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D-2017-0057CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 940 PROVIDENCE CT CUPERTINO, CA 95014-4028 (356 11 057) OWNER'SNAME: TSUCHIDA THEODORE HAND CYNTHIA BUYCO OWNER'S PHONE: 650-636-5044 LICENSED CONTRACTOR'S DECLARATION License Class C-27 Lic. #fib 5 Contractor FOUR SEASONS GARDENING Date 10/31/2018 I hereby affirm that I am licensed under the provisions of Chapter (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: 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 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 sof 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. Signat A Date 08-23-2017 OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following, two reasons: m. '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) z. . 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 whieh 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. �3. 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 ` /1( Worker's Compensation laws of California. If, after making this certificate of d'\�N 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. - L__� —/ ate 08-23-2017 CONTRACTOR: PERMIT NO: D-2017-0057 FOUR SEASONS GARDENING SAN JOSE, CA 95124 DATE ISSUED: 08/23/2017 PHONE NO: (408) 426-1131 BUILDING PERMIT INFO: BLDG —ELECT —PLUMB _ MECH JX RESIDENTIAL' COMMERCIAL JOB DESCRIPTION: DEMO POOL (836 S. F.) - USE FOR LANDSCAPE PURPOSES ONLY Sq. Ft Floor Area: Valuation: $10500.00 APN Number: Occupancy Type: 35611 057 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Jasmine Archbold Date: 08/23/2017 RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without fust obtaining an inspection, I agree to remove all new materials for inspection. Signature ofAppl. Date: 08-23-2017 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, Sections 25505, 25533, and 25534. s, Owner or authorized aged Date: 08-23-2017 CON A TIO LENDING AGENCY I 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 CUPERTINO DEMOLITION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building aaDcupertino.org _nk-1 , dC) PROJECT ADDRESS -pr APN # 02 vU I � �G � OWNERNAME Ts� PHONE �sz rej G s� STREET ADDRESS fly CITY, STATE, ZIP FAX Pro cul m4d�_ — CONTACT NAME PHONE i ^� �%Z E �-v' .SC ld f �/ r on STREET ADDRESS / CITY, STATE, ZIP FAX 2 C kS f n. 111 �- ❑ OWNER i - ❑ OWNER -BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME'&, LICENSE NUMB LICENSE TYPE BUS. LIC 9 s ` COMPANY NAME E-MAIL FAX STREET ADDRE S1 } 1 _ Z S/ CITY, STATE, ZIP _ t PHONE -/" h.J �%G1 GS v /i✓l U �� 1 L" Vbf� DESCRIPTION OF WORK yl k3 RESIDENTIAL #DWELLING _M_` . ,�;37SE .., 0�,4;,,� . ,OCC��; , T,YPE� , _ .,wSQ. �` _x • _ „!!AY,iTr1TI0N „n.r„= FLOOR AREA UNITS COMMERCIAL x3 :y �y, { xRx•x gq4 Ga s t \,3�,.b�_.:,,.�.,,,,4 FLOOR AREAa __[n x tP TYPE OF CONSTRUCTION STORIESa4 F ` y�r ° 4' KI} �y � z \ 'yam arty.._...: 'Z. a ,' AQMD JOB NUMBER 'a TOTAL VALUATION: N a By my signature below, I certify to each of the following: I am the property owner or authorized 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 is accurate. I agree to comply with all applicable local ordinances and state laws relating to building constru 'on. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date:—!?- ate: -SUPPLEMENTAL SUPPLEMENTALINTFORMAT N REQUIRED PRIOR TO ISSUANCE OF DEMOLITION PERMIT , oFrTCE vsE ot,L� Provide Job Number from Bay Area Air Quality Management District www.baaamd.org 9415-749-4762.cxEc�"�a�F��y„ � j EaPliEss �� `" fltx Provide three copies of a site plan showing protection for any trees 10" in diameter or more at 3' above grade. \ _ l] STANDARD 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. Provide letter of clearance of all vermin from a licensed pest control contractor. `; t Applicant shall call the Public Works Department at 408-777-3104 and schedule a "habitable dwelling" inspection.£ _ k — Provide signed Debris Bin and Recyclable Materials form. s Commercial Buildings Only: Provide Fire Dept clearance for fire suppression / alarm system review. DemoApv 2016.doc revised 03/29/16