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D-2016-0403CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: D-2016-0403 21731 STEVENS CREEK BLVD CUPERTINO, CA 95014-1119 (326 20 048) METHOD CONSTRUCTION INC GILROY, CA 95021 I OWNER'S NAME: FREELAND URI AND BATIA TRUSTEE I IDATE ISSUED: 08/25/2016 I OWNER'S PHONE: 650-8234543 I I PHONE NO: (408) 842-0054 III lei1 1 �� t_� I t 1_@JWA Mv V LIX11 License Class.B Lic. #B57112 Contractor METHOD CONSTRUCTION INC Date 04/30/2017 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. 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 -�'performancc of the work for which this permit is issued.- 'J2-:-_ 2- 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. 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 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 may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cypar�ino Municipal Code, Section 9.18. hereby affirm that I am exempt from the Contractor's License Law for one of the allowing two reasons: 1. I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Scc.7044, Business & Professions Code) 2. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). hereby affirm under penalty of perjury one of the following three declarations: s.. 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. 2. 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. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with. such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION I certify that l have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned properly for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date 8/25/2016 BUILDING PERMIT INFO: —BLDG _ ELECT —PLUMB MECH _ RESIDENTIAL X COMMERCIAL JOB DESCRIPTION: DEMO EXISTING BUILDING (1,610 S.F.); PAVING SURROUNDING BUILDING (4,900 S.F.) Ft Floor Area: I Valuation: $1100000.00 APN Number: Occupancy Type: 326 20 048 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: AbbyAyende Date: 08/25/201.6 RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: 8/25/2016 ALL ROOF HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 0 , 25533, and 25534. Owner -or authorized agen Date: 8/2612016 ' CONSTRUCTION LENDING AGENCY hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name - Lender's Address ARCHITECT'S DECLARATION 1 understand my plans shall be used as public records. Licensed . E, N PERMIT� ��. ATION iMIJNIq08Y�4.QPMEN$u4jKii\ t= aip01MI4Lar Li� 3V iL%S't - 1t13U0 TORRE AV$N JE > OUPERTINO, CA 95014-3255' 0$ 777 3223 FA (408) 71-33�3Itallc 111 cIt€aertinrl,elrcl PROJECT ADDRESs 21731 STEVEN$-,OBtVD API = 326- 2-0;-'048 QW\6R NANM 13kt RF-5-1,A_L3 ".azl f#'ee#.##1 e�"?r ya1#c.wt'o. $TREFTADDRESS AVCITY. STT,ZE, . X -�� CONLAc i NAME HONF )EMAAIL effrey�A€ �ell� �u�i#u �brrl STREETADDRESS 15,01 'tHS ALAMDA, $Tl -105 CITY, STATE. ZTi' SAN JO E,:CA 9,5126 FAQ fl aIV#�EP.. ;Q Q11VIvER�BUILt?ER aW\Eli. ACEI' T ONTR;,cTalz Q C04TRACt'OR x'IGENT C'J Ak2 ITECf IP ENGNE#=•.R © bEVELOPER B` TFNART CONTRACTORN"s g LICEN LICENSF TV15E GOvIgANYAiAMEj6110YU FAX r r E-m" r _ ivl_ pry S t ✓ s Cil j& TATE # O f/ 00 DE5GRFPrIOAI OF WORif 3erYI#allflorl'L? >610 tYiSiii# i1### # #nC n l �}13t4 .4: 1 (} f �1T#II9 sLt."Und#nth �7 #I{ 1Titg. RESIDENTIALFFICE USE ONLY DtvELL ING FLOOR AREAUNITS USE t3CC. 7YP S Fr. VAL AT#O` cOm&iERc1AL 1,610 sf (to be dernolished), 2,600 (new tl 4,305 Site Develo meat buildi FLOOR AREA 9)x ( p TYPE OFCON§fkt�CTfOi4 V -b g:F.0R1F5 Q AQMi JOB J[iA_i$Elt RECEIVE? BY; ' TAL VALUATION,,, 4T L 1- 1 t b By my signamte below, I certify to each of the following: I am the pro erty owner or authorized agent to aet,on the property owner's behalf. I have read this application and the information Ihave provided Es correct I have read , e Pescription of Work and verify it is accurate. lag,:-,- to comply with all applicable local ordinances and state laws relatir?g% ilding construe ' n, I autho ` representatives of Cupertino to enter the above -identified property for inspection purposes. -- r Signature of Applicarit/Ageiit: Date: SUPPLEMI�NTAL I OP.MATION REQ; PRIOR To ISSUANCE. OF DEMOLITION` PERMIT OFFICE USE ONLY �. Provide'lob Number from Bay Area Air Quality Management District ,baagilad.ar#; a7 415-1494762. PLANCIIEcxTYrE Provide three copies (Residential) or sic. copies (Commerical} 4f a -site plat show protection. for any trees 14" fl EFRESs [ sTANDARD in diameter or more at 3' above grade. F1 LARGE provide letter f rom PQS E, i 408-725-3325) stating all; gas and electric has been disconnected. Q §AOR Pres' de a letter of inspection, tests, and abatement of any Hazardous Materials. Letter to be initiated by persatt(s certified in asbestos, mercury and/or hazardous material examination - Dept Planning I}ept clearance to verify building is not considered an histaria4 landmark. Allow 10 business days: LApplicantihall ter of clearance of all vermin from a licensed pest control contractor. tN!call the Public Works Department at 408-777-3104 and schedule a "habitable dwelling inspection. gned Debris Bin -Md Recyclable Materialsform.. f 13emaopp ZQ.t3 doe revised 02113113`