D-2016-0397I CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
21103 TAMARIND CT CUPERTINO, CA 95014-1638 (326 08 016)
OWNER'S NAME: PANDEYANAND KAND POONAM
OWNER'S PHONE: 408-718-1718
LICENSED CONTRACTOR'S DECLARATION
License Class B Lie. #681633
Contractor JONATHAN WEI CHIH SU Date 12/31/2017
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.
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
2Xperformance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance, as provided for by
<tf Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
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
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
may accrue against said City in consequence of the granting of this permit.
Additionally, the applicant understands and will comply with all non -point
source�regulations per the Cupertino;Wniclpal Code, Section 9.18.
Date 7/21/2016
I hereby affirm that I am exempt from the Contractor's License Law for one of the
CONTRACTOR: PERMIT NO: D-2016-0397
JONATHAN WEI CHIH
SU
CUPERTINO, CA 95014
DATE ISSUED: 07/21/2016
PHONE NO: (408) 255-8999
BUILDING PERMIT INFO:
—BLDG —ELECT _ PLUMB
_ MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
DEMO EXISTING HOME (2003 S.F.); ATTACHED GARAGE (440 S.F.)
Ft Floor Area: I Valuation: $8000.00
APN Number: Occupancy Type:
326 08 016
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
by: Abby yende
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: 7L21/2016
I hereby affirm under penalty of perjury one of the following three 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.
3. 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 Compensation laws of California. If, after making'tlus certificate of
exemption, I become subject to the Worker's Compensation provisions of the
Labor Code, I must forthwith comply with such provisionsorthis permit shall
be deemed revoked.
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 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 may accrue against said City in
consequence of the 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.
Signature Date 7/21/2016
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sections 5505, 255m—,2 and 25534.
Q,wner or authorized agent:
Date: 7/21/2016
CONS RUCTION LENDING AGENCY
I hereby affirm that there is a construction 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
DEMOLITION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333
Z-0 (P- 09RIT
PRO,1EcT-h,DDus--s 21103 Tamarind Court, Cupertino, CA 95014
APN 9 0\�
O"'NFRN"��`E- Anand & Poonarn Pandey PHONE 408-718-1718
E-114Au- anand.poonam.pandey@gmai
STREET ADDRESS 21103 Tamarind Court,
CITY. STATE, ZIP Cupertino, CA 95014 -FAX
CONTACT NAME Jonathan Su
PHONE
E�Nmu, supply168@yahoo.com
STREETADDRESS 10080 Stern Ave,
Crn', STATE , ZIP Cupertino, CA 95014
FAX
❑ OWNER ❑ OWNER -BUILDER 0 OWNERAGENT CONTRACTOR D CONTRACTOR AGENT 0 ARCHITECT 0 ENGINEER 0 DEVELOPER [I TENANT
CONTRACF01Z NAME Jonathan Su
I N'effd 3 3
FLlCrNSETIPE B
Bu --s. Lic # 27723
COMPANYMAME Homestead Construction, Inc.
...
E-MAIL supplyl68@yahoo.com
FAX
STREET -ADDRESS 10080 Stern Ave, Cupertino
CITY- STATE, ZIP Cupertino, CA 95014
PHONE 408-916-8559
DESCRIPTION OF NVORK New construction for single family house
usmENqiAL 1st floor 2426SF
5
FLOOR AREA + 2nd fl 1470 SF
COMMERCLAI
FLOOR AREA
$
'RA w
TYPE OF CONSTRUCTION rr STORMS
.... . . ..............
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JOB NMIDERTOTALVALUATION-
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By my signature below, I certify to each of the following; I am the property owner or authorized agent to act on the pr+nty owner's behalf. I , have read this
application and the information I have prwAded 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. l authorize represe -ativesofCupertino toenter tlid,, , thove-Mcntified property for inspection purposes.
Signature ofApplicant!Agent:.. Date:
SUPPLEMENTAL INF(k—MRTION REQUIRED PRIOR TO ISSUANCE OF DEMOLITION PERTv11T
VProvide Job Nuniber fi-om Bav Area Air Quality Management District -vvurw.baaqmd.org @ 415-749-4762.
Provide three copies ofa site plan showingprotection foranytrees 10" in diameter or more at Yabove
ARS
Im
grade.
V'Pro-6de letter from PG&E (408-725-3325) has been disconnected.
A
iffl
stating all gas and electric
Planning Dept building is
clearance to verify not considered an historical hutdinark. Allow 10 business days.
%,/Provide letter of clearance of all vermin from a licensed pest control contractor.
115�`
Applicant shall call the Public Works Department at 408-777-3104 and schedule a "habitable dwelling" inspection .
re E
VProvide signed Debris Bin and Recyclable Materials forin.
Commercial Buildings Only. Provide Fire Dept clearance for fire suppression alarm system review.
DemoApp.2016.doc revised 03129116
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