B-2017-0008CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: D-2017-0008
18831 ARATA WAY CUPERTINO, CA 95014-3670 (375 12 032)
BAY HOME
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RENOVATIONS INC
SAN JOSE, CA 95123
OWNER'S NAME: DMJ HOME SOLUTIONS LLC ET AL
DATE ISSUED: 03/09/2017
OWNER'S PHONE: 510-364-7924
PHONE NO: (928) 848-8081
LICENSED ONT TOR' DECLARATION
BUILDING PERMIT INFO:
License Class a Lie. #1016029
Contractor BAY HOME RENOVATIONS INC Date 07/31/2018
—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 (E) SFD (990 S.F.)
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
performance of the work for which this permit is issued.
Ihave 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
Sq. Ft Floor Area:
Valuation: $10000.00
permit is issued.
APPLICANT CERTIFICATION
I' certify that I 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
375 12 032
375
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 said Ci inc sequence of the granting of this permit.
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally, the applicant u er rids and will comply with all non -point
source regulations per the p o Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signature mate 03/09/2017
Issue y:
¢
Date: 03/09/2017
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
REROOFS:
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 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)
z. 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: 03/09/2017
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.
2. i have and will maintain Worker's Compensation Insurance, as provided for by
HA?ARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter of the
Section 3700 of the Labor Code, for the performance of the work for which this
34.
25533, and ter 9.1 I will
California Health &Safety Code, Sections Municipal
maintain compliance with the Cupertino Municipal Code,. Chapter 9.12 and the
permit is issued.
Health & Safety Code, Section 25532(a) should I store or handle hazardous
s. 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 m any manner so as to become subject to the
air contaminants as defined by the Bay Area Air nail Management District I
Worker's Compensation laws of California. If, after making this certificate of
will maintain compliance with the Cupertino ip Code, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety Code, Sections 0 25 33, 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: 03/09/2017 1>.
CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is
I hereby affirm that there is a 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
ARCHITECT'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 03/09/2017
professional
DEMOLITION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 FAX (408) 777-3333 building(acupertino,org
. ZO 1 � - 0008
PROJECTADDRESS (9%31
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OWNERNAME
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STREET ADDRESS CITY, STATE, ZIP
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FAX
CONTACT NAME
PHONE
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STREET ADDRESS
CITY, STATE, ZIP
FAX
X OWNER ❑ OWNER—BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECTS ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
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LICENSE NUMBER
LICENSE TYPE
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BUS. LIC #
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COMPANY NAME E-MAIL
FAX
STREET ADDRESS CITY, STATE, ZIP
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PHONE
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DESCRII'TION OF WORK
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RESIDENTIAL /%j # DWELLING OFFICE USE ONLY
FLOORAREA �...-_ / UNITS i USE OCC, TYPE SQ. FT. VALUATION
COMMERCIAL
FLOOR AREA
TYPE OF CONSTRUCTION —
# STORIES
AQMD JOB NUMBER /� RE CE TOTAL VALUATION:
By my signature below, I certify to each of the following: I am the property owner or authopKed a wact on the property owner's behalf. I have read this
application and the information I have provided is correct. I have read the Description of and verify it is accurate. 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 -identified property for inspection purposes.
Signature of Applicant/Agent: Date: 3 —7 1
SUPPLEMENTAL INFORMATION REQUIRED PRIOR TO ISSUANCE OF DEMOLITION PERMIT
OFFICE USE ONLY
PLAN CI ECKTYPE
Provide Job Number from Bay Area Air Quality Management District www.bMmd.org @ 415-744-4762.
le Provide three copies of a site plan showing protection for any trees 10" in diameter or more at 3' above grade.
El
Provide letter from PG&E (408-725-3325) stating all gas and electric has been disconnected.
ElESS STATANDDARD
El
❑ TARGE
/Planning Dept clearance to verify building is not considered an historical landmark. Allow 10 business days.
El MAJOR
/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 dwelling' inspection.
/Provide signed Debris But and Recyclable Materials form.
Commercial Buildings Only: Provide Fire Dept clearance for fire suppression 1 alarm system review.
Demovipp_2016.doc revised 03129116
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