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D-2017-0010CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRESS: 20610 KIRWIN LN CUPERTINO, CA 95014-4303 (359 23 038) CONTRACTOR: JONATHAN WEI CHIN PERMIT NO: D-2017-0010 SU CUPERTINO, CA 95014 OWNER'S NAME: SU PHILIP AND CHEN MICHELLE MEI LIEN DATE ISSUED: 03/30/2017 OWNER'S PHONE: 510-585-8808 PHONE NO: (408) 255-8999 LICENSED CONTRACTOR'S DECLARATION ARATION BUILDING PERNUT INFO: License Class 5 Lic. #681633 Contractor JONATHAN W I CHIH SU Date 12/31/2017 —BLDG —ELECT,_ PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing — MECH X RESIDENTIAL — COMMERCIAL with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: I hereby affirm under penalty of perjury one of the following two declarations: DEMO (E) SFD (1158 S.F.) m. 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 l Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $6000.00 APPLICANT CERTMCATION 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 and state laws relating to building construction, and hereby authorize 359 23 038 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 this permit. Additionally, the applicant understands and will comply with all ll non -point WITHIN 180 DAYS OF PERMIT ISSUANCE OR source regulations per the Cupertino nieipal Code, Section 9.18. 180 DAYS 4N Signature_„%% Date 03/30/2017 Issued by: MELI J i OWNER -B iiLDER DECLA ATION Date: 03/30/2017 I hereby affirm that I am exempt from the Contractor's License Law for one of the RF ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is m. 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 Applicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 03/30/2017 I hereby affirm under penalty of perjury one of the following three declarations:ALL m. I have and will maintain a Certificate of Consent to self -insure for Worker's ROOF COVERINGS TO BE CLASS "A” OR BETTER 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 s. I certify that in the performance of the work for which this permit is issued, I Health & Safety Code, Section 25532(x) 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 Worker's Compensation laws of California. If, after making this certificate of 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 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:03/30/2017 I certify that I have read this application and state that the above information is v.� 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 this permit is issued (Sec. 3097, Civ C.) to enter upon the above mentioned property for inspection purposes. (We) agree Lenders 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. 1 understand my plans shall be used as public records. Signature Date 03/30/2017 Licensed Professional • DEMOLITION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(cDcupertino.org PROJECT ADDRESS_,, //w V OWNER NAME e V-N®r� PHONE ^ �� EMAIL a 1� eI jCTe STREET ADDRESS j y n /7 g� aorj( ��° u'�+l�� Lr1 CITY, STATE, ZIP ry� J yl a FAX CONTACT NAME � �Jj 1�: (� _fT a V V\ i% S"M(A ' /6 P mit f' 06 ' STREET ADDRESS/ 6 Q -ile r yl n CITY, STATE, ZIP ��11 FAX El OWNER ❑ OWNER -BUILDER ❑DOWNER AGENT t7 ONTRACTOR ❑ CONTRACTOR AGENT' ❑ ARCIRTECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTORNAME T1221 0 LIC SE 1 +j LICENS TYPE BUS.iiry- COMPANY NAME /� ry %T C'�� J u E -MAI 1 y�r1 ��;�� %" - / U l=. ~P L5�% CMO FAX i STREET ADDRESS eJ y n /J - CITY, STATE, ZIP /J�� r� PrHONE �w DESCRIPTION OF WORK RESIDENTIAL #)WELLING - OFFICE USE ONLY - - USE OCC. TYPE So, FI. - VALUATION FLOOR AREA UNITS COMMERCIAL FLOOR AREA TYPE OF CONST C�TION # STORIES f AQMD JOB NUMBER y VALUATION - By my signature below, I certify to each of the following: I am the property owner or authorized agent &c -ton the ope Ier's behalf. I have read this application and the information I have provided is c I have read the Description of Work and verify it is . agree to comply with all applicable local ordinances and state laws relating to buil ' -tion. I au epresentatives of Cupertino to enter th Ove -identified propertylfo�r inspection purposes. Signature of Applicant/Agent: SUPPLEME - AL INFORMATION REQUIRED PRIOR TO ISSUANCE OF DEMOLITION PERMIT OFFICE USE ONLY PLAN CHECK TYPE _ Provide Job Number from Bay Area Ai'r Quality Management District www.baagmd.org @ 415-749-4762. El _EXPRESS Provide three copies of a site plan showing protection for any trees 10" in diameter or more at 3' above grade. ❑ STANDARD. Provide letter from PG&E (408-725-3325) stating all gas and electric has been disconnected. ❑ LARGE 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. &V Provide signed Debris Bin and Recyclable Materials form. Commercial Buildings Only: Provide Fire Dept clearance for fire suppression / alarm system review. DemoApp_2016.doc revised 03129/1.6 21 71