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D-2016-0408CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: D-2016-0408 10553 I.A RODA DR CUPERTINO, CA 95014-4430 (369 33 011) RODERICK COOPER DEMOLITION PALO ALTO, CA 94306 OWNER'S NAME: WANG STANLEY B AND YANG YA-LING TRUSTEE DATE ISSUED: 09/02/2016 OWNER'S PHONE: 408-505-3267 PHONE NO: (650) 720-1301 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C-2 Lie. #984437 Contractor RODERICK COOPER DEMOLITION Date 06/30/2017 —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: DEMO EXISTING HOME (1543 S.F.); ATTACHED GARAGE (451 S.F.) I hereby affirm under penalty of perjury one of the following two declarations: i. I - d will maintain a certificate of consent to self insure for Worker's Comp cation, as provided for by Section 3700 of the Labor Code, for the _pe - ante of the work hich this permit is issued. I ve and will i ant'ui Wo ker's Compensation Insurance, as provided for by ecfion of the Labor Code, for the performance of the work for which this Sq. Ft Floor Area: Valuation: $15000.00 t is issued. APPLICANT CERTIFICATION certify that l have read this application and state that the above APN Number: Occupancy Type; information is correct. I agree to comply with all city and county ordinances 369 33 011 and state laws relating to building construction, and hereby authorize • 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 s ' City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally, the� ica t understands and will comply with all non -point source regulati5ns pe he Cupertino Municipal C emiction 9.18. 180 DAYS FROM LAST CALLED INSPECTION. r, Sign ure Date 9/2/2016 Issued by: Abby-A_y-ende LMR Date: 09/02/2016 - DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RF ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is following two reasons: 1. I, as owner of the property, or my employees with wages as their sole installed without first obtaining an inspection, I agree to removeallnew 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: 9/2/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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. 2. 1 have and will maintain Worker's Compensation Insurance, as provided for by HAZARDOUS MATERIALS DISCLOSURE 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 maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the p ermit is issued. Health & Safety Code, Section 25532(a) should I store or handle hazardous 3. I certify that in the performance of the work for which this permit is issued, I material. Additionally, should I use equipment or devices which emit hazardous shall not employ any person in any manner so as to become subject to the air contaminants as defined by the Bay Area ' uality Management District I Worker's Compensation laws of.California. If, after making this certificate of will maintain compliance with the C no nicipal Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety C , Sectio 25505, 25533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. y. Owner or authorized age APPLICANT NT CERTIFICATION Date: 9/2/2016 1 certify that I have read this application and state that the above information is CONSTRUCTION LENDING aY I hereby affirm that there is construction lending agency for the performance correct. I agree to comply with all city and county ordinances and state laws of work's for which this permit is issued (Sec. 3097, Civ C.) relating to building construction, and hereby authorize representatives of this city Lender's Name to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Address judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands ARC'HITECT'S DECLARATION and will comply with all non -point source regulations per the Cupertino Municipal I understand my plans shall be used as public records. Code, Section 9.18. Licensed Signature Date 9/2/2016 Professional PROJECT ADDRESS' APN#Nil .47 / Up e-1 4 OWNERNAME _ 0 PHONE E -MATT STREET ADDRESS -. ' (. Y, STATE, ZIP - , -FAX CONTACT NAME - . - - PHONE - " . E-MAIL STREET ADDRESS . _ ... ... CITY, STATE; ZIP - FAX ElOWNER,❑ OWNER -BUILDER (]-OWNER AGENT ❑ CONTRACTOR. .(] CONTRACTQRAGENT -(] ARCHITECT (] ENGINEER ❑ DEVELOPER, ❑:TENANT CONTRACTOR NAME -� �'§ LICENSENUMBER,�el_� LICENS E-MAIL FAX °`�TYTBUSLIC# f (` COMPANY NAME . E-MA� f�T\ Y _e te rN STREET ADDRESS� r f _ 0, CTTY, STATE; ZIP PHONE,+�j�, DESCRIPTION OF WORK RESIDENTIAL # DWELLING _ OFFICE USE ONLY _. FLOOR AREA - / �+:. UNITS e - ,., - USE OCC. TYPE SQ. FI'. VALUATION COMMERCIAL FLOOR AREA . TYPE OF CONSTRUCTION # STORIES AQMD JOB NUMBER A 'RECEIVED BY: By my signature below, I certify to each of the following: I am the property owner or authorized agent to act onthe property owner's behalf. hhave 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 authorize resentatives of Cupertino to enter the above -identified property for inspection purposes. Signature,of ApplicantlAgent: Date: SUPPLEMENTAL INFORMATION REQUIRED PRIOR TO ISSUANCE OFDEMOLITION PERMIT OFFICE USE ONLY Provide Job Number from Bay Area Air Quality Management District www.baUmd.org @ 415-7494762. PLAN CHECK TYPE _ Provide three copies of a site planshowingprotection for any trees 10" in diameter or more at 3' above grade. _ Ci EXPRESS © STANDARI> Provide letter from PG&E (408-725-3325) stating all gas and electric has been disconnected. El LARGE l Planning Dept clearance to verify building is not considered an historical landmark. Allow 10 business days. Q MAJOR '�..�,✓Provide letter of cle'arance- 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." inspeption. V"Provide Construction and Demolition Recycling Diversion signature form: Commercial Buildings Only:. Provide Fire Dept clearance for fire suppression / alarm system review.