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D-2017-0061 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:D-2017-0061 18655 LOREE AVE CUPERTINO,CA 95014-3837(375 19 008) F LUNA CONSTRUCTION SALINAS,CA 93915 OWNER'S NAME: LIANG WAN HAR CINDY TRUSTEE DATE ISSUED: 10/11/2017• OWNER'S PHONE:408-887-5437 PHONE NO:(831)595-6590 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class J3 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(897 S.F.);GARAGE(264 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 .performance of the work for which this permit is issued. . 4.s•ve 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 19 008 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. Date 10/11/2017 Issued by:AbbyAyende - Date: 10/11/2017 OWNER-BUILDER DECLARATION I hereby affirm that I ant 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 firstobtaining 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 t. 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 z. 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,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,Sections 25505,25533,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. �O ,or authorized agent: APPLICANT CERTIFICATION °° a[3`te: 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 1 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 ' Licensed Professional r0et0n-- 0SI \e,/DEMOLITION PERMIT APPLICATION in,,,, COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION „5-c,,9ss 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228•FAX(408)777-3333•buildinqcupertino.org PROJECT ADDRESS IZ(.0 z,/€ �‘, ... APN# 315om,"1il1��y Q OWNER NAME t � W - 1-) PHONE Lilt_�y��+-gyL STREET ADDRF�Svg`�5 LEI g`r � CITY, STATE,ZIP e_ti?Et f r , LA FAX CONTACT NAME ey ,1 M1L-G. PHONE /f 0-3-'61t nr`u d7o E-MAIL STREET ADDRESS (A V, CITY,STATE,ZIP `J VC a! hUV FAX ❑OWNER 0 OWNER-BUILDER ❑ OWNER AGENT 0 CONTRACTOR 0 CONTRACTOR AGENT 0 ARCHITECT 0 ENGINEER 0 DEVELOPER 0 TENANT CO R j3AME k v I LICENSE NUMB `a LICF E TYPE BUS.LIC 2 . o 3 j Pp C ANY r V liv r. O /� E-MAIL c FAX (4r1xf i i E D SS CITY,STATE,ZIP ^ PI ` I t 4Lc rA c. fi 544 C,�fr/e- s cAL 7-c/ 52$-(c? o DESCRIPTION OF WORK D S o 4/ei°C RESIDENTIAL #DWELLING OFFICE USE,ONLY i FLOOR AREA UNITS USE , OCC. TYPE - SQ.Fr. VALUATION: - COMMERCIAL FLOOR AREA _ - - TYPE OF CONSTRUCTION #STORIES , AQMD JOB NUMBER J rt: S E a RECEIVED BY: ad "f�T.. VA N: • By my signature below,I certify to each of the following: I am the property owner or authorized agent toact on the pro erArtyy1('/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 bui•'.: -::struction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent. �`, _ Date:G p-4 l..-. !7 SUPPLEMENTAL INFORMATION REQUIRED PRIOR TO ISSUANCE OF DEMOLITION PERMIT , , OFFICE USE ONLY I Provide Job Number from Bay Area Air Quality Management District www.baaqmd.org @ 415-749-4762. PLAN CHECK TYPE} EXPRESS Provide three copies of a site plan showing protection for any trees 10"in diameter or more at 3'above grade. . ; ❑ STANDARD. \/ Provide letter from PG&E(408-725-3325)stating all gas and electric has been disconnected. 0 LARGE anning Dept clearance to verify building is not considered an historical landmark.Allow 10 business days. ❑ MAJOR Provide letter of clearance of all vermin from a licensed pest control contractor. A( plicant shall call the Public Works Department at 408-777-3104 and schedule a"habitable dwelling"inspection. Provide signed Debris Bin and Recyclable Materials form. _ Commercial Buildings Only: Provide Fire Dept clearance for fire suppression/alarm system review. ' DemoApp_2016.doc revised 03/29/16