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D-2016-0367 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:D-2016-0367 10101 N DE ANZA BLVD CUPERTINO,CA 95014(326 34 071) PRINCIPAL BUILDERS INC SAN FRANCISCO,CA 94103 OWNER'S NAME: WATERDRAGON 289 LLC DATE ISSUED:03/14/2016 1 OWNER'S PHONE: PHONE NO:(415)297-0327 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO' License Class& Lic.#829808BLDG _ELECT PLUMB Contractor PRINCIPAL BUILDERS INC Date 12/31/2017 —MECH_RESIDENTIAL X 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: 1 REMOVAL OF 3 AC UNITS AND MECHANICAL SURROUND ALL i hereby affirm under penalty of perjury one of the following two declarations: NON-STRUCTURAL. 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. 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. Sq.Ft Floor Area:455 Valuation:150000.00 APPLICANT CERTIFICATION I certify that I have read this application and state that the above APN Number Occupancy Type: information is correct.I agree to comply with all city and county ordinances 326 34 071 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 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 i TION. source regulations per the Cupertino Municipal Coda,Section 9.18. 180 DAYS FROM LAST C ED N ! Signature __-r� fir+' Date 03/14/2016 Issued by'ALEX VALLEL UNGA f, 1111.1."'----- Date:03/14/2016 OWNER-BUiLDER DF.CLARATION II.hereby affirm that Fant 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, 1,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 inspection. compensation,will do the work,and die 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 Signature of Applicant: contractors to construct the project(See.7044,Business&Professions Coda). Date:03/14/2016 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 andwill maintain a Certificate of Consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the HAZARDOUS MATERIALS DISCLOSURE performance of'the work for which this permit is issued. 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 Coda,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. I will mahttain compliance with the Cupertino Municipal Code,Chapter 9.12 and the permit is issued. Health&Safety Code,Section 25532(a)should i store or handle hazardous s. I certify that in the performance of the work for which this permit is issued,l material,Additionally,should I use equipment or devices which emit hazardous shall not employ any person in any manner so as to become subject to the 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. Owner or authorized agent: l APPLICANT CERTIFICATION Date:03/14/2016 CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance correct.I agree to comply with all city and county ordinances and state laws of work's for which chis permit is issued(Sec.3097,Civ C.) relating to building construction,and hereby authorize representatives of this city Lender's Name to enter-upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities, lender's Address judgments,costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands ARCHITECT'S DECLARATION and will comply with ail non-point source regulations per the Cupertino Municipal I understand my plans shall be used as public records. Code,Section 9.18, Licensed Signature Date 03/14/2016 professional \\ 1 / DEMOLITION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION /,yt,,9s\ 10300 TORRE AVENUE•CUPERTINO,CA 96014-3255 CUPERTINO (408)777-3228•FAX(408)777-3333•build incnaicupertino.arq ... - `/UlLe O aLel PROJECT ADDRESS t a` F N.. (1_ R n Q t U`i A I APN# / i,(f 0 ! OWNER NAME...44, t )J� j �j {Jt PHONE l l 1E-MAIL er 1 STREET A•rRE.' .33 Jail Ca r. PW tl 1 a* CITY STATEof,fv 150 FAX CONTAC�]AM�E l PHONE E-MAIL l I 1L n e-1 dg Ii.- 512"5L 24 LGL».1os¢yiI. l94re-A i i�,rv.Caowl STREET ESS CITY„STATE, FAX 226 4 Cmip+ it- IS ,T'rv,-*;,. r['yi. Z OWNER 0 OWNER BUILDER 0 OWNER AGENT 0 CONTRACTOR' ❑CONTRACTOR AGENT 0 ARCHITECT ❑ENGINEER 0 DEVELOPER ETENANT - LICENS NIM91LICENST E BUS,LIC# 275 L vrOw-3i Sultdp _ T✓tC CO PAY NAME ,r E-MAIL _. ((ff FAX e...&NAME„,-,, <ena Yrinalpetl614i erK, C-bY4 STREET ADDRESS CIT TATE Z PHONE �� KiVtY S sof - 941°3 116294- 032_4 DESCRIPTION OF WORK Y� l/ / C ( I i 611,14A k^e r [ n=G,WIv ""'� �� J � V � Ch. � F'�C,�" l 7 Surfovv.,( crAk A 4 t)Y1' 93-0C Ura ` j RESIDENTIAL A #DWELLING I OFFICE USE ONLY FLOOR AREAbLi UNITS USE 0CC. TYPE , iSO,FT. VALUATION COMMERCIAL 5 v FLOOR AREA TYPE OF CONSTRUCTIQINt 1. #STORIES AQMD JOB NUMBER `L RECEIVED BY: (�4 I I TOTAL VALUATION: Bymysignature below,I certifyto each of the following: I era the property owner or authorized agent o aeon the r•perty owner .- al£ I have read this application and the information I have providedis 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 construction. I authorize representatives of Cupertino to enter the above-identified property 16operty for inspection purposes. Signature of Applicant/Agent: =� . .� __ ! Date: , / j f SUPPLEMENTAL INFORMA ION REQUIR`°"r 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(Residential)or six copies(Commerical)of a site plan showing protection for any trees 10" © EXPRESS in diameter or more at 3'above grade. 0 STANDARD 0 LARGE Provide letter from PG&E(408-725-3325)stating all gas and electric has been disconnected, 0 MAJOR _Provide a letter of inspection,tests,and abatement of any Hazardous Materials.Letter to be initiated by person(s) certified in asbestos,mercury and/or hazardous material examination. PIanning 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, Applicant shall call the Public Works Department at 408-777-3104 and schedule a"habitable dwelling"inspection. Provide signed Debris Bin and Recyclable Materials form. De,noApp_2013.doc revised 02/13/13