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D-2016-0359CITY OF CUPERTINO BUILDING PERMIT 13UILDINGADDRE.SS.- CONTRACTOR: PERMIT NO; D-2016-03 59 10320 MORETTI DR CUPERTINO, CA 95014-3639 (375 15 009) (CHEN'S CONSTRUCTION a COMPANY) SAN JOSE, CA 95130 OWNER'S NAME: LAI LEE JEE-JEAN TRUSTEE DATE ISSUED: 01115/2016 OWNER'S PHONE: PHONE NO, LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class Lie. # Contractor is CHEN'S CONSTRUCTION COMPANY) Date —BLDG —ELECT _PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing —M' CH X RESIDENTIAL — COMMERCIAL with Section 7800) of Division 3 of the Business & Professions Code and that my license Is in full force and effect. JOB DESCRIPTION: Dema (e) house (12I5 SF) 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 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 Comliensation 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 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 APN Number: Oceupancy Type: ordinances and state laws relating to building construction, and hereby 375 15 009 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 PERMIT EXPIRES IF WORK ISNOT STARTED expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will WITHIN 180 DAYS OF PERMIT ISSUANCE OR comply with all non -point source regulations per the Cupertino Municipal 180 DAYS FROM LAST CALLED INSPECTION. Code, Section 9,18. Issued by: k9 9'1 d YLs� s+n Signature Date g Date: 03YNER-BUILDER D_BU ARATION R>;..RooFs: I hereby affirm that I am exempt from the Contractor's License Law for one of the All roofs shalt be, inspected prior to any roofing material being installed, If a roof is following two reasons: installed without first obtaining an inspection, I agree to remove all new materials for 1. I, as owner of the property, or my employees with wages as their sole inspection. compensation, will do the work, and the structure is not intended or offered for sale (Sec,7044, Business & Professions Code) Signature of Applicant: z. 1, as owner of the property, am exclusively contracting with licensed Date: contractors to construct the project (Sco.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR SETTER 11 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 HAZARDOUS MATERIALS DISCLOSURE performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the z. I have and will maintain Worker's Compensation Insurance, as provided for California Health & Safety Code, Sections 25505, 25533, and 25534. I will by Section 3700 of the Labor Code, for the performance of the work for which maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the this permit is issued. Health & Safety Code, Section 25532(a) should I store or handle hazardous 9. 1 certify that in the performance of the work for which this permit is issued, J material. Additionally, should I use equipment or devices which emit hazardous 4 shall not employ any person in any maturer so as to become subject to the 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 Worker's Compensation laws of California. If, after making this certificate of the Health & Safety Code, Sections 25505, 25533, and 25534. 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 Owner or authorized agent:, be deemed revoked. Date• f qq �t i 5- f 7 0 `6NSTRUCTION LENDTIN'G AGE NC V APPLICANT CERTIFICATION I certify that I have read this applicafion and state that the above information is I I hereby affirm that there is a construction lending agency for the performance correct. I agree to comply with all city and county ordinances and state taws of work's for which this permit is issued (Sec. 3097, Civ C.) relating to building construction, and hereby authorize representatives of this City Lender's Name to enter upon the above mentioned property for inspection purposes. (We) agree to save Indemnify and keep harmless the City of Cupertino against liabilities, Lender's Address judgments, costs, and expenses which may accrue against said City in of the granting of this permit Additionally, the applicant ARCHITECT'S DECLARATION understands and will comply with all non -point source regulations per the I understand my plans shall be used as public records. Cupertino Municipal Code, Section 9.18. ` � t l7 o'� Licensed Professional Signature r frl� DateO CUPERTINO DEMOLITION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buiiding(aacuperting.ora PROJECTADDRESS / L A-APH #37ir— T I OVThERNAME � � PHONE ftp rri .� ZtIL u.� E.MATG CJ STREETADDRESS '� /� _ _ y� + CITY, $�, TEAT Z �i CCN 1'"'i� t . t CONTACT NAME °"—�'� Q\ E-MAIL �(3� -�' 2-- 0 SMEETADj C Y, STA ZI?P FAX TRACTORAENT PRCHIE❑ D OWIR-BULDER CT NIEEW�I CON EELOPER ©TENANT CONTRACTO NAt LICENSE NUMBEPq .'p yam], ( LICENSE TYPE rj ` F� BUS. LIC # COWAITY NAME E i o e44 5 t>i1 EMPTL mit_ 2"3 O ���V ( FAx zA 5lr.7 STREET ADDRESS �j _ (, 1 G7L`f E, ZIPLZLt Pi302�Ea it,� y� uO i'L� 1 DES CRIPTION OF WORK Atc / / ! 1_ n'%46h"L_ t @Gi S` f� ! eb u r f d' i r D �'} ftf !�A_P RESIDENTIAL {) � # DWELLING FLOOR AREA / r w L UN79vsE COMMERCIALSn?ON FLOOR AREA n - ,nfi a; TYPE OF CONSTRUCTION # STORIES ,. _y..r� cS�v t�:':"=�,;�-;=-c4-fh.�e;s_r��'�r:.�t::��-v. ..--i rt - ':`'- _ - _. x:£ ii 3Y .;.�.� +-F'ev3' .-.: rfi"s.^-`-•_'-E:.,r:.;„t.^�..rF:`:,:�_�varc=-_u- r:, :''--:ci.'�`� - .,5�-.,.. �,�+'r `_i�;•:}''::fi?-.: .;s�_�.=-�.hsr_��::+:���:;.+=.*L;:Mr:>;ui::i.- 30 ` _ _ - :_�,s�r..,;•>. .'e: S4•ei AQMD JOB AUMPYR Tp p 7 l: - _ _ _ -N; `^.: ']E _ LIS - _ ?r�� ..-- :1,, t M11`0 Y�1i}_- F�''1"4-Lam„'_.:•.}`� - - _ _r. 7 .� TOTALVALUATIQN: xa r^j : By my signature below, l certify to each of the following: I am the property owner or authoriz ` gent to act on the properly owner's behalf, X have read this application and the information I have provided is correct. I have read the Description of 1Vork and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building constroction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of ApplicanftAgent: Date;' SUPPLEMENTAL INF -ATION REQUIRED PRIOR TO ISSUANCE OF DEMOLITION PERMIT =” Provide Job Number from Bay Area Air Quality Management District ww tv.baaomd.ore @ 415-749-4762, _ I LAH c> cxTir> T Provide three copies (Residential) or six copies .(Commerical) of a site plan showing protection for any trees 10" PxFss in diameter or more at 3' above grade.sTAArn Provide letter from PG&E (408-725-3325) stating all gas .and electric has been disconnected. "I ARG t xk _ Provide a letter of inspection, tests, and abatement of any Hazardous Materials. Letter to be initiated by person(,) #I�SAdOR ' certified in asbestos, mercury and/or hazardous material examination.RF °�O s X Planning Rept clearance to verify building is not considered an historical landmark. Allow 10 business days. e. Provide letter of clearance of all vermin from a licensed pest control contractor. , x ?} Applicant shall call the Public Works Department at 408-777-3104 and schedule a "habitable dwelling" inspection _ Provide signed Debris Bin And Recyclable Materials form, Derno.4pp`?013.docreutsed 021.13113 3r� per'� Br;.n:31;i .: t:C.tt-.t•.Y :.gip ...�.F'1_. .....•c. __:-•tn.... i...Y.•.'.:`aVu•.ei'i:T:a'K.:.r4..+....gir. :.c:P:Yic. •r.i.:nY�sx.. :Lt4!.r � � r:tr0.'rsc•nw:te..tr l: I.:: !:ur.::'i.:. E City of Cupertino Public works Department Environmental Programs Division 103:00 Torre Ave Cupertino, CA 95014 Program a (408) 777-3354 Co istru ction and Def iolition Recycling Di.Version Regtiiremexits• and n.s ructioiis Covered projects, or all construction, demolition and renovation projects that are 36000 square feet or more are required. to complete a Waste Manage.inent�Plah for the City of C i ertino demonstrating that 60% of the material generated is recycled, in cainpliance %with of dinanco :CMC 16,72.050;-. At the conclusion of the project a Constniction Recycling Report must be filed withthe Public Works Depailmimf/Environtnental Division' showing the tons recycled and disposed by matexi�l .type, Usq._tonnage inforniaiion from weight tags provided by facilities to quantify total estimated waste'and percentages for materials eight Tags of aII material' recycled and disposed must be submitted with the final report iia order to -receive a Final Building Inspection. Debris from a project 3,000 square feet or more in Cupettino can be collected and disposed byus' lia: PIeas� fieck all that. apply: 90 I am not using a Recology debris, bin, however, the projectis less than 3,000 sI, e.g. buildings, patios, sidewalks, driveways. 0 1 will use a Recology debris bili. By Agreement with the City, Recology will, prepare my required Waste Management Plan & Recycling Report, Contact Recology; (409) 725-4020. Cl I am not using 'aRecology debris bin. I will provide the following submittals to the City's Public Works Department, showing that I have recycled at least -60%o of all construction demolition material: Ask for the Construction & DenioIition Recycling Packet from the Building Department and complete the following.-, Submit a Construcdi n unci• Denzolitlo.n Waste lilanagentent flan with your building permit application. No fee for this plan. Fonns are available at t1se.BuIlding-I 'ublic ]Forks cozinter and online atii,i4)i4s.cupoi-iiiia.org/em,iro77i;?e77tal. Report the tonnage recycled a77d disposed, by material type. RecyclhigJacilities insist be selected frena the City's approved list i5fRecycfhzgResources . ✓ Subinit a Construction Recycling .report form. The report is required before the Building Department will schedule a fanal ir:spectios. The reportform is available at the BuildinglMINic Works Counter and onliiie wwmi.cuzaertirao.or 1a�onraaerztal. Signature: Dame: Title; Phone; Project Tliisforni to remain i ihepicrject's building permif f le for tho duration of the project. Revised 317112:1 °l%JK%/, � ' OWNER -BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE . CUPERTINO, CA 95014-3255 CUi'iARTitfU (4DS) 777-3228 - FAX (408) 777-3333 • buildinp5cupertino.org Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: SITEADDRESt :.... +.. ,.APN- 7,�� SP# OWNER NAM z ..... . OYVNE DRESS —� 'DESCRIPTION OF WORK: We are providing you with an Owner-BuliderAckhowledgment and'Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION (DIRECTIONS; Please read and initial each statement below to signify you understand or verify this information.) I. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner - Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. 1, as an Owner --Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. [ am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage fpr injuries to workers on my property. N1' 2. 1 understand building permits are not requited to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. 3. I understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. J, 4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. 15. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" under state and federal law, 00- _,6.1 understand if 1 am considered an "employer" under state and federal law, [,must register with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee," I also understand my failure to abide by these laws may subject me to serious financial risk. 7. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. -LIL8. I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s) that result from any iatent construction defects in the workmanship or materials. OwnerBuilder•Forn: 2010.doc revised 0-4/14110 9.1 understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, - and the California division of Industrial Accidents. l also understand I may contact the California Contractors' State License,Board (CSLB) at 1-800-321-CSLB (2782) or www.csib.ca.govfor more information about licensed contractors,. • 10. 1 am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that l am the party legally and financially responsible for proposed construction activity at -the site address listed above. `11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will aUrde by all applicable laws and requirements that govern Owner -Builders as well as employers. 12. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information -1 -have -provided on this form. Licensed contractors are regulated by -Jaws designed to protect.the..public. if . you contract with -someone who does not have a license, the Contractors' State License Board may be unable to assist you with arty financial -loss you may sustain as a. result of a complaint. -Your only remedy against unlicensed Contractors maybe in -civil court. itis also important for. you -to understand that if an unlicensed Contractor or employee of that individual or firm is injured.while working on your property, you may be held liable for damages. if ybd obtain a permit -as Owner -Builder and wish to hire Contractors, you will be responsible for verifying whether or note those Contractors- are properly licensed and the status of their workers' compensation insurance coverage. CONSTRUCTION LENDING AGENCY (DIRECTIONS: Please complete the following constructloh lending agency information.) I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (See 3097 Civ.) Lender Name: Lender Address: Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note: A copy of the property owners drlver's license, form notarization, or other verification acceptable to the city maybe required to be presented when the permit is issued to verify the ro erf owners si nature. Property Owner's Signature: Date: 1 ----------------------- ----------------------------------------------------------------------------------------------------------------- (NOTE. The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner -Builder). AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNEM'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, l hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner -Builder Permit for my project. Scope of Construction Project (or Description of Work); Project Location or Address: Name of AuthorizedAgent: Address of Authorized Agent: Tel No I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's signature. Properly Owner's Signature: Date: OxvnerBv!1derF6nn 2010. doc revised 04114/10 Regulation 11, Rule 2 Acknowledgement of Notification and Payment of Pees 1/5/2016 Chen , s /5/201VChen,s Construction Catntsany Job Iu6: 4S]78 4045 Moreland Way Sail lose, CA 95130 Invoice No: 3Si,85 The Bay Area Air Quality Mariagenient District (BAAQMD) acknowledges receipt of your payment and your Asbestos Removal or Demolition i'1a11 clescribecl as: Demolition Site address 10320 Moretti Dr Cupertino, CA 95414 Start .Date March I, 2016 Completion Date March 2, 2016 Removal amounts of friable ACM 0 linear feet 0 square feet 0 cubic feet Should it beconie necessary toxevtss t�t5 plan, please do so tai the spaces provided below and inuneciiatel copy the District f? taxi(}} ,* �' *U'Z'0�-i mss. '.., zrs�'i�. s: -s �'`t' _ t�1s,s -N a vei-iIiccatirait ©f^eith t= C XCJhlt) Regulation 1.1-2. If jyo P. , vtrr r)f f lce tit (4155) 749762; 1.,.. t COMPLIANCE & B AY Arun ENFORCEMENT AtRQi,AF.ITY DIVISION ASSANA C[.m1,N-r Regulation 11, Rule 2 Acknowledgement of Notification and Payment of Pees 1/5/2016 Chen , s /5/201VChen,s Construction Catntsany Job Iu6: 4S]78 4045 Moreland Way Sail lose, CA 95130 Invoice No: 3Si,85 The Bay Area Air Quality Mariagenient District (BAAQMD) acknowledges receipt of your payment and your Asbestos Removal or Demolition i'1a11 clescribecl as: Demolition Site address 10320 Moretti Dr Cupertino, CA 95414 Start .Date March I, 2016 Completion Date March 2, 2016 Removal amounts of friable ACM 0 linear feet 0 square feet 0 cubic feet Should it beconie necessary toxevtss t�t5 plan, please do so tai the spaces provided below and inuneciiatel copy the District f? taxi(}} ,* �' *U'Z'0�-i mss. '.., zrs�'i�. s: -s �'`t' _ t�1s,s -N a vei-iIiccatirait ©f^eith t= C XCJhlt) Regulation 1.1-2. If jyo P. , vtrr r)f f lce tit (4155) 749762; 1.,.. t Pao& Gas and Is ne Electaccompaw January 05, 2016 JEAN LAI 812 COAKLEY DR SAN JOSE, CA 95117 Dear JEAN LAI, We received your application for service.. Here are the next steps and additional information we may need from you. Thank you for submitting your application with Pacific Gas and Electric Company. We appreciate the opportunity to assist you in evaluating your gas and/or electric service request for the following project: 10320 MORETTI DR 10320 MORETTI DR, CUPERTINO, CA 95014 If you have any questions about this project please feel free to discuss them with your representative during the call. During the discussion, your PG&E representative will evaluate the type of service being requested, the process flow, and if an engineering advance will be required for your project. Engineering advances would cover PG&E's time and costs associated with visits to your site, travel and preparing job estimates and a contract for your project. If we do require an advance, we will apply it against the costs of your project and will either bill you for any additional amounts or refund any excess you pay. We also want you to be aware that we may need to cancel your application if: It is incomplete and we do not receive the supporting documents and project data we request within 120 days of submitting your application We do not receive your engineering advance, if required, within 90 days of when we sent your invoice We do not receive a signed copy of your contract with the required payment within 90 days of when we mailed the contract to you Customer Connections Online (CCO) makes it easy to manage your project, 24 hours a day, 7 days a week. If you haven't already enrolled, you can sign up at www.pge.com/CustomerConnections to access your application. Our online tool offers additional features to help manage your project. Just use the Application Number and Security Code below to link to your application: Application Number: 111157867 Security Code: J1017271 Again, thank you for your application for service with PG&E. We are proud to be your energy partner and look forward to serving you. If you have any questions, please don't hesitate to contact the Building & Renovation Service Center, Monday through Friday, from 7:00am to 6:00pm at (877) 743-7782. Sincerely, Pacific Gas and Electric Company Page 1 of 1 ID: 111157857