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B-2016-2173 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2173 22342 MCCLELLAN RD CUPERTINO,CA 95014-2771(357 05 060) A TAMAM i CONSTRUCTION INC TARZANA,CA 91356 OWNER'S NAME: CHIEN MING L DATE ISSUED:06/21/2016 OWNER'S PHONE:408-290-7001 PHONE NO:(818)261-6101 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lic.#1003075 Contractor A TAMAM CONSTRUCTION INC Date 04/30/2017 X BLDG _ELECT _PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9(commencing MECH X RESIDENTIAL COMMERCIAL with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. JOB DESCRIPTION: REMODEL MSIR BATH(130 S.F.);SMALL BATH(40 S.F.);SMALL I hereby affirm under penalty of perjury one of the following two declarations: BATH(40 S.F.);POWDER ROOM(35 S.F.);AND REPLACE TILE ON i. I have and will maintain a certificate of consent to self-insure for Worker's 2ND FLOOR BALCONY(60 S.F.) Compensation,as provided for by Section 3700 of the Labor Code,for the �performance of the work for which this permit is issued. A': 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 permit is issued. Sq.Ft Floor Area: Valuation:$32000.00 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 357 05 060. 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 th rtino Municipal Code,Section 9.18. 180 DAYS FROMM—( E PECTION. Signature Date 6/21/2016 Issued by:Abby Ayende Date:06/21/2016 OWNER-BUILDER DECLARATION I 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 t. 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(Scc.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:6/21/2016 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. 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 any person in any manner so as to become subject to the material. Additionally,should I use equipment or devices which emit hazardous 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 Cupertino Municipal Code,Chapter 9.12 and exemption,I become subject to the Worker's Compensationprovisions of the the Health&Safety Code,Se tions 25505,25533,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or author_ize__d_agen APPLICANT CERTIFICATION Date:6/21/2016 I 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 Cupertino Municipal ARCHITECT'S DECLARATION Code,Section 9.18. 1 understand my plans shall be used as public records. Signature Date 6/21/2016 Licensed Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT'DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA•95014-3255 (408)'777-3228 FAX(408)777-3333 a building(a.cupertino.org �.�1 Ul/ 2 1— CUPERTINO L U/ t 5 ❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT it PROJECT ADDRESS APN# o C) OWNERNAME C 6h V PHONE, A o E-MAIL - — STREET ADDRESS�rCC CITY, STATE,ZIP Go y�J� ��C,JC�) C e �AX CONTACT NAME a h-- -. PHONE ��Q_ \ _ 1 E-MAIL - STREETADDRESS h!p` CITY,STATE,ZIP tl�p�� I� FAX — I �v I$00' rsSOj-S'1 6 ❑ OWNER ❑ OWNER-BUILDER ElOWNER AGENT ElCONTRACTOR 11CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER 1:1TENANT ® CONTRACTOR NAME y,} �^'� LICENSENUMBER 1 LICENSE TYPE )� BUS.LIC# O J COMPANY NAME (�(1 �(•,tea VJ 1 \rte V � E-MAIL S"0)30TC FAX STREET ADDRESS 5 '9� /J \-/ CITY,STATE,ZIP tIe1 AI,, PHONE ARCHITECT/ENGNEER NAME V VV LICENSE NUMBER 1 ) BUS.LIC# J 1 1 COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK 'Rth-�Q`e\ pace tb soh EXISTING USE PROPOSED USE CONSTR.TYPE I -#STORIES USE TYPE OCC. SQ.FT. VALUATION($) 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: LJ 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 ❑YESR7~CENED £ TOTAL VALUATION: PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO O� By my signature below;I certify to each of the following: I am the property owner or authorized a nt ct 09tte property wne;s behalf. I have read this application and the information I have rov'ded is correct. I have read the Description of Work and verify it is accurate. I agre comply with all applicable.local ordinances and state laws relating to ild' g struction. I authorize representatives of Cupertino to enter the abov -identi\ed property for inspection purposes. Q G `�. 6 Signature of Applicant/Agent: Date: - SUPPLEMEN AL INFORMATION REQUIRED r'iaN cxECK TYPE Rp[rriNG sLP _New SFD or Multifamily dwellings: Apply for demolition permit,for ER THE COUNTER ❑ BUILDING PLAN RES 11E existing building(s). Demolition permit is required prior to issuance of building permit for new building. �,°EAPRESS ❑ PLAN.REVIEW ,. _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑,STANDARD ❑ PJBLIC woRKS , r form if any Hazardous'Materials are being used as part of this project. ❑, LARGD ` ❑ 'FIRE DEPT,- _ Copy of Planning Approval Letter or Meetingwith Plann ng prior to submittal of Building Permit application. b ❑.MAJOR« ❑J SAniTARY SEWER DISTRICT EIVVIRO"ENTAL HEALTH B1dgApp 2011.doc revised 06/21/11