08120131 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION is
BUILDING ADDRESS: - PERMIT NO,
21988 MC CT,Ft,T,AN RT) YES BUILDER ogi ?nvii
OWNER'S NAME: PERMIT 3SUE DATE
PHOAgr A CONTROL NO.
408) 866-8352
ARCHITECr/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
�o jCLICENSED CONIRAC-fOR'S DECLARATION
ery aMon that I am license under provisions of Chapter 9(mng
rroun
I,
lob Description
1 thereby
sh Session 70BB)of Division 3 ofd¢Bulinus and Poreuio,u Code.atrd my license is
^�„ nruilforteaneuta REVISION: MINOR CHANGE OF REDUCED FRONT PORCH
a ash z Lkenm Clans tic.a -
=p Da¢ Contractor
7W ARCHITECTS DECLARATION
J W U 1(cersssndsel
my p� l be bilk{li/A A
MIucnsed RVl seta arll 8 /' ^�
cm3 OWNER-BUILDER DECLARATION
E i hereby affirm that 1 am eacmpt from 0e Conuaetan's License Law for the
O o following reason.(Salon 79315,Business and Professions Code:My city or county
Sm which rcqulma a permit to cnnswc4 alar,improve.MmnlLsh,on mpom any ewcwro
z_i prior to its ismance.also requires theapplicant forsech permit to 01C aslgnesulmont
< that he is licensed rumors to she provisions or the Contractors Ucenso Uw(Chaps,9 'Sq. Ft. Floor Area Valuation
(commencing with Section 7ffi))of Division 3 of dm 0udocesand Pofevl.ns CoM)01
— that he Is eaempt therefrom and the basis for the alleged eremption.Amy violation of S100
Section 70.113 by any applicant ror a permit subjects the applicant m a Civil Penalty of APN Number - Occupancy Type
nom mom than five hundred dollars(5300}
❑Luawner of she property,er mY moPbYce•wW wgeaas thele set tanputsadon, 35608027 . 00
win do rho wark..nd the suunure U not inmMed arofrmd far sok(See701a,Buds..
and Pofeamts Code:rue Comsat masse Low dare rot appy so an Omer a Required Inspections
property who Wilds w improves mhernoo,aM rho does atr8 wok 6irmelf er W mogh his
ow.cmployee,provided shm such improvements;ase oatrno:nded or.Bere Waste.If.
however,the building or hnprovernent Is sold wait arc yes,of ewopledon.the gwwr-
builde,will have the burden of moving thus M did not Wild or hvprow run purpose of
sek.1
❑1,as owner of the property.am=elusively conoacang with license onnmcors o
construct the project(Sec.70sa,Business and Profevlons Code:)the Cwtr.noses U.
cease Law does not apply to an owner of pmpcmy who builds or bnprove thereon,and,
who concocts for such projects wish aconrranor(s)Hat pursuant to We Cons ectora
License Law.
❑1 ons=cmps under Scn .B&PC for this ressan
Owner Dau
WORKER'S COMPENSATION DECLARATION
1 hereby Almon under Penalty of perjury mm of the following M=lantiartc
❑Ih...a der t..dnWn.cc fia .rf smtwsrir-immefarwo k sCompere
section,as provided ear by Section 3700 of she Labor Cade.Ism the perfarecartce of she
wast for which this permit is issue
❑1 have and will maintain Worint Compensation InswouCe,m acquired by session
3700 of the Labor Code.for the puRarmarr¢ofthe wok farwhich this punch is Issued '
My Workees Compensation Laurance carrier Lod Policy number ase:
Cartier. Policy Na:
CERTIFICATE OF EXEMPrION FROM WORKERS
COMPENSATION INSURANCE
(This well..need not he camplcmd lithe permit Is ferro n,hi ndmddollan(SIM)
or less)
I Century that In thc pCrformance of the work for which this permit is based,l shall not
employs,perm.In any mannorso Aso baromom eetothetwod¢n'Compewlon
L of California.Dare
Applicam
NOTICE TO APPILICARV.If.after making dihs Cemol of Exemption,you should
become subject to the Worker's Compensation povisions or she lobar Code.you muss
.JO foMhoh Nal
wirComply wish such provisions or this pol D<dwmed result
z CONSTRUCTION LENDING AGENCY
F. 1 hereby salon that aero is a Construction lending agency,for the perfancan¢of
Cft work for which this permit Is issued(Sc..3091.CM.CI
[Ll Q Loners Name
CL
i7. z Tonder'Addm<.
V Q I certify that I have red this application and awe that the above information ts
Lp.F' corm=L l agree in comply with all city and county ordinances and Aute laws reladngo
-0 V building conswean,and hereby authoire reprexnwirrs of this city to Cost upon the
W above-mentioned Property for inspection purposes
(We)agree to save,indemnify and kapro
heroics,the City of Cupertino against
fQ/1 H.1,11ides.judgments.Cut and Capes..-,which may to my way averse agalnss said City
V z in eentere nee Of the grumfing Of this Pencia
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE ULATIONS. 2�05 a
�� 'A '
(Z4, +144 an b VN )
-I Re-roofs
Smgnmu pplronUCon ` '� Dal - .
HAZARDOUS MATERIALS DISCLASU Type of Roof
Will she appllont or ruuue building eauPanLaore m bank baardom material
as refined by the Cupertino Municipal Code.Chapter 9.11.and the Health W Safety
Code.sesnatu532(a)+ All roofs shall be inspected prior to any roofing material being installed.
❑Yu CA.
Will the applicant or future building aaapant Out equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit harardnns sir ccou ninants as define by the Bay Atha Al,Quality Management all new materials for inspection.
OimicO
❑Yes No
I have read she Baerdous maeriah mwiremuts under Chmacrii.95orde Califory
nk Health&Safety CAM,Savgns25505.25533 and25530.1 uMrimnd thatnsho building
der not currently have a woos der it h my responsibility o mdfy the as Want of she
requirements hmus5cmct prior o' of.CeNMlof O=e•Nom=y Signature Of Applicant Date
Owner ri ed as=n ) All roof coverings to be Class'%"or better /
CITY OF CUPERTINO
CITY OF
CUPEkTINO REVISION/DEFERRED
PERMIT APPLICATION FORM /"v6& �
APN # Date:
3nch -0 i1 I
Original Permit #:
0-1 11 D ( OCA
Building Address: 2l - I V6 I 1
Mailing Address (if different from building address):
Owner's Name: ` Phone #:
Contractor:Yes 'gelll6l CJ qIfone:
Fax:
Contractor License #:
Cupertino Business License #:
Contact: Phone: �1kJ�}) �t (� -�4L�
i �V\ Fax:
Building Permit Info:
Bldg LTJ ngElect [ Plumb ❑ Mech ❑
Residential ❑ Commercial
Job Description: J y-
Q�oY ��wh9JL &6 'Y-L&pckop �-O"z Po-vC1.
Is the project in the Wildland- Urban Interface Fire Area? Yes ❑ No ❑
Type of Construction (Usage Class): * Occupancy Type:
1-A, I-B ❑ 11/III/V-A ❑ 11/111 B, IV-HT, V-B V R
Valuation (cost of project
Oo
Project Size: Express Standard E Large LJ Major LJ
Green Building: Please complete relevant portion of the Green Building/LEED Checklist & attach it
to the application or if applicable, include in plan set & the sheet index.
Points Achieved: V
For help, contact Build it Green at www.builditgreen.org
Revised 9/15/08
CITY OF
i
I ,CUPERTINO
City of Cupertino
10300 Tone Avenue
Cupertino,CA 95014-3255
• Telephone: (408)777-3228
PAX: (408)777-3333
BUILDING DEPARTMENT
TO: Youngjian;YVang
FROM: City of Cupertino
DATE: September,14;2010
RE: Address: -21988' McC-lellanRd.,Lot 1
Permit: ;07130100
With the length of time ittakes,for PG;&'E to provide gas and electric to a project we are
allowing both'utilitiesto be released prior to finals. This is allowed only if the inspector
agrees and feels it is safe'to':do so.
The owner and contractor need to sigfl this form stating that they understand they can-
11
not move into-the residence`until they have received all of the required finals and the
City has givena'ce`rtificate of occupancy. If both do not sign this form,the inspections
will be incomplete arid' ,the iii lities not released until we have a signed form.
l
Owner(s)/Builder.`—'Youngjian Wang'
Contractor- Yes Builder, 0 '\