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D-2017-0060
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:D-2017-0060 18710 NEWSOM AVE CUPERTINO,CA 95014-3855(375 30 006) NILSENE BUILDER INC • CUPERTINO,CA 95014 OWNER'S NAME: LIANG QIBIN AND WEI LIU TRUSTEE DATE ISSUED: 10/06/2017 OWNER'S PHONE:408-406-3284 PHONE NO:(408)993-1229 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: ,License Class B Lic.#1019073 Contractor NILSENE BUILDER INC Date 10/31/2018 _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 SFD(1100 SF)GARAGE(102 SF) 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 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. Sq.Ft Floor Area: . Valuation:$7000.00 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 375 30 006 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 ap>'lica t understands and will comply with all non-point source regulations'.er e Cusertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signets: I l I, Date 10-6-2017 Issued by:Kim Dunbar I Y� Date: 10/06/2017 . ► '-B I I k'DE ' •TIS► I hereby affirm t I am exempt from the Contractor's License Law for one of the RE-ROOFS: following two reasons: All roofs shall be inspected prior to any roofing,material being installed.If a roof is 1. 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: 10-6-2017 I hereby affirm under penalty of perjury one of the following three 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's • 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 haveread 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 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 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 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 Cupertino Municipal Code,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code ect ons 25505,25533,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized a I I APPLICANT CERTIFICATION Date: 10-6-2017 IT r I certify that I have read this application and state that the above information is ►. LUll► E►D! A V correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a corruction 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 Lender's 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. I understand my plans shall be used as public records. • Licensed • Signature Date 10-6-2017 Professional //° DEMOLITION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION /.1 y(,• 9,t,1, 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 I (408)777-3228•FAX(408)777-3333•buildinaCc icupertino.orct CUPERTINO 1)--20 1 i'''— 0 b (i0 PROJECT ADDRESS a g 718: ye w Se v► v.e APN# 3i-S-1 _• 3D— D 0 OWNER NAME I Pio) tt(��/},s2�,�/i- NL STREET ADDRESS CITY,STATE,ZIP �/ (' r FAX '%G-..vsr, e _ / /t CONTACT NAME ^J� /� PHONE ) 6 e- q q2_�2 2�1 E-MAIL I I ' Sean e 1 n` f 6 w,ail, r IA- STREET ADDRESS f7 lc,6 NA e,y,,,e S tea.A ./J CITY,STATE,ZIPZI /1U �j + FAX UVJ l�� P r�Imo ye 8_542_ 46�S ❑OWNER 0 OWNER-BUILDER 0 OWNER AGENT I 'CONTRACTOR ❑CONTRACTOR AGENT 0 ARCHITECT 0 ENGINEER 0 DEVELOPER 0 TENANT CONTRACTOR NAME �,^A,c LICENSE VBI Q LICENS TYPE LICI 1V 1 l9 `1 ZLl{ --s COMPANY NAME/✓'i I S et, E-MAIL ,Pa t FAX y o s 5 Z.A,� u!> �U1 Pf I C v�I Sen1Aealvnat1q•Cc0-1 J STREET ADDRESS l:V�P S ,/ 7l CITY,STATE,ZIP PHONE �-ea� 6 C11 Pe(� t �►n 'me-Q(42;1 fel C 2=I 2 2 el DESCRIPTION OF WORK Demme 1aoc, e--)6s i 1.A6 ho pie:, RESIDENTIAL it DWELLING - `.I z ig' + FFCUS--n OtuL4iY tgv rn tg F�e t FLOOR AREA try©O UNITS "©O xssXS RW **ea TurPfoN} i "V��A1 ,..",+.1+1.„., COMMERCIAL ', S7 � fd nrOpal*"44414-* ¢4 1 y = > t�' lfY , l p n i4 �2 E FLOOR AREA 44 xNy 41ar ! ,,,,,4k,/,` ' ,v1zml - t - rv4 , i Y , fir F TYPE OF CONSTRUCTION #STORIES AsV`t' 4a}Iw}n s tnQroP fa 1. :02.1A ° 1 sM j $ , ' FxL e,w lt9 -1 . �0 `agy ^ ani itv e s . x ` uzs . AQMD JOB NUMBER ta � J ca ! � f ,, � TOTAL VALUATION: 'ti6'',4 a % # t3 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 hav pr vided 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 it 'ng 1 nstruction. I authorize representatives of Cupertino to enter the above-identified property,for inspection purposes. Signature of Applicant/Agent: Dater 10 — ti— 1 . SUPPLEMENTAL IN ATION REQUIRED PRIOR TO ISSUANCE OF DEMOLITION PERMIT ""'' }�`z41�'axi"5� F' ovide Job Number from Bay Area Air Quality Management District w�vw.baagmd.ort @ 415-749-4762. ,zzx"+ ' EC , 1 "a}` tieLLVAVORM{sic ' n a royide three copies of a site plan showing protection for any trees 10"in diameter or more at 3'above grade. ,„ rir� rs ¢ �' =t'}t rovide letter from PG&E(408-725-3325)stating all gas and electric has been disconnected. c ;# 4 ;' `�I,": VPlanning Dept clearance to verifybuildingis not considered an historical landmark.Allow 10 business days. � sx } r c �'` e, g1s ,F J' 4�Iw a�; rovide letter of clearance of all vermin from a licensed pest control contractor. lu° �„ , t Jy• VOM .,• Applicant p�licant shall call the Public Works Department at 408-777-3104 and schedule a"habitable dwelling' inspection J4 sak t + (WI/Provide signed Debris Bin and Recyclable Materials form. .te a #rev� �,V� %':4�r4 commercial Buildings Only Provide Fire Dept clearance for fire suppression/alarm system review. d rr E t DemoApp_2016.doc revised 03/29/16