D-2017-0062 CITY OF CUPERTINO BUILDING PERMIT
•
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:D-2017-0062
10190 CALVERT DR CUPERTINO,CA 95014-3806(375 19 018) F LUNA
CONSTRUCTION
SALINAS,CA 93915
OWNER'S NAME: KOMPELLA VACHASPATHI P AND JACINTHA DATE ISSUED: 10/11/2017
OWNER'S PHONE:408-777-8493 PHONE NO:(831)595-6590
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#538530
Contractor F LUNA CONSTRUCTION Date 08/31/2018 _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 ONE STORY SFD(814 S.F.);CARPORT(225 S.F.)
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
formance of the work for which this permit is issued.
•: . e 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:$3500.00
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 19 018
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 per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
nater Date 10/11/2017 Issued by:Abby Ayende
Date: 10/11/2017
OWNER-BUILDER DECLARATION
Thereby affirm that 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: 10/11/2017
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 have read 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,arid 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.i2 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. r authorized agent:
APPLICANT CERTIFICATION -Der oate:10/11/2017
I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction 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.
•
Signature Date 10/11/2017 LicenseProfessionald
•
•
1---
• D-Zoll• oc(►2
\ / DEMOLITION PERMIT APPLICATION
/' COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
,,t,,,f, 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINO (408)777-3228•FAX(408)777-3333•buildinq(a�cupertino.orq
PROJECT ADDRESS tO kc O � V�,,/,ty,N{/� Dir,
c _t APN# a�, tcl....013OWNER NAME v 1 PHONE '1 E-MAIL
VhtFFg ,?fTlt 1 koM1't LUQ PHONE/40'6111
� (�
STREET ADDRESS CITY, STATE,ZIP FAX
io _/�
ao C1)ERT bk. r C_uPelrF
f1 (---Ac
CONTACT NAM aii PHONE E-MAIL ` .1. %01M
STREET ADDRESS_ CITY,STATE,ZIP _ FAX
foS1J$ r 1-t0Kp V1&T7. /1/4-ve c f�ErSI f Nc,
❑OWNER 0 OWNER-BUILDER 0 OWNER AGENT t71 CONTRACTOR 0 CONTRACTOR AGENT 0 ARCHITECT 0 ENGINEER 0 DEVELOPER 0 TENANT
30C Or4 1,I E(Q. v I r LICEN U ER c� D LICE TYPE BUS.LIC#/�02
CO
CrL (/ U w C d it,
C V E-MAIL FAX
STREETRESS/% L o�( lCJ S 1 CITY,STATE,ZIP /� I/nq $• c;(9-6._1 ' (J7 - J gc-cc 9DESCRIPTION OF W ORK 1n n t1 _�o „ 314 L(),J ?0 f l_ 17�1 '� 7?VS
cat
RESIDENTIAL #DWELLING OFFICE USE ONLY ,
FLOOR AREA UNITS - USE OCC.. TYPE. SQ.Fr. VALUATION '
COMMERCIAL
FLOOR AREA ,
TYPE OF CONSTRUCTION #STORIES
•
AQMD JOB NUMBER RECEIVED BCUITI - TO VALUATION:
alltdAAIL
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on he prope 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 build•s onstruction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date: --/ j ---
SUPPLEMENTAL
SUPPLEMENTAL INFORMATION REQUIRED PRIOR TO ISSUANCE OF DEMOLITION PERMIT OFFICE USE ONLY
Provide Job Number from Bay Area Air Quality Management District www.baaqmd.org @ 415-749-4762. PLAN CHECK TYPE
_Provide three copies of a site plan showing protection for any trees 10"in diameter or more at 3'above grade. 0 EXPRESS
0 STANDARD
Provide letter from PG&E(408-725-3325)stating all gas and electric has been disconnected.
0 LARGE
gtanning Dept clearance to verify building is not considered an historical landmark.Allow 10 business days.
.0 MAJOR
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 dwelling"inspection. , •
/,0 Provide signed Debris Bin and Recyclable Materials form. •
Commercial Buildings Only: Provide Fire Dept clearance for fire suppression/alarm system review. 1,11
DemoApp_2016.doc revised 03/29/16