09100036 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21761 MEYERHOLTZ Cf CONTRACTOR:TBD-TO BE DETERMINED PERMIT NO:09100036
OWNER'S NAME: RAY CHIANG DATE ISSUED: 10/06/2009
OWNER'S PHONE: 4089814800 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
License Class_ , Lie.p �1"�/U r
c MECH r r RESIDENTIAL COMMERCIAL
Contractor C ��C Date I U 1(0(09
1 hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:RELOCATION OF RECEPTACLE IN TWO(2)BATH,
(commencing with Section 7000)of Division 3 of the Business&Professions ADD
Code and that my license is in full force and effect. ONE(I)RECEPTACLE IN MASTER. RELOCATION OF TOILET
SUPPLY&DRAIN REPOSITION SHOWER DRAIN. REPLACE
1 hereby affirm under penalty of perjury one of the following two declarations:
1 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.
1 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 Sq.Ft Floor.Area: Valuation:55000
permit is issued.
APPLICANT CERTIFICATION APN Number:32648035.00 Occupancy Type:
1 certify that 1 have read this application and slate that the above information is
correct.1 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 PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
grunting of this permit. Additionally,the applicant understands and will comply
with all non-pain qurc gulations per the Cupertino Municipal Code,Section 180 DA yS FROM LAASALLED INSPECTION.
C9.18. / —�
Signature Date /V, ( Issued by: �^ Date:
f /N
❑ OWNER-BUILDER DECLARATION V
ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to anyy roofing material being installed.If a roof is
the following two reasons:
1,as owner of the ro installed without first obtaining an inspection,1 agree to remove all new materials for
p perry,or my employees with wages as their sole compensation, inspection.
will do the work,and the structure is not intended or offered for sale(Sm.7044,
Business&Professions Code) Signature of Applicant: Date:
1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code).
ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I hereby affirm under penalty of perjury one of the following three
declarations:
1 have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE
Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Section 3700 of the labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material.
permit is issued. Additionally,should I use equipment or devices which emit hazardous air
1 certify that in the performance of the work for which this permit is issued.I shall 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
not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534.
Compensation laws of Cali fomia. If,after making this certificate of exemption,1 .
become subject to the Worker's Compensation provisions of the Labor Code,1 must Owner f9ulh ed agent:
forthwith comply with such provisions or this permit shall be deemed revoked. / Date: LOA, 0 I
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
1 certify that I have read this application and slate that the above information is 1 hereby affirm that there is a construction lending agency for the performance of work's
correct. 1 agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.)
to building construction,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
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 ARCHITECT'S DECLARATION
9-18. 1 understand my plans shall be used as public records.
Signature Date Licensed Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21761 MEYERHOLTZ CT CONTRACTOR:TBD-TO BE DETERMINED PERMIT NO:09100036
OWNER'S NAME: RAY CHIANG DATE ISSUED: 10/06/2009
`PER'S PHONE: 4089814800 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION r
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class �Ir Lic.#
-"`�� � MECH RESIDENTIAL COMMERCIAL f
Contractor C— Date U
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:RELOCATION OF RECEPTACLE IN TWO(2)BATH,
(commencing with Section 7000)of Division 3 of the Business&Professions ADD
Code and that my license is in full force and effect. ONE(I)RECEPTACLE IN MASTER.RELOCATION OF TOILET
SUPPLY&DRAIN REPOSITION SHOWER DRAIN.REPLACE
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
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 Sq.Ft Floor Area: Valuation:$5000
permit is issued.
APPLICANT CERTIFICATION APN Number:32648035.00 Occupancy Type:
1 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 PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,the applicant understands and will comply 180 DA S FROM LAS ALLED INSPECTION.
with all non-poin urc egulations per the Cupertino Municipal Code,Section
9.18. — /`
Date:
Signature Date V Issued by:
If t
va
�. OWNER-BUILDER DECLARATION v
RE-ROOFS:
I hereby affirm that 1 am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is
the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
1,as owner of the property,or my employees with wages as their sole compensation, inspection.
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code) Signature of Applicant: Date:
1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code).
ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I hereby affirm under penalty of perjury one of the following three
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE
Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material.
permit is issued. Additionally,should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District 1 will
I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534.
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 Owner fAatl zed agent: U O
forthwith comply with such provisions or this permit shall be deemed revoked. i Date:
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's
correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.)
to building construction,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
c rnd expenses which may accrue against said City in consequence of the
gi. .ng of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION
9.18. I understand my plans shall be used as public records.
Signature Date Licensed Professional
I
CITY OF CUPERTINO v/
/f ADDITIONIREMODEL
CUPEkTINO PERMIT APPLICATION FORM
APN # Date:
Is a 2" unit being added? Yes LJ No If yes, please fill out the permit application for 2" unit.
Building Address: {'
2,1101 c r
Mailing Address (if different from buildihg address
Owner's Name: Phone#
Contractor:I Phone #:
Fax #: 90k_ Z9S-2 5 91
Contractor License #: L171025y
Cupertino Business License#:
Contact: � Phone#: 4/0 - 7Z 3 -Z 5 '/
^i �' Fax #: p?- 2- S- 2 5",j/
Building Permit Info:
Bldg. ❑ Elect. Plumb. Mech. ❑ Hillside ❑
Job Description:
Addition-What is being added?(Be Specifi )
a.cP.oP aXc 4LeA' r w {?? l ug5c7�°r $ cGtac.
What is being remodeled (not including addition)?
Z- t�i�C/L�o
Remodel Includes Re-Roof: Yes ❑ No VT If yes list number of squares
E]Remodel Includes Structural: Yes No
Do you have the pre-application planning approval? Yes ❑ No�
If yes, please provide a copy of your planning approval letter. Planners name:
Square Footage:
Addition: Porch: Deck: Garage: Detached Attached
Remodel: Kitchen Bath Other
Type of Construction (Usage Class): Occupancy Type:
1- II/IIUV-A ❑ II/III B, IV-HT, V-B Si Le
Valuation: 07) Please check this Wd if the project is a
s iU second-story addition ❑
Project Size: Express ❑ Standard Large ❑ Major❑
Please complete relevant portion of the Green Building
Checklist & attach it to the application or if applicable, Green Building Points Achieved:
include in plan set & the sheet index.
***For Office Use Only***
Over-the-Counter 0 Revised 07/06/09
L..o 471034
- Si.1999
fx�s� CDS
1
Chris Hugill
_ 210 San Jose Ave.,Ste. 10 Phone#408-723-2591
San Jose,CA 95125 Fax#408-295-2591
E-mail:chugill58@gmail.com
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OCT 0 6 2009 00 F �.CE CON, C rn�.r�P, ti C� �J�uIN
BY:
a 471084
Si.1984
Chris Hugill
210 Sen Jose Ave.,Ste. 10 Phone#408-723-2591
Sen Jose,CA 95125 Fax#468-M-2591' �4✓�'v
f;x
E-mail:chugill58Qgmeil.comJ,0L,C.
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OCT 062009 1 ..I �1ub�- `i�•!- yb•�z-
BY: ��:���
Community Development
-' 'i i�i! 10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF ;:-, , Fax(408)777-3333
CUPEkTINO
Building Department
All Cupertino building;permits;must meet certain conditions related to maintaining
environmental quality and public peace and safety. The two most common
conditions are described below.
STORMWATER POLLUTION.CONTROL
State law requires:that Cupertino,. 12 other Silicon Valley cities, Santa Clara County and
the Santa�Clara Valley Water District,control stormwater pollution. Educating local
residents and businesses,andenforcing stormwater pollution control laws are key parts
of the City's compliance efforts. ,-,
Stormwater pollution preventi6w It's up to us
In northern Santa Clara Valley, storm drains flaw directly to local creeks and San
Francisco Bay; with no treatment. Stormwater pollution is a serious problem for wildlife
dependent'on our waterways;,for people living near streams and baylands, and for the
local water.supply -Common sources of stormwater pollution include:
• Dripped oil; fuel, aria antifreeze from vehicles and heavy; equipment;
• Construction'debris;,including dirt, concrete and paint;
• Landscaping runoff containing pesticides or weed killers; and
• Any material dumped"or'spilled into streets or storm drains
The property ownerand the contractor share ultimate responsibility for activities
occurringat'a,.consfruction site.and will-be held responsible for any environmental
damage caused by subcontractors or-employees.
For more Information,on construction-related stormwater requirements, see the
StormwaterQuality Regulations-section of the City of Cupertino web site at:
http:l/www:cupertino.orcl/city government/denartments and offices/
environmental services
COMMUNITY'NOISE CONTROL '
The basic noise control requirements for construction sites are as follows:
• Typical construction work;hours are:
- Weekdays.- 7 a:rn.to 8 p.m.
- Wee'kerids -.9'alm.3o 6;p:m. ,
• Construction.otherthan street-construction is prohibited on holidays.
• Residential daytime,
=noise levels from complaint site - 60 dBA
• Nonresidential daytime noise levels from complaint site - 65 dBA
• Y
For more information on noise control, please see Chapter 10.48 of the Cupertino
Municipal.Eode, which can'be.accessed at htti)://www.amlegal.com/cupertino ca/
I_U7.C EI VED UI:TG eg20asteel F��CF c on�Py
BY:_Budding_pffdl
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21761 MEYERHOLTZ CT CONTRACTOR:TBD-TO BE DETERMINED PERMIT NO:09100036
OWNER'S NAME: RAY CHIANG DATE ISSUED: 10/06/2009
`PER'S PHONE: 4089814800 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION r
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class �Ir Lic.#
-"`�� � MECH RESIDENTIAL COMMERCIAL f
Contractor C— Date U
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:RELOCATION OF RECEPTACLE IN TWO(2)BATH,
(commencing with Section 7000)of Division 3 of the Business&Professions ADD
Code and that my license is in full force and effect. ONE(I)RECEPTACLE IN MASTER.RELOCATION OF TOILET
SUPPLY&DRAIN REPOSITION SHOWER DRAIN.REPLACE
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
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 Sq.Ft Floor Area: Valuation:$5000
permit is issued.
APPLICANT CERTIFICATION APN Number:32648035.00 Occupancy Type:
1 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 PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,the applicant understands and will comply 180 DA S FROM LAS ALLED INSPECTION.
with all non-poin urc egulations per the Cupertino Municipal Code,Section
9.18. — /`
Date:
Signature Date V Issued by:
If t
va
�. OWNER-BUILDER DECLARATION v
RE-ROOFS:
I hereby affirm that 1 am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is
the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
1,as owner of the property,or my employees with wages as their sole compensation, inspection.
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code) Signature of Applicant: Date:
1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code).
ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I hereby affirm under penalty of perjury one of the following three
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE
Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material.
permit is issued. Additionally,should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District 1 will
I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534.
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 Owner fAatl zed agent: U O
forthwith comply with such provisions or this permit shall be deemed revoked. i Date:
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's
correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.)
to building construction,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
c rnd expenses which may accrue against said City in consequence of the
gi. .ng of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION
9.18. I understand my plans shall be used as public records.
Signature Date Licensed Professional