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D-2016-0382CITY OF CUPERTINO BUILDING PERMIT RUILDINGADDRESS: CONTRACTOR: PERMITNO; D -20I6-0382 21891 LO1vIITAAVE CUPERTINO, CA 95014-2829 (357 16 075) ALI'S CONSTRUCTION & REMODELING INC SAN JOSE, CA 95129 OWNER'S NAME: KU3LA KAUSHIK AND MONDALDIPANWITA DATE ISSUED: 05/20/2016 OWNER'S PHONE: PHONE NO; (408) 441-0967 LICENSED CONTRACTOR'S DECLARATION I13UILDING PERMIT INFO: License Class B Lic. #2Q9433 ContractorA_LVS CONSTRUCTION & REMODELING INC Date 01/31/2018 _BLDG —ELECT —PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing — MUCH Z RESIDENTIAL — COMNMRCIAL with Section 7000) of Division 3 of the Business ,& Professions Code and that my license is in full force and effect. JOB DESCRIPTION: DEMO (E) 505 S.F. SINGLE FAMILY 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 Ifl 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. Sq. Ft Floor Area: Valuation: $5000.00 APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. 1 agree to comply with all city and county ordinances APNNumber: Occupancy Type. and state laws relating to building construction, and hereby authorize 35716 075 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 regulation Or the Cupertino Municipal Code, Section 9.18. 184 DAYS FROM LAST CALLED INSPECTION. Signature Date(, Issued by: Phuong Devries ' � 111 ri ri�riY ri, Date: 05/20/2016 I hereby affirm thaf`I am exempt from the Contractor's License Law for one of the following two reasons: 1. I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) 2. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sce.7044, Business & Professions Code). 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, foi the performance of the work for which this permit is issued. a. I certify that in the perfomranco 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 this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT ERTIFICATION 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.representafives 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 RE -ROOFS:. All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without fust obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: LLL ROOF COVERINGS' 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 Cupe o Municipal Cade, Chapter 9.12 and the Health & Safety Code, Sec ai�f�25505, 25533, and 25534. no la�hzed agent:�f ty Date. l/ ✓v I hereby affrm that there is a constructi of work's for which this permit is issued Lender's Name Lender's Address Sing agency for the performance 3097, Civ C.) ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional DEMOLITION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CPPERTINO (408) 777-3228 • FAX (408) 777-3333 • buildirNgCa%cupettino_prg 32, � -U PROJECT ADDRESS 21HI t j+o, APN 11 ^- � _ 03:V bWNERA?AME PHONE E-Tncx STREET ADDRESS I CITY, STATE, ZIP I FAX 218q! LDmy--a Ave. OM o t COA"TACT NAI'm Ali & , PA°ISE 0 zK1- o 9 tP'nits — Con gwuaign Com; ah. STREET ADDRESS ¢�" S- .e An�R RyA. CITY.31'A�� -Jov- �t� p ��� - S��y 4 Q OWNER Q OWNED -BUILDER © O 1 IW ERAv,GENT COD7RACTOR ❑ CCONTRACTORAGENT El ARCBrrEl CT D ENGINEER 0 DEVELOPER Ql71 ❑7TENPu�7T CONTRACTORNAME - LICENTSENUMBER LTCrINSETYPE BUS. LIC; [ Dl ,t, - 2aq4 �t1 CO1WAAY NAMF� E-MAILE-MAILFFAXl-lv C f'mnr4-"i^kr—,in G �J�w.�Aof:,na�w .t^ d'ns%[ dvetr�:�,n(i br.�nn r� ldr i�sdIY hctrin I DESCR 01\TOFWORK RES7DE�tTIAI, "DWELLING FLOOR AREA ::":: 'ir%i: USE='`ii:;.,:::;'t,'' "::OGCsi;[. [;•TYPE:".:;".:::SQ.:FfS:� E`:. 'S;: (':::.vftiUAIION.::::'.::: COMMERCIAL FLOOR .:..:....:.........:. . AREA . ... .....:::. ::::.: TYPP OF CONSTRUCTION n STORIES - ZW AQMD70BNUMBER J: ItEOF�VEDB NOT VALU TION: By my signature below, i certify to each ofthe following: !am the properly owner or auth nt to ct on the property owner's behalf. I have read this application and the information I have p lied is correct. I have read the Description of Work and it is accurate. I agree to comply with all applicable local ordinances and state laws relating to bui construction. I authorize representatives of Cupertino to enter the above -A ti ed pro for inspection purposes_ Signature of Applicant/Agent SUPPLEMENTAL INFOR'vIATI V QUIRED PRIOR TO ISSUANCE OF DEMOLITION P 1L.1IT oFFic usE OK ,' Provide Job Number from Bay Ar j Quality Management District www.baaamd.or @ 415-749-4762. PLAN C��K _ Provide three copies ofa. site plan showing protection for any trees 10" in diameter or more at Y above grade. V P-nQAde tter from PG&E (408-725-3325) Stating all gas and electric has been disconnected. ✓ Planning Dept clearance to verify building is not considered an historical landmark. Allow 10 business days.MAkk V"�Vrrovide letter of clearance of all vermin from a licensed pest control contractor. Applicant shall call the Public Works Department at 408-777-3104 and schedule a "habitable dwelling inspection 'Provide Construction and Demolition Recycling Diversion signature form. gbt Commercial Buildings Only: Provide Fire Dept clearance for fire suppression i alarm system review. DemoApp 2016.docrevised05/10/16 0