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B-2017-0047CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: D-2017-0047 10325 RICHWQOD DR CUPERTINO, CA 95014-3374 (369 08 051) MARCELO CONSTRUCTION SAN JOSE, CA 95111 OWNER'S NAME: SHEH EDGAR AND SHIRLEY TRUSTEE DATE ISSUED: 07/26/2017 OWNER'S PHONE: 408-206-0957 PHONE NO: (408) 826-7757 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INF ' License Class a Lic. #1 10 4082 Contractor MARCELO CONSTRUCTION Date 05/31/2018 _BLDG —ELECT — PLU MECH X RESIDENTIAL OMMERC 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 DESCRIPTIO DE O MAIN HOU (15 6 SF) - G GE 0 REMAIN 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 Worke s Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. •z.: ` I have and will maintain Worker's Compensation Insurance, as provide for by ' Section 3700 of the Labor Code, for the erformance of the work for wh h this Sq. t Floor Are Valuation: $18000.00 permit is issued. APP C_'T CER CATION I certify that I have read this application and stat that th ove APN N ber Occupancy Type: information is correct. I agree to comply with all ity and unty ordin ces and state laws relating to building construction, a d her y authorize 69 08 05 representatives of this city to enter upon the abo me t ned property f inspection purposes. (We) agree to save indemni y an ep harmless th City of Cupertino against liabiliti ' , judgments, co s,;an expenses which RMIT EXPIRES OT STARTED may accrue against said City in c sequence of th gran ng of this permit. WITHIN 180 DAYSSSUANCE OR XCALLEDP Additionally, the applicant unders ds and will co ly wi all non-point source regulations p r e e in o unicipal Cod , Sec on 9.18. 180 DAYS FROM LINSPECTION. Signature Date 2 /2 17 Issued by: Kim Dunbar Date: 07/26/2017 I hereby affirm that I am exempt from the Con ctor's Li ense Law for one of the RF ROOFS: All roofs shall a inspected prior to any roofing material being installed. If a roof is following two reasons: 1. I, as owner of the property, or my employe with w ges as their sole installed wi ut first obtaining an inspection, I agree to remove all new materials for compensation, will do the work, and the struc a is t intended or offered for inspection. sale (Sec.7044, Business & Professions Code) 2. I, as owner of the property, am exclusively contr ting with licensed Si tore of Applicant: contractors to construct the project (Sec.7044, Bus ess & Professions Code). te: 07/26/2017 I hereby affirm under penalty of perjury one of the following ee 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' Compensation, as provided for by Section 3700 of the Labor Code, for e performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE 2. I have and will maintain Worker's Compensation Insurance, as pro ded 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 wor or 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 performance of the work for which this permit is issued, I Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous shall not employ any person in any manner so as to become subject to the 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 Cupertin Muniei al Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Code, Sec ' s 2 25533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall i be deemed revoked. Owner or authorized agent: APPLICANT CERTIFICATION Date: 07/26/2017 N TR N 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 07/26/2017 Professional DEMOLITION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPERTiNC3 (408) 777-3228 • FAX (408) 777-3333 • buiidind(a)cupertino.org PR07ECTADDRESS® p ` APN# 3 � Cl � ®C OWNF.RNAME lJ� Yl 51PHONE/ oa) za`"® 15/ E 5 . ""s Ci l � U`t'1�i I aC iia STREET ADDRESS 6 f-.-% e , 1 CITY, STATE`, ZIP — e �, ® _ . _ FAX CONTACT NAME PHONE E-MAIL GeoMni oar �E® li ??_ 00 STREET ADDRESS CITY, STATE, ZIP FAX Z�3` v1a ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AG ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME � � �^ ° � E-MAIL ; � <� FAX STREET ADDRESS2A a Ct CPi Y, ST ZIP �) i PHONE 516 ISMGq i (� DESCRIPTION OF WORK RESIDENTIAL # DWELLING OFFICE USE ONLY ALA 0FLOORAREA T— COIRCIAL FLOOR AREA TYPE OF CONSTRUCTION # ORIES AQMD 70B NUMBER RB Y TO NMI) J #: � C1 By my signature below, I certify to e of the following: I am the property owner or authorized gent to act on the property owner's behalf. I have read this application and the information I ha e provided is corre t. I have readthe Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating o building cons on. _Ia*ogfze representatives of Cu ertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: 17-01-7 SUPPLEMENTINFORKTWN-9'EQ6RiD PRIOR TO ISSUANCE OF DEMOLITION PERMIT OFPT0I USE p DemoApp 2016.doc revised 03/2.9116 July 24, 2017 CITY OF CUPERTINO 10300 Torre Ave Cupertino, CA 95014 ADDRESS: 10325 RICHWOOD DR CUPERTINO 95129 REMOVAL OF GAS METER & REGULATOR (N: 7/19/2017 CUT GAS SERVICE AT THE STREET: 7/20%2(017 ELECTRIC SERVICE & METER WAS If you have any°question co Sincerely, Sherry Medrina Pacific Gas & El DeAnza Service r" 1 t,ric Company anning 10900 N Blaney Ave Cupertino, C 95014 OVER ON: 7/12/2017 s at (408) 725-3325 I 10900 No. Blaney Avenue Cupertino, CA 95014