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14060209CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19160 TWIG LN CONTRACTOR: JEREMY MAO INC PERMIT NO: 14060209 OWNER'S NAME: LIN FELIX CHANGMIN AND RUBY C 13212 CARRICK ST DATE ISSUED: 12/01/2014 OWNER'S PHONE: 4082658668 SARATOGA, CA 95070 PHONE NO: (408) 449-9942 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL E] CONSTRUCT 2ND UNIT 505 SQ FT 2 License Class_ Lic. # CN p � 7 � �" Contractor .1 SK� 7 MAO INC . Date 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. I hereby affirm under penalty of perjury one of the following two declaration,: 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. Sq. Ft Floor Area: Valuation: $55000 I have and will maintain Worker's Compensation Insurance, as provided for by ApN Number: 37508021.00 Occupancc I) pe: Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. IAq. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXP RK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 D Y PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS FRO AST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the Issued by: Date: granting of this permit. Additionally, the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code, Section 9.18. Signature �� Date !�� RE-ROOFS: 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 inspection. ❑ OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER I, as owner of the property, or my employees with wages as their sole compensation. will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(a) should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25505, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this ft ��� Owner or authorized agent: Date: ' permit is issued. 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 become subject to the Worker's CONSTRUCTION LENDING AGENCY Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 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 and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION g 10300 TORRE AVENUE •'CUPERTINO, CA 95014-3255 B10 imam (408) 777-3228 • FAX (408) 777-3333 • building() cuDertino.org CUPERTINO r-1 r—I 11 /71L'LT:4A1Zr) nRTC: AL r LRMIT n LNEW CONSTRUCTION LJ ADDITION ALIE7RAIIVIS/ II u— rL PROJECT ADDRESS 1 � (% O -TVJ 1 6J L hrN � ` f1 APN 9 ':7 i-�- � 9 Pc �B�-E} lr1 `E ` " V OWNERNP.ME ' — t PHONE .0 --MAIL_ , Z/OL STREET ADDRESS o4 p N a �j CITY, STATE, ZIP C ` 9f 2-0' FAX '/ Y6 �.s'i�'e lLC G� Jja��� cJ C�S� C.A % COT'TACT NAME ' `1 Mkt �z ` f� j PHO? L _ i4r Q. E-MAIL�'NI CY1 ® �N1A9 fCv 41 STREET ADDRESS { l VI t j� �j CrrY, S ATE ZIP C�uv / /7 � � F J t _ O L�. ❑ OwNER ❑ OWVNER-BUILDER ❑ OWNERAGENT ❑ CONTRACTOR 13CONTRACTOR AGENT ARCHITECT ❑ ENGD.'EER ElDEVELOPER ❑ TENANT CONTRACTOR NAME I LI CENSE NUMBER LICENSE TYPE BUS. LTC N COMPANY NAME E-MAIL F < X STREET ADDRESS CITY, STATE, ZIP PHONE GINEER NAME LICENSE NUA�ER BUS. LIC CHITE COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE WORK DESCRIPTION OF 7t U r 1 EXISTING USE PROPOSED USE CONSTR TYPE : STORIES + + l � ..Z L`SE TYPE OCC. SQ.FT. VALUATION (5) In � 12—( V 1 `��//��� DEMO TOTAL NET ARE - NEWFL/O,O'Rii AREA �1�`f L-,� �O� p0� T"f' AREA `- - O � �- � a ! EA 1AZ KITCHEN OTHER REMODEL AREA. REN,ODEL AREA /,a� (�j OOGL DECK AREA TOTALDECK/PORCH AREA GARAGE AREA: DETACHl� �.rrrracxof C� \ •ry oU\ Q D� >�. UNITS' IS A SECOND UNIT S SECOtiD STORY ❑YES BEING ADDED? NO ADDITION? ❑NO 2 BLDG.iv YES GEi1rEDBY . }' TOTAL VALUATION: Y' _ PLANNING APPL R ❑ N PLAA't�°D1CZ,APPROVALLETTER EI HLER HOME? []NO "*,� �e 19 MIN 170-70 b_q 0 11 By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this it is I armee to comply with all applicable local application and the information I have provided is correct. I have read the Description of Work and verify accurate. Cupertino to enter the above -identified property for inspection purposes. ordinances and state lavas relating to_buihiing construction. I authorize representatives of S ienature of App] icanUAgent: Date. co 7,"' SUPPLEMENTAL INFORMATION REQUIRED Ro u.c $IW4 New SFD or Multifamily dvlellings: Apply for demolition pelTnit for IF VON o BT3�_ existing building(s). Demolition permit is required prior to issuance of building - _ = permit for new building. ��PRsS Y ps n Nt,rG Lin• mq KK' Bldgs: Provide a completed Hazardous Materials Disclosure PGS UBL �YORI 4�s ;�`Rn � �� _Commercial form if any Hazardous Materials are being used as part of this project. � fl � 3 ^•rx� ra`Yti —Copy of Planning Approval Letter or Meeting with Planning prior to ©R ;ITSRI crRnle. M s� submittal of Building Permit application. 2 ,:'. Bldg4pp_2011.doc revised 06/21/11 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19160 TWIG LN CONTRACTOR: JEREMY MAO INC PERMIT NO: 14060209 OWNER'S NAME: LIN FELIX CHANGMIN AND RUBY C 13212 CARRICK ST DATE ISSUED: 12/01/2014 O ER'S PHONE: 4082658668 SARATOGA, CA 95070 PHONE NO: (408) 449-9942 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ _ License Class_ Lic. # In 1 7 CONSTRUCT 2ND UNIT 505 SQ FT 1/2/14 - REV #1 - ADD ADDITIONAL 21 SQFT TO GUEST Contractor 1/2/14 - REV #1 - ADD ADDITIONAL 21 SQFT TO GUEST RM IN IST UNIT & I hereby affirm that I an licensed under the provisions of Chapter 9 RELOCATE WATER HEATER LOCATION TO OUTSIDE UNIT 2 (commencing with Section 7000) of Division 3 of the Business & Professions BEDROOM -NEW TOTAL 526 SQFT- ISSD 1/15/15 Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: 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 Sq. Ft Floor Area: Valuation: $55000 performance of the work for which this permit is issued. 1 have and will maintain Worker's Compensation Insurance, as provided for by Section 37000f the Lab r Code, for the performance of the work for which this APN Number: 37508021.00 Occupancy Type: permit is issued. A PLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS FRO I D INSPECTIO . indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply Mate: with all non -point source regulations per the Cupertino Municipal Code, Sectio t/1G,_ 9.18. ROOF Signature /�% Date l ��� any r All roofs shall be inspected prior to y roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. ❑ OWNER -BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(a) should I store or handle hazardous I have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25505, 25533, and 25534. !` Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: Date permit is issued. _�?i✓ G� 1 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 become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 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 and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date UTILITY RELEASE REQUEST FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL CUPERTINO 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building aacupertino.org I a11.7all,I 1 For residential single family or duplex construction, there are cases where gas and electric utilities are requested to be released prior to the issuance of the certificate of occupancy. Upon approval from the building inspector, the City of Cupertino is allowing both utilities to be released prior to the final sign -off of the building. INSTRUCTIONS 1. Download this format: http://www.cupertiiio.org/index.as . x?page=297. 2. Complete the form and obtain signatures from both the owner of the property and the primary contractor. 3. Fax, E -Mail, Mail or hand deliver the original signed form to: City of Cupertino Building Division Attn: Utility Release Request Form 408-777-3228 office 10300 Torre Ave. 408-777-3333 fax Cupertino, CA 95014 buildingLwcupertino.org 4. Schedule a Gas Meter Release inspection (#403) and/or Electric Meter Release inspection (#404). Please note, a Gas Test inspection (#506) is required prior to or at the same time of the Gas Meter Release inspection. BUILDING INFORMATION (Please complete the following information): APN BLDG PERMIT #: DATE: -6 SITE�-• ADDRESS (�%' `w "� .Y L �t (�i I�rdt �`1 t� 95 Z OWNER'S NAME:: 'i `� (r` `✓� FAX # PHONE #' �e� e?too MAILING ADDRESS (if different from site address): `?v��S' r-jc-c�fS •f� � � or,l� 3-0 C'iq 91s ..sevn CONTRACTOR:.�-- PHONE #: FAX #: p CONTACT: �9� PHONE #: FAX #: �1 — !� _ 1S /� I request the City to release my utilities prior to obtaining a final inspection approval for the building. I fully understand the occupants of the building cannot move into the residence until they receive all of the required final sign -offs and the City has issued a certificate of occupancy for the building. Owner:..... ..�::z°::.............................. ............................. Print:..�.�=::.`'".�.�.......�"'..r�............................. Date:.S...�.�f.G.'�..`.... Contractor: ..w ................. ---....'"sf-'...... 1 ................... Print:..... ......................... Date: .. ('.... UtilhtvReleaseForm_2011.doc remised 08/09111 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS: , j `6D GeU' PERMIT # 14CO6o ipl6o �1 OWNER'S NAM t v PHONE # 4,0,a- - 2 - GENERAL CONTRACTOR: �" QC-' GENERAL BUSINESS LICENSE # ADDRESS: CITY/ZIPCODE: $� /ZA7v G,+ 9 - D *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: Owner / Contractor Signature 0!!�// e� --�--�/C Date Z;2- SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating 5 cc Zs-�2-7 Insulation Landscaping Lathing Masonry Painting / Wallpaper FtjS s AtAj � &v/-v,�V F/c®1pAl 3 Plastering Plumbing Roofing C s j2 iso 2 2 Septic Tank Sheet Metal Sheet Rock Pq VV4j .1,4jC . Tile Owner / Contractor Signature 0!!�// e� --�--�/C Date Z;2-