D-2019-0019 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:D-2019-0019
10400 S STELLING RD CUPERTINO,CA 95014-4227(359 13 037) OWNER BUILDER
OWNER'S NAME: Wu Yun J And Chin-yun DATE ISSUED:05/29/2019
OWNER'S PHONE:408-476-4628 - PHONE NO:
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class Lic.#
Contractor OWNER BUILDER 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. JOB DESCRIPTION:
I hereby affirm under penalty of perjury one of the following two declarations: DEMO EXISTING HOUSE(1800 SF),CARPORT(400 SF)
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.
Sq.Ft Floor Area: Valuation:$10000.00
APPLICANT CERTIFICATION
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 59 Number: Occupancy Type:
3
and state laws relating to building construction,and hereby authorize 359 13 037
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.
Signature Date 5-29-2019 Issued by:Kim Dunbar
Date:05/29/2019
OWNER-BUILDER DECLARATION
I hereby 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:5-29-2019
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 b the Ba Area Air '
Worker's Compensation laws of California. If,after making this certificate of Y Y Quality Management District I
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. L
Owner or authorized agent: f`
APPLICANT CERTIFICATION Date:5-29-2019 ki J V
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. 1 understand my plans shall be used as public records.
�r ..�; f Licensed
Signature t� Date 5-29-2019 Professional
DEMOLITION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING
DIVISION 10300 TOR.RE AVENUE • CUPERTINO,CA 95014-3255
(408)777-3228 * 777-3333 +building@cu]2ertino,.org U P E RT`1 ilii O -------�.____ -._,�
PERMIT#D
❑BUILDING/STRUCTURE 0 SWIMMING POOL/SPA
PROJECT ADDRESS - ...� APN# ....�..�..�...._..__ � _.._. ���no _ ...._...._.. �...__
0 k" d 67 4- -3
...........
OWNER NAME PHONE E-MAILya STREET ADDRESS CITY STATE ZIP
c A-
CONTRACTOR NAME OWNER-BUILDER COMPANY NA LICENSE NUMBER LICENSE TYPE,
STREET ADDRESS CITY,STATE, ZIP
02647 >t� M
E-MAIL PHONE BUS.LIC#
"o- 9030
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0 ARC TECT , OWNE40OWNERAGENT 0 CONTRACTOR AGENT OENGINEER0 DEVELOPER 0 TENA NT
CONTACT NAME E-MAIL
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION
1 K
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0 5
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❑SINGLE-FAMILY/DUPLEX ❑MULTI-FAMILY ❑INDUSTRIAL ❑COMMERCIAL USE* TYPE S .FT.
� VALUATION($)
SWIMMING POOL ATTACHED SPA DETACHED SPA
LANDSCAPE PURPOSE ONLY ❑STRUCTURE TO BE BUILT
No structural or floor stab support shall be built unless the pool shell is removed in its entirety.
Backfill must be certified by a licensed Geotechnical or Civil Engineer to verify backfill materials, REC D y TAL
soil type and compaction percentage of 90%maximum density prior to inspection. IND
yv .
#DWELLING UNITS ASB# OTHER:
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 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 building construction. I authorize representatives of Cupertino to enter the above-identified
property for inspection purposes. '
I acknowledge and authorize all information contained on this application form to be made available for public record.
Signature of Applicant/Agent: r ' t
�' Date. /,?-t)
NOTES:
DemoApp_2018.doc revised 04114118