13060069CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10181 EMPIRE AVE
CONTRACTOR: DIANLI CHEN
PERMIT NO: 13060069
OWNER'S NAME: DIANLI CHEN
101$ I EMPIRE AVE
DATE ISSUED: 06/10/2013
OWNER'S PHONE: 4088882898
CUPERTINO, CA 95014 PHONE NO:
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIALE] .
13 LICENSED CONTRACTOR'S DECLARATION
�" 6!<
DEMO (E) 960 S.F. SFD TO PREPARE FOR (N)
License Class__ Lic. #
CONSTRUCTION
JJ
Contractor 1�ic;ta..V C` e1A 6Q Sjbcs&te l
I hereby affirm that I am licensed under the provisions f 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:
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
Valuation: $7000
performance of the work for which this permit is issued.
Sq. Ft Floor Area:
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
APN Number: 32624049.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
PERMIT EXPIRES IF WORK IS NOT STARTED
correct. Iagree to comply with all city and county ordinances and state laws relating
WITHIN 180 DAYS Of PERMIT ISSUANCE OR
to building construction, and hereby authorize representatives of this city to enter
190 -DAYS FROM LAST-CALLEDINSPECTION.
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 may accrue against said City in consequence of the
_
Issfied -- Date: i
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Date -13
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
Signature
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
❑ OWNER -BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
the following two reasons:
I, as owner of the property, or my employees with wages as their sole compensation,
do the work, and the structure is not intended or offered for sale (Sec.7044,
will
Business & Professions Code)
property, rty, am exclusively contracting with licensed contractors to
I, as owner of the roe y g
HAZARDOUS MATERIALS DISCLOSURE
construct the project (Sec.7044, Business & Professions Code).
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
I hereby affirm under penalty of perjury one of the following three
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Code, Section 25532(x) should I store or handle hazardous
declarations:
I have and will maintain a Certificate of Consent to self -insure for Worker's
Health & Safety
material. Additionally, should I use equipment or devices which emit hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the
air contaminants as defined by the Bay Area Air Quality Management District I
ill compliance with the Cupertino Municipal Code, Chapter 9.12 and
performance of the work for which this permit is issued.
wmaintain
the Health & Safety Code, Sections 25505, 25533, and 25534.
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
Owner or authorized agent: Date:
permit is issued.
I certify that in the performance of the work for which this permit is issued, I shall
not employ any person in any manner so as to become subject to the Worker's
CONSTRUCTION LENDING AGENCY
Compensation laws of California. If, after making this certificate of exemption, I
I hereby affirm that there is a construction lending agency for the performance of
become subject to the Worker's Compensation provisions of the Labor Code, I must
work's for which this permit is issued (Sec. 3097, Civ C.)
forthwith comply with such provisions or this permit shall be deemed revoked.
p y p p
Lender's Name
APPLICANT CERTIFICATION
Lender's Address
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 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
ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
I understand my plans shall be used as public records.
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
Licensed Professional
9.18.
Signature Date
CITY OF CUPERTINO
�'VU F cT1M e'rnR _ RTITT .T)TN(T T)TVISION
FEE ID FLR AREA
s.f.
1DEMORES 960
Xtech. Plan C'hec.tc
Plumb. Plan Check
Elec, Plan Check
xtech. Permit Fee:
10181 EMPIRE AVE
DATE: 06/10/2013
REVIEWED BY: MELISSA
liaADDRESS:
APN: 326 24 049
BP#: i ' ��(��
*VALUATION: 1$7,000
*PERMIT TYPE: Demolition Permit
PL,4N CHECK T)'PE:
PRIMARY
SFD or Duplex
rr-... o,.... V- ,. Il infx of .Q,1-1
PENTAMATION 1 SFDWL-DEM
PERMIT TYPE:
USE:
hrs
$0.00
WORK
DEMO E 960 S.F. SFD TO PREPARE FOR N CONSTRUCTION
Plund).4feclUElec Perodt Fee:
SCOPE
FEE ID FLR AREA
s.f.
1DEMORES 960
NOTE: This estintate does not include fees due to other Departments (i.e. rtanning, runic rr urns, 11ne, .ru....... y .1 rr 1. .......,
_. . __. __ __ ___....c ... .: .. --H-hl. —d — nr.1u n.. octi..rnto_ Contort the Dent for addil'l into.
etc. . mese Lees are nas•ea un me r—
District m
FEE ITEMS (Fee Resolution 11-053 E . 7f /f 1112)
Xtech. Plan C'hec.tc
Plumb. Plan Check
Elec, Plan Check
xtech. Permit Fee:
Mind). Permit Fee:
Dec. Permit Fee:
Other rllech, hasp.
0/her Plhnnb Insp,
Otlter Glee. Lisp.
illech. Insp. Fee:
Phnnb. Tulp. Fee:
Dec. Imp. Fee:
Permit Fee:
rr-... o,.... V- ,. Il infx of .Q,1-1
NOTE: This estintate does not include fees due to other Departments (i.e. rtanning, runic rr urns, 11ne, .ru....... y .1 rr 1. .......,
_. . __. __ __ ___....c ... .: .. --H-hl. —d — nr.1u n.. octi..rnto_ Contort the Dent for addil'l into.
etc. . mese Lees are nas•ea un me r—
District m
FEE ITEMS (Fee Resolution 11-053 E . 7f /f 1112)
... y........ 1. ur......
FEE
. •«••• ••.
QTY/FEE
___________
MISC ITEMS
Plan Check Fee:
A
Suppl. PC Fee
Phonh.i111ecklElec
Permit Fee:
$534.00
Suppl. Insp. Fee:') Reg. Q OT
0,0
hrs
$0.00
P1umb./111ech./E1ec
Plund).4feclUElec Perodt Fee:
Constt•uction T cis:
Aduniiiisowlive Fee:
Work. Without Permit/
Advunced Plcrinting Fees:
Ti-4-wel Docionentolion Fees:
Strong Motion Fee: IBSEISMICR
$0.70
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$535.70
$0.00 TOTAL FEE: "
$535.70
Revised: 04/29/2013
a
10900 Po. Blaney Avenue
611per6flo, GA 95014
City of Cupertino
10300 Toffe Avenue
Cupertino, Ca. 95014
To Whorn It May Concern:
The gas and electric facilities have been renioved and. / or abann.aned at:
b�� l l: niVe� on 6 6 !3
If you have any further questions, Tease contact me at (408)725-3325
Sincerely,
v -AV
Service PlaDming