B-2016-0421 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:D-2016-0421
18840 TILSON AVE CUPERTINO,CA 95014-3653(375 16 047) SILICON VALLEY
DEMOLITION INC
SAN JOSE,CA 95136
OWNER'S NAME: SATINI SANJEEV AND CHAWLA SEEMA TRUSTEE DATE ISSUED:12/13/2016
OWNER'S PHONE:408-242-2154 PHONE NO:(408)218-0993
LICENSED CONTRACTOR'S DECLARATION BUILDING PE T INFO:
License Class c-21 Lic.#970115
Contractor SILICON VALLEY DEMOLITION INC Date 08/31/2018 _BLDG —ELE T PLUMB
—
MECH X RES ENTIAL 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 DESCRIPTI N:
DEMOLISH SFD( 34)
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.
3irI 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:$10000.00
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 APN Number: Occupancy Type: _.--
and
and state laws relating to building construction,and hereby authorize 375 16 047
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 non-point
source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
ri
Signature_ / _ , Date 12/13/2016 Issued by:AbbyAyend e
/or— Date:12/13/2016
OWNER-BUIL I ER 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. 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)
2. I,as owner of the property,am exclusively contracting with licensed Signature of Applican:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:12/13/2016
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 Huth&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:12/13/2016
I certify that I have read this 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 tiis 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. I understand my plans shall be used as public records.
Licensed
Signature Date 12/13/2016 Professional
4^
i DEMOLITION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
s.ry 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERT N0 (408)777-3228•FAX(408)777-3333•buildinq(a�cupertino.orq
PROTECT ADDRESS (�
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OWNER NAME N PHONE E-MAIL r
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STREET ADDRESS CITY,STATE,ZIP FAX
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CONTACT NAME- 5k e p �^ �I o V e .PHONE E-MAIL
STREET ADDRESS—• ky o tit I'Y,STATE,ZIP FAX
❑ OWNER-BUILDER WNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT 0 AZCHITECT 0 ENGINEER 0 DEVELOPER 0 TENANT
CONTRACTOR Np_totiALmA LICENSE Nq7ohts LITYPE B
UMBER CENSE TUS.LIC#
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6 T I r00,Iet h-AMr► WAR_ SA TaTEZIP PHONE
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DEWORK
SCRIPTION N k ctsuivloit+tubi 5 k v►'11liszkite
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RESIDENTIAL #DWELLG OE'FI&USE ON 1� e
FLOOR AREA �IU INUNITS USE OCC TYPE SQ ET .,_a.. YJAE13ATION,
COMMERCIAL
FLOOR AREA
TYPE OF cONST UCT'ION #STORIES
AQMD JOB NUMBER - ,RECENT BY TQTAL VALUATION:
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act o th-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•ccurate. 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-iidentifi /property for inspection purposes.
Signature of Applicant/Agent: Date: 2 / 3//7
SUPPLEMENTAL INFORMATION REQUIRED PRIOR TO ISSUANCE OF DEMOLITI9 PERMIT 9 JCE1?s> 0NL
‘/Provide Job Number from Bay Area Air Quality Management District www.baaqmd.org @ 41.-749-4762. I'1:AN CHECK TYRE
Provide three copies of a site plan showing protection for any trees 10"in diameter or more at 'above grade. ❑ XPRss
0 STANDARD
Provide letter from PG&E(408-725-3325)stating all gas and electric has been disconnected.
0 LARGE
_Planning Dept clearance to verify building is not considered an historical landmark.Allow 10 I usiness days.
' / ❑ 1♦IAJOR
If 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 d ening"inspection.
Provide signed Debris Bin and Recyclable Materials form. .
Commercial Buildings Only: Provide Fire Dept clearance for fire suppression/alarm system -view.
DemoApp_2016.doc revised 03/29/16