D-2017-0045CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: D-2017-0045
20627 SUNRISE DR CUPERTINO, CA 95014-2928 (359 10 021)
TITAN GENERAL
CONSTRUCTION INC
FREMONT, CA 94539
OWNER'S NAME: CAO YAHONG
DATE ISSUED: 07/24/2017
OWNER'S PHONE: 408-707-9817
PHONE NO: (408) 883-8668
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class B Lic. #9488ti7
Contractor TITAN GENERAL CONSTRUCTION INC Date 06/30/2018
— 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 MAIN HOUSE ATTACHED GARAGE (1500 SF)
I hereby affirm under penalty of perjury one: of the following two declarations:
t. Lhave and will maintain a certificate of consent to self-insure for Worker's
Compensation, as piovided 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
Sq. Ft Floor Area:
Valuation: $18000.00
- 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
APN Number:
Occupancy Type:
and state laws relating to building construction, and hereby authorize
35910 021
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 p ino Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signatur Date 07/24/2017
Issued by: Kim Dunbar
Date: 07/24/2017
OWNER-BUILDER'DECLARATION
11 hereby af5rin'that Lam exempt from'the Contractor's License Law for one of the
I..
following o reason
tw
RE-ROOFS:,
All roofs shall be inspected prior to any roofing material being installed. If a roof is
t. I, as ownei 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.
'e
sale (Sec 704'4, Business'&Professions Code)
i z. 1, owner of the proper ty,'am'exclusively contracting with licensed
Signature of Applicant:
contractors to construct the',project(Sec.7044, Business & Professions Code).
,
Date: 07/24/2017
f
I hereby affirm,under penalty of perjury one of the following three declarations:
I have a a Certificate of Consent to self-insure for Worker's
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
r. nd'will'maiptain
Compensation,, as provided for by Section 3700 of the Labor Code, for the
of the woik-for which this permit is issued.
HAZARDOUSMATERIALS DISCLOSURE
performance
z. I have and will maintain Woik&'s Compensation Insurance, as provided for by
I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700of the Labor Code, fo'r the performance of the work for which this
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
permit is issued.
3. I certify that in the of the work for which this permit is issued, I
Health & Safety Code, Section 25532(a) should I store or handle hazardous
performance
I
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 Ar dityManagement District I
will maintain compliance with the Cuper o MunicipX Code, Chapter 9.12 and
exemption, -I' become subject to the Worker's Compensation provisions of the
the Health & Safety Code, IStOl"s 5505, 25 3, 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: 07/24/2017
I certify that I have read this application and state that the above information is
TI LE AGENCY
correct. I agree to comply with all city and county ordinances and state laws
I hereby affirm that there is, construction lending agency for the performance
relating to building construction, an'd.herebyauthorize 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
Lender's Name
to save indemnify and! keep. harmless the City of Cupertino against liabilities,
judgments, costs; andjexgenses 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.
Signature Date 07/24/2017
Si 9
licensed
Professional
DEMOLITION PERMIT APPLICATION
COMMUNITY DEVELOPMENT, DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPLRTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(a)-cuoertino.org
7D en tl e,
AQMD JOB NUMBER ..- TOT�
UATW.
�J #: 5CS RY<
�0
By my signature below, I certify to each of the following: I am the property owner or autliorized agent to act 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 Work and verify it 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:
/ SUPPLEMENTAL INFORMATION REQUIRED PRIOR TO ISSUANCE OF DEMOLITION PERMIT
�* OFFICE vsE oI,LY R
Provide Job Number from Bay Area Air Quality Management District v.,ww.baagmd.org @ 415-749-4762. z `P�aty CIIECKT]PE
ru=
�EAPRESSr r
RPM
✓Provide three copies of a site plan showing protection for any trees 10" in diameter or more at 3' above grade. ,
,/ (]°iSTANDARD t
V PIovide letter from PG&E (408-725-3325) stating all gas and electric has been disconnected. Mai,�
1 g Dept clearance to verify building is not considered an historical landmark. Allow 10 business days.
i�Provide letter of clearance of all vermin from a licensed pest control contractor.
U.1 Applicant shall call the Public Works Department at 408-777-3104 and schedule a "habitable dwelling" inspection.Y
Provide signed Debris Bin and Recyclable Materials form.h
Commercial Buildings Only: Provide Fire Dept clearance for fire suppression / alarm system review. T
DemoApp_2016.doc revised 03129/16
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AQMD JOB NUMBER ..- TOT�
UATW.
�J #: 5CS RY<
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By my signature below, I certify to each of the following: I am the property owner or autliorized agent to act 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 Work and verify it 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:
/ SUPPLEMENTAL INFORMATION REQUIRED PRIOR TO ISSUANCE OF DEMOLITION PERMIT
�* OFFICE vsE oI,LY R
Provide Job Number from Bay Area Air Quality Management District v.,ww.baagmd.org @ 415-749-4762. z `P�aty CIIECKT]PE
ru=
�EAPRESSr r
RPM
✓Provide three copies of a site plan showing protection for any trees 10" in diameter or more at 3' above grade. ,
,/ (]°iSTANDARD t
V PIovide letter from PG&E (408-725-3325) stating all gas and electric has been disconnected. Mai,�
1 g Dept clearance to verify building is not considered an historical landmark. Allow 10 business days.
i�Provide letter of clearance of all vermin from a licensed pest control contractor.
U.1 Applicant shall call the Public Works Department at 408-777-3104 and schedule a "habitable dwelling" inspection.Y
Provide signed Debris Bin and Recyclable Materials form.h
Commercial Buildings Only: Provide Fire Dept clearance for fire suppression / alarm system review. T
DemoApp_2016.doc revised 03129/16