Loading...
B-2016-2075CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-2075 20667 CRAIG CT CUPERTINO, CA 95014-2912 (359 15 017) BAY AREA CUSTOM BUILDERS INC SAN JOSE, CA 95129 OWNER'S NAME: ZHOU XIAOFAN AND WANG YUMEI TRUSTEE DATE ISSUED: 06/06/2016 OWNER'S PHONE: 408-306-8003 PHONE NO: (408) 446-1200 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lic. #920644 Contractor BAY AREA CUSTOM BUILDERS INC Date 08/31/2016 X BLDG X ELECT -PLUMB MECH X RESIDENTIAL COMMERCIAL I hereby affirm that I am licensed under the provisions of Chapte% 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: NEW TEMPORARY POWER POLE (100 AMP); POLE/ABOVE I hereby affirm under penalty of perjury one of the following two declarations: GROUND t. I have and will maintain a certificate of consent to self -ins e 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. V 2. 1 have and will maintain Worker's Compensation Insuranc , as provided for by Section 3700 of the Labor Code, for the performance of the work for which this Sq. Ft Floor Area: Valuation: $500.00 permit is issued. 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 359 15 017 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 against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9'.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature n//_ / til Date 6 2016 Issued by: Abby A eti nde Date: 06/06/2016 OWNER -BUILDER DECLARATION Jaw I hereby affirm that I am exempt from the Contractor's License 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 r. I, as owner of the property, or my employees with wages a 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: 6/6/2016 I hereby affirm under penalty of perjury one of the following three declarations: I have Certificate Consent to self -insure for Worker's ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER t. and will maintain a of Compensation, as provided for by Section 3700 of the Labgr 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 ermit is issued, I Health & Safety Code, Section 25532(a) should I store or handle hazardous shall not employ any person in any manner so as to become subject to the material. Additionally, should I use equipment or devices which emit hazardous Worker's Compensation laws of California. If, after making this certificate of air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Code, Sections 25505, 25533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: APPLICANT CERTIFICATION Date: 6/6/2016 1 certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY correct. I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction 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 app'icant 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 6/6/2016 Professional GENERAL PERMIT COMMUNITY DEVELOPMENT APPLICATION DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUI • CUPERTINO, CA 95014-3255 (408) 777-3228 •FAX ( 08) 777-3333 • building(C cuoertino.org 7PLUmBING 71\4_F('HA1N1('AT. �I it ill FT T:rTR Tr AT f3 -Z0[ (P- gom Is C nt,,TTcrFTT At.TL'nTrc PROJECT ADDRESS ®/ 1 - - CL&, __ w APN # O\NNERNA>fEh 2119L, PHONE���7`�lJ STREET ADDRESS,r-©/ Cr, I C,(� CITY, STATE, ZIP _e_ V- ' F.43 CONTACT NAME n' - C.V � 5 e( PHO 4 4u _ I.� ^� E-) ZAIL STREET ADDRESS Vd 1 Wei s, � CITY, STATE, ZIP �b J�, n/,(� V `❑3 FAX ID OWNER ElHR OR-BUILDER ❑ OR?.*ERAGENr 1:1CO?TRACTOR 1:1 CONTRACTOR AGENT ARCHITECT ❑ ENGLIMIR ❑ DEVELOPER ❑ TE:..ANT CONTRACTOR "'CAA,)" IQ 5 n Ck ICA, C h 0,* LICENSE NT SER LICKS 'PE I BUS. LIC n 3 } CQ oC 11 W COAIP.AN A) 4E t a e'2 GaS l� r E-MAIL 6 -, FAX STREEET A DRESS CITY, STATE, ZIP , NE PHONE L v e C RS12 ARCHTTECT/ENGLNEERNAME I LICENSE NUMBER BUS. LIC= COMPANY NAME E-?vLAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD or DUPLEX ❑ MULTI -FAMILY PROJECT LN WILDLAN'D ❑ )as PROJECT IN ❑ YES ! IS THE BLDG AN ❑ YES BUILDLNG: ❑COAIT',ERCIa.L TJRBA. INTERFACE AREA ❑ NO FLOOD ZONE ❑ NO I EICHLERHOME? ❑ NO DESCRIPTION OF \YORK �ew'Lweir e C�c� �t - above >c TOTAL VALUATION: ,: RECEIVED BY..: By my signature below, I certify to each of the following: I am the properly owner or authorized agent to act on the property owner's behalf. I have read this application and the information 1 have provided is I havie read the Description of Work and verify it is accurate. I agree to comply with all applicable local �cc000rrr�ect. I authorize ordinances and state laws relating to building cony representatives of Cupertino to enter the above -identified property for inspection purposes. /. Signature of Applicant/Agent: Date: E) C5 SUPPLEIvIE"TTAL INFO 1ATION REQUIRED x. ❑ 01 ER THE i. :� EJ.PRESS 4kSTAI�33 ARD err ti "' ' yry. �J, r RGE rft cX P. -U`PA'iscApp-2011.doc revised 06/21/11