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15020081CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS; 10290 STERLING BLVD CONTRACTOR: CRISANTOS QUALITY PERMIT NO: 15020081 1 CONSTRUCTION INC I OWNER'S NAME: XIE CAIXING ET AL. 137110 SYCAMORE, ST DATE ISSUED: 02/12/2015 OWNER'S PHONE: 4082184090 ❑ LICENSED CONTRACTOR'S DECLARATION <--I . �? � ,T, License Class Lac. # ContractorL5� U011 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: 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 pernift: is issued. 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 r the Cupertino Municipal Code, Section 9.1& Signature Oam ❑ OWNER- BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1, 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 (See.7044, Business & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: 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. 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 NEWARK, CA 94560 1 PHONE NO: (510) 713-8770 JOB DESCRIPTION* RESIDENTIAL COMMERCIAL R DEMO SFDWL LIVING 1200 DETACHED 180 SQ FT Sq. Ft Floor Area: Valuation- $15000 APN Number.- 37524019.00 Occupancy Type: Issued by: FF"130 NO king Date: All roofs shall be inspected prior to any roofing material being installed. If roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZA"OUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 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 25505 33, and 25534. _�nOwner or authorize (,g t�,� Date CONSTRUCTION LEN-DING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I must I hereby affirm that there is a construction lending agency for the performance of _U_1.1�u I ; t, lu ; ions or this ermit shall be deemed revoked 1 work's for which this permit is issued (Sec. 3097, Civ C.) — comp Y W L So F , - F 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 rcprcsontatives of this city to enter upon the above mentioned property for inspection purposes. (Ale) 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 Lender's Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional_ DEMOLITION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 - buiIdina(a)cuperLino.org PROJECT ADDRESS /O-Z 0141cu Use ONLY", Pr ide Job Number from Bay Area Air Quality Management District ww-w.baaqrnd,or2 @ 415-749-4762. APN # 3-7:5 Z-4 OWNER NAME -K t WBEsS PH!10),2 '10 70 E-MAIL ku�,Kqltcow STREET ADDRESS vide a letter of inspection, tests, and abatement of any Hazardous Materials. Letter to be initiated by person(s) CITY, STATE, Z:-rl AAQ FAX CONTACT NAME Planning Dept clearance to verify building is not considered an historical landmark. Allow 10 business days. PHONE �ovide letter of clearance of all vermin from a licensed pest control contractor. STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT 1:1 ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT DESCRIPTION OF WORK RESIDENTIAL # DWELLLNG OFFICE iJSE ONLY I COMMERCIAL TYPE OF CONSTRUCTION # STORIES 0. q� AQMD JOB NUMBER i RECEIVED BY TOTAL VALUATI%.,,_ By my signature below, I certify to each of the following! I am the property owner or authorized agent t�ac n the perty owner behalf. I have read this it t �ono information I have provided is correct. h ff.�e Description of Work and verify it is ac orate. I agree to comply with all applicable o I application and the infoi I have app icab In a ordinances and state laws relating to building construction. I adth-orize AP resentatives of Cupertino to enter the above-identified pyoperty for inspection purposes. Signature of Applicant/Agent Date: "4- S— SUPPLEMENTAL INFO liMATION REQUIRED 4400RTO ISSUANCE OF DEMOLITION PERMIT' 0141cu Use ONLY", Pr ide Job Number from Bay Area Air Quality Management District ww-w.baaqrnd,or2 @ 415-749-4762. PLAN CHECK TYPE. Provide three copies (Residential) or six copies (Commerical) of a site plan showing protection for any trees 10" WBEsS lameter or more at 3' above grade, STAItDAAD Brovide, letter from PG&E (408-725-3325) stating all gas and electric has been disconnected. LARGE,, vide a letter of inspection, tests, and abatement of any Hazardous Materials. Letter to be initiated by person(s) MAJO R 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. �ovide letter of clearance of all vermin from a licensed pest control contractor. cant 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 NOTE, This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School hictrirf ot.- I Thava foc nro hnead nn tho nrolimi"nru hiMpmatin" availahip and arp milu an octimato 1-nntapt thi, Dont far addn 11 info_ FEE ITEMS ffiee Resolution .1.1-053 Eff 7111,'13 FEE QTY/FEE MISC ITEMS F"fel- 7-f'[ 7,7 7,-, supjvl 11C, 111'.,C Lj LJ NOTE, This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School hictrirf ot.- I Thava foc nro hnead nn tho nrolimi"nru hiMpmatin" availahip and arp milu an octimato 1-nntapt thi, Dont far addn 11 info_ FEE ITEMS ffiee Resolution .1.1-053 Eff 7111,'13 FEE QTY/FEE MISC ITEMS Plot -, , Chck 11"?e: supjvl 11C, 111'.,C Permit Fee: $574.00 Suppl. Insp. Fee.(F) Reg. 0 01' 0.0 hrs $0.00 ol'qs!;uc?110 F 11')% V,v"oll", Wi fow Permil'l Am,,a�wed PhVh"IiT7,iY Ft e",S, Strong Motion Fee: IMEISMICR $1.95 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS.- $576.95 $0.00 TOTAL FEET $576.95 Revised: 0211412015 ci Eil w n,. s �> f o t r Ln t- cu I — — — z ses { I r 4 E HS Q� W 0.t Y a