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D-2017-0056CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: D-2017-0056 10590 STERLING BLVD CUPERTINO, CA 95014-3834 (375 23 026) DIG & DEMO INC SAN RAMON, CA 94583 OWNER'S NAME: NIU CHENG YAND KUO Y OWNER'S PHONE: 408-463-6250 LICENSED CONTRACTOR'S DECLARATION License Class A. C21 Lic. #993947 Contractor DIG & DEMO INC Date 06/30/2018 hereby affirm that I am licensed under the provisions of Chapter 9 (commencing ith Section 7000) of Division 3 of the Business & Professions Code and that my cense is in full force and effect. 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 erflormance of the work for which this permit is issued. 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. 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 understaggs and will comply with all non -point source regulation4-per-t#Ze CupeA6 Municipal Code, Section 9.18. DATE ISSUED: 08/16/2017 PHONE NO: (925) 933-4448 PERMIT INFO: BLDG —ELECT —PLUMB MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: DEMO POOL (420 S.F.) USE FOR LANDSCAPE PURPOSES ONLY Sq. Ft Floor Area: I Valuation: $10500.00 APN Number: Occupancy Type: 375 23 026 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Date 8/1612017 Issued by: Jasmine Archbold Date: 08/16/2017 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: t. I, 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. s. 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. Date 8/16/2017 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: 8/16/2017 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS 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(a), 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, Se tion 5505, 2 , and 25534. Owne a thorized agent: CONSTRUCTION AGENCY 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 ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CUPERTINO DEMOLITI0N PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(cDcupertino.oro fl- 2_0 11 06 S"L PROTECT ADDRESS l 7AP r ,5 r 2- ^ O OWNERNAbEV\�i� V PHONE 163 - (,16(:>E 1 o`tA5 4,Wi. Cc7��1 STREET ADDRESS CITY, STATE, ZIP FAX �► 9 Sg� , . moi. A) c>>¢ CONTACT NAME ^ PHONE E-MAIL J d� STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER e ❑ OWNER -BUILDER ❑ OWNER AGENT A CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER9 g gLO � LICENSE TYPE BUS. LIC # \ 3 ,111 GZ �� COMPANY NAME D Dem E-MA�� FAXK G- 0[ Gx�O M STREET ADDRESS - L 1 6� * 3'0 CITY, STA ,ZIP �r �. (�(��Q � PHONE 413 � IMI _7 C/T A� A �T/ / (�U ZSR ! DESCRIPTION OF WORK ` ` POV I { -O `kiOti 1 on (` RESIDENTIAL # DWELLING FLOOR AREA UNITS COMMERCIAL • t5 FLOOR AREA«.. TYPE OF CONSTRUCTION #STORIES R ' " s ' 3 �d J��•s 3v u._i. x.., xdt :£X `�' ..+; �_.� t.�`.�..b ..moi R � 1.,.�,'i�X,� a��fi,Y n � ...E.s, k-+��'J:'" AQMD JOB NUMBER 3 HAr- TOTAL VALUATION: J #: �uo to By my signature below, I certify to each of the following: I am the property owner or airdforized 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 )ATork and verify it is accurate. I agree to comply with all ,applicable local ordinances and state laws relating to building constructio . 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 ' �� oi�ICE vsE onzY Provide Job Number from Bay Area Air Quality Management District wv 'Nv.baagmd.org @41 5-749-4762. PLA11 CIIECxiPE ,.,,, :. ❑ `EaPri>JSS '`�� t' �. Provide three copies of a site plan showing protection for any trees 10" in diameter or more at 3' above grade. � _ �3 L Provide letter from PG&E (408-725-3325) stating all gas and electric has been disconnected. Planning Dept clearance to verify building is not considered an historical landmark. Allow 10 business days. = � 0` ; 2 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 dwellinj' inspection. _ Provide signed Debris Bin and Recyclable Materials form. n Commercial Buildings Only: Provide Fire Dept clearance for fire suppression / alarm system review. , De71WADD 2016.dor rPvrced 03/29/76 SMOKE / CARBON MONOXIDE ALARMS10, (t.)9 OWNER CERTIFICATE OF COMPLIANCE rr �c,tps COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION CUPERTINO 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408)777-3333•buildinc a.cupertino.orq Permit No.D`0! 7-005 Address e / a _ #of Alarms Smoke: 1 Carbon Monoxide: PERMIT CANNOT BE FINALED AND COMPLETED UNTIL THIS CERTIFICATE HAS BEEN SIGNED AND RETURNED TO THE BUILDING DIVISION PURPOSE This affidavit is a self-certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2013 CRC Section R314,2013 CBC Sections 420.6 and 907.2.11.2 where no interior access for inspections are required. GENERAL INFORMATION Existing single-family and multi-family dwellings shall be provided with Smoke Alarms and Carbon Monoxide alarms. When the valuation of additions, alterations, or repairs to existing dwelling units exceeds $1000 00, CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or Carbon Monoxide Alarms be installed in the following locations: AREA SMOKE ALARM CO ALARM Outside of each separate sleeping area in the immediate vicinity of the X X bedroom(s) On every level of a dwelling unit including basements X X Within each sleeping room X Carbon Monoxide alarms are not required in dwellings which do not contain fuel-burning appliances and that do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal. Power Supply In dwelling units with no commercial power supply, alarm(s)may be solely battery operated. In existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do not result in the removal of wall and ceiling finishes or there is no access by means of attic,basement or crawl space. Refer to CRC Section R314 and CBC Sections 907.2.114 and 420.6.2. An electrical permit is required for alarms which must be connected to the building wiring. As owner of the above-referenced property,I hereby certify that the alarm(s)referenced above has/have been installed in accordance with the manufacturer's instructions and in compliance with the California Building and California Residential Codes. The alarms have been tested and are operational, as of the date signed below 1 have read and agree to comply with the terms and conditions of this statement Owner(or Owner Agent's)Name: itq I lam' Signature `- ?!: " Date. �" Contractor Name: Date. .? 1� Signature Lic.# Date. Smoke and CO form.doc revised 03/18/14