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D-2017-0004CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: D-2017-0004 19031 BARNHART AVE CUPERTINO, CA 95014-3501 (375 09 034) M S CONSTRUCTION SAN JOSE, CA 95129 OWNER'S NAME: HUANG HONGm N AND KONG MEI OWNER'S PHONE: 408-426-5899 LICENSED CONIRACTOR'S DECLARATION License Class E Lie. #884933 Contractor M S CONSTRUCTION Date 09/30/2018 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 r performance of the work for which this permit is issued. 2) I have and will maintain Worker's Compensation Insurance, as provided for by n� 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. 1 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 i Municipal Code, Section 9.18. Signature Date 02/14/2017 OWNER-BUILDERDECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1. 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 (Sec.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). I hereby affirm under penalty of perjury one of the following three 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 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. 3. 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 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 Cupertino Municipal Code, Section 9.18. Signature Date 02/14/2017 DATE ISSUED: 02/14/2017 PHONE NO: (408) 230-5080 BUILDING PERMIT INFO: BLDG —ELECT _ PLUMB MECH X RESIDENTIAL _ COMMERCIAL DESCRIPTION: OVAL OF MAIN HOUSE AND CARPORT (1102 SF) Sq. Ft Floor Area: l Valuation: $7500.00 "N Number: Occupancy Type: 375 09 034 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. by: MELISSA NAMES 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: 02/14/2017 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HA.ZARC90115 MAT=RIALS 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(4) 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, 25533, and 25534. Owner or authorized agent: Gr - Date: 02/14/2017 CONSTRUCTION LENDING AGENCY I 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 ARCEEITECT'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 • buildin-g9cupertino.org r , 0v0 PROJEC AD RFS 31 Y t 11-v\e- APN# h� Oq, 03q OWNER NAME < 0a 0 +w N e� E-MAIL i , C I if 1'(% 1 plt Y _�/_. STREET ADDRESS► 1 eu-,, `moi f ve CITY, TATE, vv� FAX CONTACT NAME 14 p414) , 11 , o q q EMAIL STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER OWNERAGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACT� aUL/P LICDS LIE _ BUS. LIC # 3 0 COMPANY NAME -f jn® <7,1E-MAIL�� n FAX STREETADDRE oCITY, STATE Z PooS) z lam{ DES[[CRIPTION OFjWORK /� ,✓ RESIDENTIAL cls # DWELLING OFFICE USE ONLY - FLOOR AREA A UNITS USE OCC. . - TYPE SQ. FT. VALUATION i COMMERCIAL FLOOR AREA s� TYPE OF CONST' UCTION jl/) # STORIES v AQMD JOB NUMBER 7 J #: RECEIVED BY: TOTAL VALUATION: '•- By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the infonnation 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 co tr•I�ction. �authoriz representatives of Cupertino to enter the above -identified for inspection purposes. rproperty t Z"/ Signature of Applicant/Agent: Date: (1 V SUPPLEMENTALINFORMATION REQUIRED PRIOR TO ISSUADTCE OF DEMOLITION PERMIT OFFICE USE ONLY PLAN CHECK TYPE Provide Job Number from Bay Area Air Quality Management District wwxv.baagmd.org @ 415-749-4762. [I EXPRESS Provide three copies of a site plan showing protection for any trees 10" in diameter or more at 3' above grade. rovide letter from PG&E (408-725-3325) stating all gas and electric has been disconnected. ❑ "STANDARD ❑ LARGE V"Planning Dept clearance to verify building is not considered an historical landmark. Allow 10 business days. ❑ MAJOR Provide letter of clearance of all vermin from a licensed pest control contractor. Cp-plicant shall call the Public Works Department at 408-777-3104 and schedule a "habitable dwelling" inspection. t,!f_ Provide signed Debris Bin and Recyclable Materials form. Commercial Buildings Only: Provide Fire Dept clearance for fire suppression / alarm system review. Demo-4pp 2016.doc revised 03129116 CUPERTINO eemovt q-uilding Department PI&TYK 1 2ffr REVIEWED FORiGODE COMPLIANCE Reviewed 0: Y I IN33 C1 K q"4mjz&cn hd(y r-\(� 0 W MF--k- EGET F --k - MET �4 1 �081 PAk,,J Fthf-FAv-gAjv& Cukrl TAIci CA q�-o 1� 48k -8Q-sm 1 %b-3cc*G- of '00 01&+ "�) lzevave, 41p- coomb Po, b Paz- -Tb ids P,Vmve dfivt L -,-j AR*Tk,',ENT Tr - F C 0 MNl U �A I " C DIVISION RTINO APPROVED r1p 8A9A11i#PjT A viethe This set of plans and spPatications %',UST be kept at the f 1 1 1z Z !I , OFFICE COSY job site duringc-crst-iction. it is unlaw1ul to 111c,1 u a"y ken vp- cover4 P0 changes or alterations on sarne, or to deviate k- therelfrom, wizhopit approval from the Building Official. 00pjAq The. Stamping of this p'an aad-,Specifiic-a� SHALL NOT PEA10 L1 71 be held 'LO Lo Ee ate �jpi-5`al of the Violation +4,;,,ce or State Law. By DATE=— PEJ,�MIT #