D-2017-0068 e
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:D-2017-0068
10699 GASCOIGNE DR CUPERTINO,CA 95014-3845(375 31 017) Piyush Kothary
5669 La Seyne Place San
Jose,CA 95138
OWNER'S NAME. Piyush Kothary DATE ISSUED• 12/07/2017
OWNER'S PHONE.408-656-7643 PHONE NO:None
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO'
License Class Lic.#
Contractor Piyush Kothary Date _BLDG —ELECT —PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing —MECH X RESIDENTIAL—COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. j JOB DESCRIPTION
j DEMO EXISTING HOUSE(1249 SF);DEMO GARAGE(297 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.
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. 1Sq.Ft Floor Area. Valuation.$15000.00
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 31 017
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 Cityn in stands andce of the hg this 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
Signature I Date 12/7/2017 Issued by'Jasmine Archbold
Date: 12/07/2017
. WNER~BUILDER DECLARATION
I hereby affirm that I am exempt froth the Contractor's License Law for one of the RE-ROOFS:
following two reasons: I 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)
O
I,as owner of the property,air exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:12/7/2017
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,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 subjectiito the Worker's Compensation provisions of the the Health&Safety Code,Sections 25505,25533,and 25534.
Labor Code,I must forthwith coniply with such provisions or this permit shall
be deemed revoked. / —
Owner-or authorized agent:
APPLICANT CERTIFICATION Date: 12/7/2017
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 l 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 harmlesis 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 .4� Date 12/7/2017 Licensed
Professional
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j\j/I
MOLITION PERMIT APPLICATIONCOMMUNITYDEVELOPMENTDEPA°RTMENT•BUILDNG D'I ISION
90300 TORRE AVENUE CUPEF TING,GA 95094-3255
(404 77T-3228•FAX`('408)777-3333•building curiertino.orq
PROJECT ADDRESS APN#
10699 Gascoigne Drive,Cupertino 37 S —• -1. — o l ''— 1'
OWNER NAME Punit Minocha and riyush Kothary PHONE 408-656-7643 E-MAIL kothary@yahoo.com
STREEY-ADI)REss 5669_La_Seyne.Place _ -:` CITY' STATE;zI _San.Jose,.CA-95138_ FAX
CONTACT NAME
Piyush Kothary PHONE E-MAIL kothary@yahoo,com
STREET ADDRESS CITY,STATE, ZIP FAX
5669 La Seyne Place San Jose, CA 95138
LT OWNER. 0 OWNER-BUILDER ❑ OWNER AGENT 0 CONTRACTOR 0 CONTRACTOR AGENT 0 ARCHITECT 0 ENGINEER 0 DEVELOPER 0 TENANT
COACTf383NAaftE `RceT'C
Y�opl{ L N t' fihCENSE TYTE FIs.plc
984437 i 4,%628
COMPANY NAME E-MAIL
Rebuild Green rebuildgreen@gmail.com FAX 650-644-0196
STREET ADDRESS CITY,STATE,ZIP PH
2625 Middlefield Rd, Unit 106 Palo Alto, CA 94306 ON 6%0-720-1301
DESCRIPTION OF WORK I i
c if ,� igasx ,� 6 aL Q q°1 .14:1
I or
CI ct Ck_ __ r 2 917 cti
"RESIDENTIAI y,,p WSL-L-ING17 OFFICE USE ONT Y
FLOOR AREA >� C / UN
USE - OCC, 'TYPE 'SQ FT VALUATION
COMMERCIAL/
FLOOR AREA
-TYPE OF CONSTRUCTION #STORIES
AQMD JOB NUMBERRE BY: A0 TOALUATION-
J i' Z .1
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.ehalf. 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 bul,1di ng-construction..,I authorize representatives of Cupertino to enter the-above-identified property for inspection pz oscs:
Signature-ofApplicant/Agent: <''''----7.:..---.'''---'-'—"--
^- -0 `'Z/ !//°
�^ z Date:
SUPPLEMENTAL INFORMATION REQUIRED PRIOR TO ISSUANCE OF DEMOLITION PERMIT `°FFreiv USE ONLY
Provide Job Number from Bay Area Air Quality Management District www.baagmd.org @ 415-749-4762. ?IAN CUECKTYPE'
Provide three copies of a site plan showingprotection for anytrees 10"in diameter or more at 3'above Exexss
P� p grade. _
I ❑ sTANnalar
V Provideletter from-PCs&E_(408-725-3325)..stating_aligas_and electric)as_been-disconnected.
❑ LARGE
Planning Dept clearance to verify building is not considered an historical landmark.Allow 10 business days.
-Provide letter of clearance of all vermin from 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.
Commercial Buildings Only: Provide Fire Dept clearance for fire suppression/alarm system review.
DemoApp,2016.doc revised 03/29/16
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