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B-2016-1872 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1872 20432 SILVERADO AVE STE 5 CUPERTINO,CA 95014-4454(369 52 005) RAY TORRES AND ASSOCIATES INC SAN JOSE,CA 95148 OWNER'S NAME: FANG FRED AND JOANNA DATE ISSUED:05/02/2016 OWNER'S PHONE:650-468-7288 PHONE NO:(408)561-3217 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lic.#971534 Contractor RAY TORRES AND ASSOCIATES INC Date 03/31/2018 X BLDG —ELECT —PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9(commencing MECH RESIDENTIAL X COMMERCIAL with Section 7000)of Division 3 of the Business&Professions Code and that.my license is in full force and effect. JOB DESCRIPTION: REMOVE SHEETROCK PER INSPECTOR'S REQUEST-CODE I hereby affirm under penalty of perjury one of the following two declarations: ENFORCEMENT CASE 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 'erformance of the work for which this permit is issued. 410r!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:$500.00 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 ordinances APN Number: Occupancy Type: and state laws relating to building construction,and hereby authorize 369 52 005 A(Tenant Improvements) 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 ga' st said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additional) , h a plicant understands an ill comply with all non-point source re u ti ns erti o M icipaI Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. rg�nature Date 5/2/2016 Issued by:Abby Ayende41 Date:05/02/2016 OWNER-BUI DER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is 1. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for compensation,will do the work,and the structure is not intended or offered for inspection. sale(Sec.7044,Business&Professions Code) 2. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant: contractors to construct the project(Sec.7044,Business&Professions Code). Date:5/2/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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. HAZARDOUS MATERIALS DISCLOSURE 2. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the 3. 1 certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store or handle hazardous material. Additionally,should I us eq ment or devices which emit hazardous shall not employ any person in any manner so as to become subject to.the air contaminants as defined by th ay ea Air Quality Management District I Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with th u ert nicipal Code Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety ct'o 5 5, 533, nd 25534. Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revolted. ener or authorized agent: APPLICANT CERTIFICATION 5/2/2016 1 certify that I have read this application and state that the above information is CONSTRUC ION LENDIN AGENCY correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a co struction lending agency for the performance relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.) to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments,costs,and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code,Section 9.18. 1 understand my plans shall be used as public records. Licensed Signature Date 5/2/2016 Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 cuPER-rtNo (408)777-3228• FAX(408)777-3333•building(d-)cupertino.org ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS 3 2 ,2fLe005 P��'�4�� APN# OWNER NAME J� n�� / �� 4 PHONE ;YW 7� MAIL STREET ADDRESS /�7��_" CITY,STATE,ZIPJ 9W2 (,713 CONTACT NAME PHONE L_ - F—E-MAIL STREET ADDRESS CITY,STATE, ZIP FAX ❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME � LICENSE NUMBER LICENSE TYPE ,� BUS.LIC# '�;/0y P�� COMPANY NAME,6_,,/ ` J h / E-MAILWAq �j e ` y�' FAX v STREET ADDRESS CITY,STATE,ZIP �� 1 H0NE�le) ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK EXISTING USE PROPOSED USE CONSTR TYPE #STORIES OFFICE USE ONLY OCC. TYPE DE CRIPTION S .I.I': VA L ATION a EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA:❑ DETACH ❑ ATTACH #DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES BEING ADDED? ❑NO ADDITION? ❑NO ^ TO PRE-APPLICATION YES IF YES,PROVIDE COPY OF PLANNER'S NAME: RECEIVED BY:t TOTAL V ON -J1 PLANNING APPL# NO PLANNING APPROVAL LETTER lrV jell-Y) By my signature below,I certify to ea f b following: I am the property owner or authorized agent to act on tilprope owner's behalf. I have read this application and the information I ha o e 's. I ha e read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating t it g on c' authorize representatives of Cupertino to enter the above-identified p/perty for inspection purposes. Signature of Applicant/Agent: _ Date: / SUPPLEMEN AL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP _New SFD or Multifamily dwellings: Apply for demolition permit for ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW , existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ :'EXPRESS ❑'PLANNING PLAN REVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ !STANDARD L1PUBLIC WORKS form if.any Hazardous Materials are being used as part of this project. ❑ 'LARGE° ❑ FIRE DEPT Copy of Planning Approval Letter or Meeting with Planning prior to ❑ 'MAJOR SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH B1dgApB_2011.doc revised 03/16111