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B-2016-1980 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: i CONTRACTOR: PERMIT NO:B-2016-1980 10601 S DE ANZA BLVD CUPERTINO,CA 95014-4451(359 18 061) KENT DENG CONSTRUCTION SAN FRANCISCO,CA 94112 OWNER'S NAME: FRANGADAKIS KENNETH AND ANGEL*1 TRUSTEE& DATE ISSUED:05/23/2016 OWNER'S PHONE:408-507-3560 PHONE NO:(415)308-8628 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lic.#Z78689 Contractor KENT DENG CONSTRUCTION Date 11/30/2016 X BLDG _'ELECT _PLUMB MECH_RESIDENTLAL X COMMERCIAL I hereby affirm that I am licensed under the provisions of Chapte'r 9(commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. JOB DESCRIPTION: SUITE 306,T.I.-REMODEL 500 SQ FT;INSTALL WASHER AND I hereby affirm under penalty of perjury one of the following two declarations: DRYER-LUX HEALTH CARE&ACUPUNCTURE t. I have and will maintain a certificate of consent to self-ins are for Worker's Compensation,as provided for by Section 3700 of the Lat or Code,for the REV#1-CHANGE MODEL DRYER,CHANGE 220 V TO 110 V FOR performance of the work for which this permit is issued. DRYER,REMOVE AND RETURN AIR DUCT FROM SCOPE 2: 1 1 have and will maintain Worker's Compensation Insuran e,as provided for by BECAUSE OF(E)RETURN AIR PLENUM. Section 3700 of the Labor Code,for the performance of a work for which this ISSUED:6/06/2016 permit is issued. Sq.Ft Floor Area: Valuation:$6000.00 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 count ordinances APN Number: Occupancy Type: and state laws relating to building construction,and hereby authorize 359 18 061 A(Tenant Improvements),A(Tenant Improvements),A representatives of this city to enter upon the above mentioned property for (Tenant Improvements),A(Tenant Improvements),A inspection purposes. (We)agree,to save indemnify and keep Harmless the (Tenant hnprovements),A(Tenant Improvements),A City of Cupertino against liabilities,judgments,costs,and expenses which (Tenant Improvements),A(Tenant hnprovements),A may accrue against said City in consequence of the granting oi this permit. (Tenant Improvements),A(Tenant Improvements),A Additionally, Oe applicant understands and will comply with all on-point (Tenant Improvements) source regul tions per the Cupertino Municipal Code,Section .18. :- Signature Date PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR OWNER-BUILDER DECLARATION 180 DAYS FROM LAS D INSPECTION. I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: Issued by:Alex Vallelunea I. I,as owner of the property,or my employees with wages as their sole Date 05/23/2016 compensation,will do the work,and the structure is not' ended or.offered for sale(Sec.7044,Business&Professions Code) 2. I,as owner of the property,am exclusively contracting wt�licensed RE-ROOFS: contractors to construct the project(Sec.7044,Business&Professions Code). 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 I hereby affirm under penalty of perjury one of the following three declarations: inspection. 1. I have and will maintain a Certificate of Consent to self-it'sure for Worker's Compensation,as provided for by Section 3700 of the Lai oor Code,for the Signature ofApplicant: performance of the work for which this permit is issued. Date:6/06/2016 2. I have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of tl}l a work for which this ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER permit is issued. s. 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 beco a subject to the HAZARDOUS MATERIALS DISCLOSURE Worker's Compensation laws of California. If,after in g this certificate of I have read the hazardous materials requirements under Chapter 6.95 of the exemption,I become subject to the Worker's Compensaii n provisions of the California Health&Safety Code,Sections 25505,25533,and 25534. I will Labor Code,I must forthwith comply with such provisions or this permit shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&Safety Code,Section 25532(x)should I store or handle hazardous be deemed revoked. material. Additionally,should I use equipment or devices which emit hazardous APPLICANT CERTIFICATION air contaminants as defined by the Bay Area Air Quality Management District I I certify that I have read this application and state that the above information is willmaintain compliance with the Cupertino Municipal Code,Chapter 9.12 and correct.I agree to comply with all city and county ordinances and state laws the Health&Safety ode,Sections 25505,25533,a� L25534 relating to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree r_Qwner or authorized:age_nt:.. to save indemnify and keep harmless the City of Cupertino against liabilities, Date:6/06/2016 judgments,costs,and expenses which may accrue against said City in CONSTRUCTION LENDING AGENCY consequence of the granting of this permit. Additionally,the applicant understands I hereby affirm that there is a construction lending agency for the performance and will comply with all non-point source regulations per the Cupertino Municipal, of work's for which this permit is issued(Sec.3097,Civ C.) Code,Section 9.18. Lender's Name Lender's Address Signature Date 6/061201 C®NSTRUCTI®N PERMIT APPLICATION ... V A LMCOMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISIO 10300 TORRE AVENUE• ICUPERTINO, CA 95014-3255 (408)777-3228 m FAX(408)777-3333^ buildingC cupertino.org yr/ CUPERTttVO [:]NEW CONSTRUCTION n❑ ADDITION ❑ A TERATyIO�N/TI '/'' SIO /DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS l u 6o f J, � A I� 901), 1 jw s 10 6 APN#�3((� p ,^6 OWNER NAME PHONE E-MAIL ,tk STREET ADDRESS � A,1,ZA let 6Q09� CITY, STATE,ZIP %i Q �� � FAX CONTACT NAME J�1 5 747,QU �I d� PHONE/o oQ�_42v--7633 E-MAIL t,0-r y 1 y �+ e%SMad. C*A STREET ADDRESS 113'18 �y�� e� CITY,STATE,ZIP� T,s/� ��� (�$�31 J FAX l N ❑ OWNER ❑ OwNER-BUn.DER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER KTENANT CONTRACTOR NAME I LICENSE NUMBER LICENS TYPE BUS.LIC# 1B l !Vk/_001 COMPANY NAMW E-MAIL FAX STREET ADDRESS6 CITY,STATE,ZIP l PHONE s 151V_1nn / ARCHITECT/ENGINEER NAME pavf o� �ny LICENSE NUMBER C , _I8-7 BUS.LIC# ng COMPANY NAME �J C/ E-MAIL�qp`. vv,( � FAX qd- ?V- Wo? STREET ADDRESS t L)26p PIRV O/Dr, 3Ili I � CITY,STATE,ZIP /'�r K„� L d I Win))/- PHONE��p �fl�� DESCRIPTION F 0 G i1�►.` ,^ ✓ �� pb ri '� /Tl. V e \o `n r. rZ a f EXISTING USE PROPOSED USE CONSTR.TYPE _#STORIES USE TYPE OCC. SQ.FT. VALUATION($) EXISTG I NEW FLOOR DEMO TOTAL AREA AREA I AREA NET AREA BATHROOM KITCHEN OTHER REMODELAREA REMODELAREA REMODELAREA 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 PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECEIVE ,� TOTAL VALUATION: PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO �• #�' By my signature below,I certify to each of the following: I am the property owner or authorized WIIALAct 4rte 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 uilding construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTALIN FORMATION REQUIRED riai5 cHEcx`TYrE w.RofTltdc sim _New SFD or Multifamily dwellings: Apply for demolition permit for [) ovER THE COUNmER ❑zBUILDINc PLAN REvEw existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑ PLANNING PLANREVIEIN _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑'sTANriAitD u El 1'uBLIc woRxs form if any Hazardous Materials are being used as part of this project. J] LARGE ❑n FIRE DEPT'. _Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. ❑ MAJOR,= ❑ SANITARY SEWER ❑"EIVVIBONIVIENTAL HEALTH,. B1dgApp_2011.doc revised 06121/11 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1980 10601 S DE ANZA BLVD CUPERTINO,CA 95014-4451(359 18 06 1) KENT DENG SAN FRANCISCO,CA 94112 OWNER'S NAME: FRANGADAKIS KENNETH AND ANGELIKI TRUSTEE& DATE ISSUED:05/23/2016 OWNER'S PHONE:408-420-7633 PHONE NO:(415)308-8628 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lic.#778689 Contractor KENT DENG Date 11/30/2016 X BLDG _ELECT _PLUMB MECH RESIDENTIAL X_COMMERCIAL I hereby affirm that I am licensed under the provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. JOB DESCRIPTION: SUITE 306,T.I.-REMODEL 500 SQ FT;INSTALL WASHER AND I hereby affirm under penalty of perjury one of the following two declarations: DRYER-LUX HEALTH CARE&ACUPUNCTURE 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 Compensation Insurance,as provided for by r^•.Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$6000.00 APPLICANT CERTIFICATION I certify that I have read this application and state that the above APN information is correct.I agree to comply with all city and county ordinances Number: Occupancy Type: 359 and state laws relating to building construction,and hereby authorize 359 18 061 A(Tenant Improvements),((Tenant Improvements),( representatives of this city to enter upon the above mentioned property for (Tenant Improvements),A(Tenant Improvements),A inspection purposes. (We)agree to save indemnify and keep harmless the (Tenant Improvements),A(Tenant Improvements),A City of Cupertino against liabilities,judgments,costs,and expenses which (Tenant Improvements),A(Tenant Improvements),A may accrue against said City in consequence of the granting of this permit. (Tenant Improvements),A(Tenant Improvements),( Additionally,atiapplicant understands and will comply with all non-point (Tenant Improvements) e source reg ons per the Cupertino Municipal Code,Section 9.18. PERMIT EXPIRES IF WORK IS NOT STARTED Signature Date 5/23/2016 WITHIN 180 DAYS OF PERMIT ISSUANCE OR OWNER-BUILDER DECLARATION 180 DAYS FROM LASKrECTION. I hereby affirm,that I am exempt from the Contractor's License Law for one of the following two reasons: Issued by:Alex Vallelunea r. I,as owner of the property,or my employees with wages as their sole Date:05/23/2016 compensation,will do the work,and the stricture is not intended or offered for sale(Sec.7044,Business&Professions Code) RE-ROOFS: 2. I,as owner of the property,am exclusively contracting with licensed All roofs shall be inspected prior to any roofing material being installed.If a roof is contractors to construct the project(Sec.7044,Business&Professions Code). installed without first obtaining an inspection,I agree to remove all new materials for I hereby affirm under penalty of perjury one of the following three declarations: inspection. t. 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 Signature of Applicant: performance of the work for which this permit is issued. Date:5/23/2016 2. 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 ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER pennit is issued. 3. I certify that in the performance of the work for which this permit is issued,I HAZARDOUS MATERIALS DISCLOSURE shall not employ any person in any manner so as to become subject to the I have read the hazardous materials requirements under Chapter 6.95 of the Worker's Compensation laws of California. If,after making this certificate of California Health&Safety Code,Sections 25505,25533,and 25534. I will exemption,I become subject to the Worker's Compensation provisions of the maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Labor Code,I must forthwith comply with such provisions or this permit shall Health&Safety Code,Section 25532(a)should I store or handle hazardous be deemed revoked. material. Additionally,should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I APPLICANT CERTIFICATION will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I certify that I have read this application and state that the above information is the Health&Safety Code,Sections 25505,25533,and 25534. 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 Owner or authorized agent: 1V�t 'T II ` to enter upon the above mentioned property for inspection purposes. (We)agree LW�N to save indemnify and keep harmless the City of Cupertino against liabilities, Date:5/23/2016 judgments,costs,and expenses which may accrue against said City in CONSTRUCTION LENDING AGENCY consequence of the granting of this permit. Additionally,the applicant understands I hereby affirm that there is a construction lending agency fora rmance and will comply with all non-point source regulations per the Cupertino Municipal of work's for which this permit is issued(Sec.3097,Civ C.) Code,Section 9.18. Lender's Name Lender's Address Signature Date 5/23/2016 ARCHITECT'S DECLARATION I understand my plans shall be used as public records. CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 GUPERTINO Cti `(� (408)777-3228•FAX(408)777-3333•buildinacupertino.org. -�, ,(�J- L-lO ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION I TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS�� � ��{t R' � 1 ?ST"nA APN# 8 —'0� OWNERNAME I..__ ( ��jl ` PHONE yt11Q�f-U"t� G�� B-MAIL..I;/�-�M1r }1 lI�lEll�lpi�^ STREET ADDRESS P 0 r n„�l/� Y QTY,STATE,ZIP eupo-J'A ��! FAX CONTACT NAME(�� 1�)4!;)t J ) t PHONE A�)`/f�� -7 E-MAIL r,yd,nl STREETADDRESS r"1 [' CITY,STATE,ZIP `J Q (V FAX 0 v1 ' CA OEG13 ❑OWNER ❑ OWNER-BUILDER ❑ OWNERAOENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPHR WTENANT CONTRACTOR NAME 'l(-/kW- LICENSENUMBER�7'� ��C} LICENSE TYPE u BUS.LICR��7/I.N COMPANYNAME.►►►"�����I���""`` -1?J ^� r-��� EMAIL I ! 1I n r� FAX STREETADDRESS6 ( L I f� r0,4- CITY,STATE,ZIP.Q � �C ( PHONE `(' Jta ARCHITECT/ENGINEER NAME E�cl�V q\olri t `pu�cN LIC NSBNUMEER Bus./LIC t�9 COMPANYNAMEE-MAIL n'ryn )I(0YYFAX ,. `GV�/�J✓�j QQ U T° INI SrREETADDRESS IDRR(}3 f/_} 1 $ I . J,fo CITY,STATE,ZIP , !no �A �{�r t I_ PHONE#02_qql .�7q&�p IC it DESCRIPTION OF WORK 1�� Inp r�A AULI• 2, as d „�1� ' 7l "l EXISTING USE 1 r� PROPOSED USE� CONSTR TYPB #STORIES 2 rr r>mo- 1 O st C3 -1 � O ` D N t LOO) DEMO TOTAL EXISTG ++ NEW F /n F3 ¢ - . AREA I3�?S AREA / AREA NET AREA �I xu BATHROOM KITCHEN OTHER ,�. REMODHL AREA d REMODEL AREA RHMODUL AREA �`�Q �a a "+ a �`-- " • PORCH DHCKAREA TDTALDECK/PORCHAREA OARAGHAREAf IJDETACH '. •`'. "- `� o-� -• ❑ATTACHv- dDWELUNG UMTS ISASECONDUNIT []Yrs SECOND STORY YES BEING ADDSDI IN PRP-APPLICATION YES D+YES.PROVIDSCDPY OP Pf.ANNSR'SNAME: PLANNEJGAMN ❑NO PIANNINGAPPROVALLETTER � ''�..?#• °, 'tr ' � ,t. •'cif �' -•' By Iny signature below,I certify to each of the following: I Dun the property owner or authorized agent to act on Aa prop rty owner's behalf. I have read this application and the information 1 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 relatin to building constructiom authorize representatives of Cupertino to enter the eb ve-identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMEN AL INFORMATION REQUIRED '�'o- °'' "° ' _ ` ~'~ ` .. �LC� CI x $�' _ �i2UiIl�iP °zy sF' Q Nmg ew SFD or Multifamily dwellings: Apply for demolition permit forjOYEij TH>iCd NU TER �tllirn P.t�NAE I x. existingbuilding(s). Demolition penitis required prior to issuance of building . permit for new building. E�atllgs�� _ Ell OMAN Commercial Bldgs: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project, LA'.AR © ze x s;- '�sXa._.+ c�*,"i a'`0'3i tr�`••••��s r Y`" _Co of Plannin Approval Letter or Mectin with Planning prior to ; t •t F PY g PP g `k submittal of Building Permit application. �_..x��.••- � d �.x�. x �•, BldgApp2011.doc revised 03116111