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D-2018-0004CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMI'r NO: D-2018-0004 18700 NEWSOM AVE CUPERTINO, CA 95014-3855(37530005) NILSENE BUILDER OWNER'S NAME: LUI PAK KIN AND WONG JESSICA PUI-YEE TRUSTE OWNER'S PHONE: 408-499-6595 LICENSED CONTRACTOR'S DECLARATION License Class B Lic. #1019073 Contractor NILSENE BUILDER INC Date 10/31/2018 1 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. I hereby affirm under penalty of perjury one of the following two declarations: t. 1 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. APPLICANT CERTIFICATION certify that I have read this application and state that the above nformation is correct. I agree to comply with all city and county ordinances and stale laws relating to building construction, and hereby authorize epresentatives of this city to enter upon the above mentioned property for nspectlon purposes. (We) agree to save indemnify and keep harmless the :ity of Cupertino against liabilities, judgments, costs, and expenses which nay accrue against said City in consequence of the granting of this permit. ldditionally, the applicant understands and will comply with all non -point source regulatl s pJr the Cupertino Municipal Code, Section 9.18. Date 01110/2018 hereby affirm that I am exempt From the Contractor's License Law for ogle of the allowing hvo reasons: r. I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the soucture is not intended or offered for sale (Sec.7044, Business & Professions Code) 2. 1, as owner of the properly, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code), hereby affirm under penalty of perjury one of lite following three declarations: 1. 1 have and will maintain a Certificate of Consent to self -insure far 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. 1 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. a. 1 certify that in the performance of the work for which this pemiit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. if, after making this certificate of exemption, I became subject to the Worker's Compensation provisions of tile Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICAN'r ciewrIFICA'1'ION artily that I have read this application and state that the above information is rrecl. I agree to comply with all city and county ordinances and state laws ating to building construction, and hereby authorize representatives of this city enter upon the above mentioned property for Inspection purposes. (We) agree save indemnify and keep harmless the City of Cupertino against liabilities, Igmenls, costs, and expenses which may accrue against said City in nsequence of the granting of this permit. Additionally, the applicant understands d will comply with all non -point source regulations per the Cupertino Municipal ide. Section 9.18. Data 01/10/2018 IPERTINO, CA 95014 DATE ISSUED: 01/10/2018 PHONE NO: (405) 993-1229 JILDING PERMIT INFO: BLDG_ ELECT _ PLUMB MECH X RESIDENTIAL COMMERCIAL )B DESCRIPTION: ,MO - EXISTING STRUCTURES - (1100 SF) . Ft Floor Area: Valuation: $12000.00 'N Number: Occupancy Type: 5 30 005 PERMIT EXPIRES IF WORI{ IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Jasmine Archbold RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. Ira muffs Installed without first obtaining an inspection, I agree to remove all new materials for inspection. lure ofApplictnC 01/10/2018 HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous mile, lots requirements under Chapter 6.95 or tile California Health & Safety Cade, Sections 25505, 25533, and 25534. 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(1) should 1 store or handle hazardous material. Additionally, should 1 use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District 1 will maintain compliance with the nper[ino Municipal Cade, Chapter 9.12 and the Health & Safety Cod See to is 25505, 25533, and 25534. Owner or authorized agent: Date: 01/10/2018 T1 O E DING AGENCY I hereby affirm that there is a struction lending agency for the performance of work's for which this permit is issued (Sec, 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed CUPERTINO DEMOLITION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • 777-3333 • buildu2¢@cupertino.ore ❑BUILDING/STRUCTURE ❑ SWIMMING POOL/SPA Ic PERMIT #D 7-0 i 0 - ,O 0i7 PROJECT ADDRESS APN # )&'700 /dew %owl e OWNER NAME zeSSiCa kw&n PHONE 110,`'8- Nq G-rogq; E-MAIL pe'iPcenslne © rv,o„i.e STREETADDRESS CITY STATE ZIP 1 6 Xaa We wSe,M e CU PP✓�in a CONTRACTOR NAME ❑ OWNER -BUILDER COMPANY NAME LICENSE NUMBER LICENSE TYPE MaG Z4lili V001,00le 1 oQ04r ire 1000;ra 8 STREET ADDRESS CITY, STATE, ZIP 21080 Na"eOet�A (d V1. COpe(flne E-MAIL PHONE BUS. LIC # ri`Senrc Atvndjic4�e8-qq2-122a 14o;r;q []ARCHITECT ❑OWNER ❑OVdNERAGENT ❑CONTRACTOR AGENT ❑ENGINEER []DEVELOPER []TENANT CONTACT NAME E-MAIL Mo STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION n q SINGLE-FAMILY/DUPLEX ❑MULTI -FAMILY I7INDUSTRIAL ❑ COMMERCIAL USE TYPE SQ.FT. VALUATION ($) IJ SWIMMING POOL O ATTACHED SPA El DETACHED SPA x LANDSCAPE PURPOSE ONLY lJ STRUCTURE TO BE BUILTP u f y No structural orfloor slab support shall be built unless the pool shell is rennoved in its entirety. „ , - N D BY TO L Backfill mist be certified by licensed Geotechnical or Civil Engineer to verify backfill materials, soil type slid compaction percentage of 90% maxinnum density prior to inspection. QCtZQ #DWELLING UNITS I J# Sr—Lt0C>` OTHER: By my signature below I certify to eachof 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 have provided is correct. I have read the Description of Work mid verify it is accurate. I agree to comply with all applicable local ordinances and state lavas relating to building construction, I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. I acknowledge and authorize all infor, ati n coy tained on this application form to be made available for public record. / Signature of Applicant/Agent: Date: 1 NOTES: DemoApp_2017.doc revised 08114117