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 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 age
APPLICANT CERTIFICATION Date:09101120 J 6
I certify that I have read this application and state that the above information is TI 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 09/01/2016
Professional
I
j DEMOLITION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION
10300 TORRE AVENUE-CUPERTINO,CA 95014-3255
1 (408)777-3228- FAX(408)777-3333•building c(1�.cupertino.om
CUPERT.INO
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PROJECT ADDRESS ' �(1 19 6 so f,( � IZ,O.�-�(o !J t I�` APN#
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OWNER NAME ! ( PHOATE , _ E-MAIL Ca
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STREET ADDRESS ra L CITY, S T r yy 60-51V t4 FAX
CONTACT NAME P ONE .• E-MAIL ,
STREET ADDRESS
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OWNER OV R-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR .:❑CONTRACTOR AGENT ❑: ARCHITECT 11ENGII EER El DEVELOPER 11 TENANT
CONTTRACTORNTAME ri�c icz Tri tg n*Tc�rvpF s I IBUS.LIC#_ r�
COMPANYNAME I t
STREETADDRESS�, ,•,� , ���- ._ CITY>5 T E � 4°� PIS,—��r`/
DESCRIPTION OF WO�RIx•—•�Y Aa SS 4.
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RESIDENTIAL #DWELLING y OFRICE i7SE ONLY - r
FLOOR AREA �6
1 UNITS [ _USE.... }v,_ OCC. -�.:.TYPEi S .fT.>s_ 111
COMMERCIAL
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FLOOR AREA -r �. .,�� _.; , 'i'� +�_we,
3 f #STORIES
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TYPE OFCONSTRUCTION I _ >. .., _;... _.. ;•, ..,.. . .= st, ._s.�,. ,.: ,... ..; ,.�>,_.'
AQMD JOB DUMBER : ! O (— RECEIVED x ` T(�AI�AL_UATS1�N:
6 J r1 h!� �rj J`
By my signature below,I certify to each of the following: I am the property owner or authorized a.-Attto a n the property owner's behalf. I have read 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 oriz•repre ntatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applic tlAgent: Date: {
SUPPLEMENTAL INFORMATION REQT TzD P RTO ISSUANCE OF DEMOLITION PERMIT {OFFICE USE ONLY
Provide Job Number from Bay Area Air Quality Management District xkwNv.baagmd.or;@ 415-749-4762, PLAN cxEcxizPE
_ Provide three copies(Residential)or six copies(Commerical)of a site plan showing protection for any trees 10' �=EXPREss
�. STAIQDARD
in diameter or more at 3'above grade: '
Provide letter om PG&E(408-725-3325)stating all gas and electric has been disconnected. �`LARGE
Provide a letter of inspection,tests,and abatement of any Hazardous Materials.Letter to be'initiated by person(s) mAaoR
certified in asbestos,mercury and/or hazardous material examination.
Planning Dept clearance to verify building is not considered an historical landmark.Allow 10 business days.
_Provide letter of clearance of all vermin from a licensed pest control contractor.
—Applicant shall call the Public Works Department at 408-777-3104 and schedule a"habitable dwelling"inspection
Provide signed Debris Bin and Recyclable Materials form.
DemoAPP_
2013.doc revised 02113113