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14050103) CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21918 LOMITA AVE CONTRACTOR:JUNJIE ZHENG PERMIT NO: 14050103 OWNER'S NAME: JUNHE ZHENG 161 MUIR AVE DATE ISSUED:08/29/2014 OWNER'S PHONE: 4089167988 SANTA CLARA,CA 95051 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL CONSTRUCT 2 STORY SFDWL LIVING SPACE 3426, License Class Lic.# ATTACHED GARAGE 448 AND PORCH 458 SQ FT Contractor Date I hereby,affirm that I am licensed under the provisions of Chapter'9 Deferred#1-gas pipe diagram-issd otc 3/24/15 (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. 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. Sq.Ft Floor Area: Valuation:$659000 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 APN Number:35715002.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAY(7 LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the Issued b Date: G� granting of this permit. Additionally,the applicant understands and will comply 3' with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature Date All roofs shall be inspected prior to any roofing material being installed.If a roof is installed without first obtaining an inspection,I agree to remove all new materials for inspection. OWNER-BUILDER DECLARATION Signature of Applicant: - Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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) as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE onstruct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous -Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date:,-Z permit is issued. 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 CONSTRUCTION LENDING AGENCY 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 I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 918. Signatur Date CONSTRUCTION PERMIT APPLICATION COPVJViiUNI 1 Y DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 T ORRE AVENUE• CUPERTINO, CA 95014-3255 B. CUPI=RTINO (408).77..7-3228 • FAX(408)777-3333•buildino(a),cuoertino.org �VlSl0WFFEEjT:;D0❑TEW CONSTRUCTION:., ❑1-ADDITION ❑ ALTERATION/TIORIGINAL P ERMIT9 PROJECT ADDRESS I AIN R OWNER NAME I PHONr. E-1AAIL STREET ADDRESS I CI Ii Y, STATE,ZIP•Sa G! I FAX ... CONTACT NANIE.. PHONE I E-A4AIL STREETADDRESS-- CITY,STATE,,ZIP FAX , 'Kf'OWNER-BbILDER" '❑ OWXEERAGENT ❑ CONTRACTOR .❑CONTIR_ACTOR:AGENT'' '❑ .ARCHITECT' ❑ENGWEER'.:;:,_13 :DEVELOPER: ❑,TENANTr CONFIRACTOR NAME LICENSE NUh4BER LICENSE TYPE BUS.LIC m COMPANY NAME I E-14.A1L FAX STREET ADDRESS I CITY,STATE,ZIP PHONE ARCHITECT,E2\'GINTEERN.A],4E /�/] ` ( LICENSENUA4BER BUS.LIC COWANYNAA4E J J '� E-MAIL me ` FAX n 19 �f STREL1 ADDRESS2`,ti ('bra�� ` r14h� ,,ITY'STATE,ZIP �✓ �7 I PHOI�'E/i��+ DESCRIPTION OF WORK d J J �J 1-�=62,2 .5�/��1 i �� '�!L � �rP;•�1rTi��.��?� EXISTLNG USE PROPOSED USE CONSTR TYPE STORIES z USE TYPE OCC, SQ.FT, VALUATION(S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHRO014 KITCHEN OTHER REMODEL AREA MN40DEL.AREA REN40DEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: ❑DETACH ❑ATTACH r DWELLINGUNTM. IS A SECOND UNIT ❑YES SECOND STORY ED YES _ BEING ADDED? 0 N ADDITION? ❑NO PRE-APPLICATION ❑YES IF YES,PROTIDE COPY OF I IS THE BLDG AN ❑YES 'CEI\�:ED TOTAL V ATI .'• PLA_NNINGAPPLF1 NO PLANND,GAPPROVAL LETTER EICHLERHOAIE? ONO I IN c By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided 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. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: .::� _ SUPPLEMENTAL INFORMATION REQUIRED n c�CI�TiPE . _ an- =_Rotjru.c sL>rF r pMxv c New SFD or Multifamily dm7elIinas: Apply for demolition permit for �] D ER r cou�rEx � �Lan�.GrL�I.,'xE� W r existing building(s). Demolition pennit is required prior to issuance of building permit for new building. ❑ ExPREss err �x �.A'I�"�INCi PL4I�StEViEI� _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure sra.DAIZD r �J $LBLIC\LnTF.S hs s: �. form if any Hazardous Materials are being used as part of this project. IlHECopyL}RGE FIREDEPF - e� .. .o Planning Permit pmit al Letter or Meeting with Planning prior to subin ttal � v�JOR ^� fl sai�Iz Y sEv ER�Fs�Rfc� rt B1dgApp_201 Ldoc remised 06121/11