B-2016-2101 CITY OF UPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2101
20649 CELESTE CIR UNIT 20649 CUPERTINO,CA 95014-0480(826 58 007) CABINET&STONE
EXPO INC
SAN JOSE,CA 95131
OWNER'S NAME: WANG CHUNYEN DATE ISSUED:06/09/2016
OWNER'S PHONE:408-573-7888 PHONE NO:(408)573-7888
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#980995
Contractor CABINET&STONE EXPO INC Date 02/28/2017 X BLDG —ELECT _PLUMB
I hereby affirm that I am licensed under the provisions of Chaptelr 9(commencing MECH X RESIDENTLAI,_COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
Convert full wall in loft to 42 inch wall.
I hereby affirm under penalty of perjury one of the following two declarations:
1. I have and will maintain,,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. 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
permit is issued. Sq.Ft Floor Area: Valuation:$3000.00
APPLICANT CERTIFICATION
I certify that I have read this application and state that the abov e
information is correct.I agree to comply with all city and county ordinances 26 Number: Occupancy Type:
3
and state laws relating to building construction,and hereby authorize 326 58 007
representatives of this city to enter upon the above mentioned property for
inspection purposes. (We)agree to save indemnify and keep harmless the
City P 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 o�this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant unde stands an ill comply with all non-point
source regulations per the o icP.a section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 6 /2016 Issued by: SEAN HATCH
Date:06/09/2016
O ER-B R DECLARATIO
I hereby of rm that I am exempt from the Contractor's License Law for one of the RE-ROOFS: a
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
i. 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. 1,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:6/9/2016
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. 1 will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
3. I 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
shall not employ in manner so as to become subject to the material. Additionally,should I use equipment or devices which emit hazardous
p y an y person any air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the ' o u iT"paT-Code;Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&S ode,Sections 25 r',25533 and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Ownero uthorized agent:
APPLICANT CERTIFICATION Dat • 20 661-7
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 applicant understands
and will comply with all non-point source regulations per the Ctlapertino Municipal ARCHITECT'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Licensed
Signature Date 6/9/2016 Professional
CONSTRUCTION PERMIT APPLICATION
4 h COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 -
(408) 777-3228• FAX(408)777-3333 • building(a)cupertino.org
CUPERTINO
❑?\�,W CONSTRUCTION ❑ ADDITION ALTERATION/T1 ❑ REVISION/DEFERRED ORIGINAL.PERMIT
PROJECT ADDRESS APN n
OVNERNAMME ` C/ /f I PH XE 7 3- � I E-1,ZAIL
STRFETADDR-ESS n/ _!y ( CITY, STATE;ZIP FAX
Z 6 cf•9 GC,CZ—S[�� G f.2' I Gr.(DLit//�✓J
CONTACT NAME �� P ONF p `� I E-T24IL
O/"\
STREETADDRESS CITY,STATE, ZIP FAX
l A- SA,v 'SosC— c 3
❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENTONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME LICENSE NUTIEER LICENSE TYPE BUS.LIC
(o✓� 2 c( S
COMPANY NA'M E-MAIL FAX
STREETADDRESS Q _ CITY,STATE,ZIP PHONE_
ARCHITECTlENGINEER NAME LICENSE NUMBER -- BUS.LIC r—
COMPANY NAME E-!\6 AIL FAX
STREET ADDRESS CITY,STATE.ZIP y PHOT'E —
DESCRIPTION OF-WORK
I
EXISTING USE PROPOSED USE CONSTR.TYPE 'STORIES
USE TYPE OCC. SQ.FT. VA.LliATIO?\(S)
EXISTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NETAREA
BATHROOM KITCHEN OTHER
REMODELAREA REMODEL AREA REMODELAREA
PORCH AREA DECI::.REA TOTAL DECK/PORCH AREA GAR AGE AREA: DETACH
❑ATTACH
DWELLING LTITS: IS A SECOND UXiT ❑}'ES SECOND STOR}' YES
BEING ADDED? E]NO ADDITION? ❑1'�O
PRF-APPLICATION ❑Y•ES IF Y' S,PROVIDE COPY OF IS THE BLDG AN F]YES RECEI��D B] `" y `" OTSL VALL?ATION:
PLANNG APPL= ❑NO PLANNING APPP.OV.AL LETTER EICHLER HOME? ❑NO
m - 0-0c)
By my signature below,I certify to each ofthe folloWine: I a the property owner or authorized anent to act on the property owner's behalf. I have read this
application and the information I have provided l correct,, ave.read t .D.espription of fork and verify it is accurate. I agree to comply}vith all applicable local
ordinances and state laws relating to buildine•c6h!fi io I authoriz epresentatives of-Eupertino to enter the abo//ve-identined property,for inspection purposes.
Signature of Applicant/Agent`'-- - / Date: C� (G
S&P 4ATION REQUIRED
I\Te« SFD(TQultifamily dwellings: Apply for demolition permit for
M O)ERTITECOTI\TERw < SUILDI\GPL3\REYIE}T
existing building(s). Demolition pelTnit is required prior to issuance of building a S
permit or new building. ❑ s ❑ ti =:
ElTRESS � pL \\L\GPA�RE�IE}p r: z
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure sTAmaRD � r5 ❑ PLELTc]6oRTt� �
form if any Hazardous aterials are belly used as Dart of this project. a
❑ L'-�RGaEA � .e� � � � .❑3 F�II2E DEPT �� ': � �s 4 x
Copy of Planning Approval Letter or 1`4eeting with Planningprior to
❑ hSAIOR v L—I S4�IT4R]SE}1ERDISTRICT
submittal of Building Permit application.
❑.E\}"IRO\1iE?�T.AL HEALTH.w_t;.;
Bldg pp_2011.doc revised 06/21/11
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
C U P E RT I N O Telephone: 408-777-3228
Fax: 408-777-3333
CONTRACTOR/SUBCONTRACTOR LIST
JOB ADDRESS: '21 p _ L G,A , PERMIT#
OWNER'S NAME: PHONE#
GENERAL CONTRACTOR: 4Jo:7 BUSINESS LICENSE# 3
ADDRESS: (0,0( _ ,At-/C— CITY/ZIPCODE:
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INS P CTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SU�BCONT TAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
Signature Date
Please check applicable su ntractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring/Carpeting
Linoleum/Wood
Glass/Glazing
Heating
Insulation
Landscaping
Lathing
Masonry I
Painting/Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
i