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B-2016-2524CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRESS: CONTRACTOR: PERMIT NO: B-2016-2524 21921 HERMOSAAVE CUPERTINO, CA 95014-2863 (357 16 108) WU'S CONSTRUCTION OAKLAND, CA 94607 OWNER'S NAME: ZHANG MING AND XIAO XUELIAN TRUSTEE & ET A DATE ISSUED: 09/19/2016 OWNER'S PHONE: 408-618-9911 PHONE NO: (510) 213-1807 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class GENERAL BUILDING CONTRACTOR Lic._ #961913 Contractor WU'S CONSTRUCTION Date 46/30/2017 X BLDG X 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: KITCHEN REMODEL - M,E,P (155 S.F.); REMODEL 2 SEPARATE I hereby affirm under penalty of perjury one of the following two declarations: BATHROOMS - E,P 2ND FLOOR MSTR BATHROOM (81 S.F); 2ND i. I have and will maintain a certificate of consent to self -insure for Worker's FLOOR BATHROOM REMODEL (57 S.F.); REPLACE (4) WINDOWS; Compensation, as provided for by Section 3700 of the Labor Code, for the ADD (2) SOLAR TUBES; REMODEL (165 S.F.) - performance of the work for which this permit is issued. REV#1 - IDENTIFY SIZE OF MAIN PANEL AND LOCATION OF z. = I have and will maintain Worker's Compensation Insurance, as provided for by SUBPANEL - ISSUED 12/7/2016 Section 3700 of the Labor Code, for the performance of the work for which this REV #2 - UPGRADE PANEL (200 AMP) - ISSUED 12/15/2016 permit is issued. Sq. Ft Floor Area: Valuation: $25000.00 APPLICANT CERTIFICATION 1 certify that I have read this application and state that the above APN Number: Occupancy Type: information is correct. I agree to comply with all city and county ordinances and state laws relating to building,construction, and hereby authorize 357 16 108 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. Additionally, the applicant understands and will comply with all non -point WITHIN 180 DAYS OF PERMIT ISSUANCE OR source regulations per the Cupertino Municipal Godee,,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. o Si6natu 04to - Date 12/15/2016 Issued by: ABBY AVENDE . Date: 09/19/2016 OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the R&ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is 1. 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. 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: 12/15/2016 I hereby affirm under penalty of perjury one of the following three declarations: u. I have and will maintain a Certificate of Consent to self -insure for Worker's ALL ROOF COVERINGS TO BE C4ASS "A" OR BETTER Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. _H R OUS M I S DISCLOSURE z 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 theperformance 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 s. 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 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 exemption, I become subject to the Worker's Compensation provisions of the will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and 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: 12/15/2016 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 applicant understands and will comply with all non -point source regulations per the Cupertino Municipal ARCHMCT'S DECLARATION Code, Section 9.18. 1 understand my plans shall be used as public records. Signature Date 12/15/2016 Licensed Professional ❑ NEW CONSTRUCTION CONSTRUCTION PERMIT APPLICP 'StO^# Y ---- COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 •FAX (408) 777-3333 • building ('a-)cupertino.org 11r.�7,r� ElADDITION ❑ ALTERATION / TI VISIO / DEFERRED ORIGINAL PERMIT PROJECT ADDRESS !� 2- ( �� n�n�� � A vz )42-( a OWNER NAME/1 AA, 6!a��LV� PHONE ! L / p E MAII CY% rt� STREET ADDRESS � � 1 �G�--lp� CITY, STATE, ZIP C CA po- ( FAX CONTACT NAME PUrA ®1 Ig PHONE ! / !l u t/ EMAIL dvaa � rlIma 0/9 ( J`i STREET ADDRESS 'IWNER-B./UILDEER❑ (AGENT CITY, STATE, ZIP C' A 710G+vi{F(iTAX+ f /❑ (ARCHITECT 0 OWNER ❑ O` owNER ❑ CONTRACTOR ❑ CONTRACTORAGENT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME / j f n �i- t� f y /; �! ( W d LICENSE NUMBER -7 LICENSE TYPE BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME L® /� ( , t LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK tv EXISTING USE PROPOSED USE CONSTR. TYPE I #STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG AREA NEW FLOOR AREA DEMO AREA TOTAL NET AREA BATHROOM REMODEL AREA KITCHEN REMODEL AREA OTHER REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH ARE 1 GARAGE AREA: DETACH ❑ ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES BEING ADDED? ❑ NO SECOND STORY_ ❑ YES ADDITION? [:]NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER IS THE BLDG AN ❑ YES EICHLER HOME? ❑ NO RE D BY[ TOTAL VALU N: - By my signature below, I certify to each of the following: I am the property owner or authorized agen to act on the 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 dd—prooperty for inspection purposes. ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above-identified Signature ofApplicant/A : �� f�+J / -746 SUPPLPEMENTAL INFORMATION REQUIRED New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. Commercial Bldgs: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project. Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. PLAN CHECKTYPE ROUTING SLIP ❑ OVER THEi _COUNTER ❑ EXPRESS ❑ STANDARD ❑ LARGE Q MAJOR ❑ BUILDING PLAN mgFw ❑ PLANNING PLAN REVIEW ❑ PUBLIC woRKs ❑ FIRE DEPT ❑ SANITARY SEwERDISTRICT ❑ ENVIRONMENTAL HEALTH BldgApp 2011.doc revised 06121111 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21921 HERMOSAAVE CUPERTINO, CA 95014-2863 (357 16 108) OWNER'S NAME: MANG MING AND XIAO XUELIAN TRUSTEE & ET A OWNER'S PHONE: LICENSED CONTRACTOR'S DECLARATION License Class GENERAL BUILDING CONTRACTOR Lic. #961913 Contractor WU'S CONSTRUCTION Date 06/30/2017 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 declarations: 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 -performance of the work for which this permit is issued. 2: 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. APPLICANT CERTIFICATION 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 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 with all non -point sourge regulations per the Cupertino Municipal Code, Section 9.18. Signature , )��--\ Date OWNER-BUH.DER DECLARATION CONTRACTOR: PERMIT NO: B-2016-2524 WU'S CONSTRUCTION OAKLAND, CA 94607 DATE ISSUED: 09/19/2016 PHONE NO: (510) 213-1807 BUILDING PERMIT INFO: X BLDG —ELECT —PLUMB _ MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: KITCHEN REMODEL - M,E,P (155 S.F.); REMODEL 2 SEPARATE BATHROOMS - E,P 2ND FLOOR MSTR BATHROOM (81 S.F); 2ND FLOOR BATHROOM REMODEL (57 S.F.); REPLACE (4) WINDOWS; ADD (2) SOLAR TUBES; REMODEL (165 S.F.) REV#1 - IDENTIFY SIZE OF MAIN PANEL AND LOCATION OF SUBPANEL -ISSUED 12/7/2016 Sq. Ft Floor Area: I Valuation: $25000.00 "N Number: Occupancy Type: 357 16108 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by . dd Date: 09/19/2016 I hereby affirm that I am exempt from the Contractor's License Law for one of the I 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 I inspection. sale (Sec.7044, Business & Professions Code) 2. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: 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 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 3: 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 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 forthwith comply with such provisions or this permit shall be deemed revoked. 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 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 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 with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous 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 the Health & Safety Code, S ctions 25505, 25533, and 2557 55 4. Owner or authorized agen .� Date: L CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall, be used as public records. Licensed Professional CONSTRUCTION PERMIT APPLICATION �VfSIQN # COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVIS ON 10300 TORRE-AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building&cupertino.org U NEW CONSTRUCTION U ADDITION PROJECT ADDRESS ALTERATION / TI ❑ REVISION/ DEFERRED ORIGINAL PERMIT # APN # OWNERNAME ��7 pi 1 os „r) J PHONE O,,, % /Q" 1? // EMAIL /e � 7rt(, STREET ADDRESS /fir \� }�J `9� CITY, STATE,, ZIIP[J CSS (l l /Q�c©( CA � ( FAX CONTACT NAME A! �2AR" V PHONE *6�� E-MAIL9 STREET ADDRESS *( CITY, STATE, ZIP FAX 5A -o 4 -6t1 .® OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAMEpw f f WLICENSE NUMBER LICENSE TYPE BUS. LIC # E-MAIL CITY, STATE, ZIP LICENSE NUMBER E-MAIL CITY, STATE, ZIP -0,1141 ( 6 c a-11-Tm PE #STORIES USE EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA I DECK AREA I TOTAL DECK/PORCH AREA I GARAGE AREA: DETACH ❑ ATTACH FAX PHONE BUS. LIC # FAX 121101Vd TYPE I OCC. I SQ.FT. I VALUATION ($) # DWELLING UNITS: COMPANY NAME SECOND STORY ❑ YES STREET ADDRESS ARCHITECT/BNGINEERNAME Ho gg COMPANY NAME STREET ADDRESS DESCRIPTION OF WORK C.V ADDITION? [:]NO E-MAIL CITY, STATE, ZIP LICENSE NUMBER E-MAIL CITY, STATE, ZIP -0,1141 ( 6 c a-11-Tm PE #STORIES USE EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA I DECK AREA I TOTAL DECK/PORCH AREA I GARAGE AREA: DETACH ❑ ATTACH FAX PHONE BUS. LIC # FAX 121101Vd TYPE I OCC. I SQ.FT. I VALUATION ($) # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING ADDED? []NO ADDITION? [:]NO PRE -APPLICATION ❑ YES - IF YES, PROVIDE COPY OF PLANNINGAPPL# ❑NO PLANNING APPROVALLETTER IS THE BLDG AN ❑ YESRE EICHLERHOME? ❑NO NED BY: TOTAL VALUA�ON: By my signature below, I certify to each of the following: I am the property owner or authorized agent to Nct on A 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 to building con Iction-cntCho resentatives of Cupertino to enter the above -identified property or inspection purposes. Signature of Applicant/Agent: Date: 2 /,5- I i o l SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP OVER-THE-COUNTER ❑ EXPRESS ❑ BUILDING PLAN REVIEW ❑ PLANNING PLAN REVIEW _ New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. _ Commercial Bldgs: Provide.a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ F1 ]RE DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. ❑ MAJOR ❑ sANrrARY SEWERDISTRICT ❑ .ENNIIRONAIENTALHEALTH BldgApp_2011.doe revised 06/21/11 CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRESS: CONTRACTOR: PERMIT NO: B-2016-2524 21921 HERMOSAAVE CUPERTINO,,CA95014-2863 (357 16 108) WU'S CONSTRUCTION OAKLAND, CA 94607 OWNER'S NAME: ZHANG MING AND XIAO XUELIAN TRUSTEE & ET A OWNER'S PHONE: 408-618-9911 LICENSED CONTRACTOR'SD R TION License Class 13 Lie. #981913 Contractor WU'S CONSTRUCTION Date 06/30/2017 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 hgrglyy affirm under penalty of perjury one of the following two declarations: i. 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. 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. 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 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 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 with all non -point source regulations per the Cupgrtino Mgnicipal Code, Section 9.18. 11-V Date 9-19-2016 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1. 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) 2. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: 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 performance of the work for which this permit is issued. 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. 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 become subject to the Worker's 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 forthwith comply with such provisions or this permit shallf be deemed revoked. 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 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 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 with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date 9-19-2016 ISSUED: 09/19/2016 PHONE NO: (510) 213-1807 BUILDING PERMIT INFO: X BLDG —ELECT _ PLUMB _ MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: KITCHEN REMODEL - M,E,P (155 S.F.); REMODEL 2 SEPARATE BATHROOMS - E,P 2ND FLOOR MSTR BATHROOM (81 S.F); 2ND FLOOR BATHROOM REMODEL (57 S.F.); REPLACE (4) WINDOWS; ADD (2) SOLAR TUBES; REMODEL (165 S.F.) Sq. Ft Floor Area: l Valuation: $25000.00 "N Number: Occupancy Type: 357 16 108 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT"ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. by: Kim Dunbar RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature ofApplicant: Date: 9-19-2016 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and _ the Health & Safety Code, Sections 25505, 25533, and 25534. Owner or authorized agent: T—� v 4 Date: 9-19-2016 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARC HITE T' DECLARATION I understand my plans shall be used as public records. Licensed Professional �CUP1=RTINO ^ry t 1 NF.W VnWRTRTTCTTOM CONSTRUCTION PERMIT ;APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (4108) 777-3333 • buildinq�"ia,cupertino.oEg MATITIITICIM I g 1 AT TPR ATTnM 1 TT F1 RTi7T1Q1n7J / TlV99T1'Q r1Tl 1�-Zote-2-s2q n177MMAT DT7T77,ATT74 PROJF.CTADDRESS 21921 Hermosa. Ave 7APN3571.6108 OWNER.NAME Ming Zhang .PHONE (40$)61$-9911 &MAIL D. ed..mingzhang@grriail.com. STREET ADDRHSS21921 Hermosa Ave CITY, STATE, ZIP Cupertino, CA 95014 FFAX CONTACT NAME. Hong Chen - PHONE (310)384-2703 E-MAIL hong.chan502@gmaii.com STREET ADDRESS 2625 Middlefield Rd #683 CITY, STATE, "Palo Alta, CA 94306-2516:E: 13 OWNER ❑. OWNER -BUILDER ❑ 0WNERAGENT n CONTRACTOR ❑ CONTRACTOR AGENT 13 ARCHITECT El ENGINEER Il DEVELOPER ❑ TENANT CONTRA..CT.QIi_NItiN1.E) •. I J LIC .NSCNUtv1_BEtt f g I LICENSFTVTF HUS, LIC __ ^ COMPANY-`NAM11— &MAT. =� FAX STREET;ADDREq%,, /I/I l� A j(� �� 1)' (V/ I CITY STATEI.ZIP /� q = /VJ PHONE ARCHITECTIENOINEERNAME Qlang Xlao LICEN5ENUMBER 5.5289 BUS. LIC (/ COMPANYNAMEAQX Engineering Inc E-MAIL hong.chen502@gmiil.com FAX STREET ADDRESS 2825 Middlefield Rd #683 CITY, STATE, ZIP Palo Alto, CA 94306-2516 PHONE (310)384-2703 _DESCRIPTION OF -WORK ,- _, --' 1 st floor: remodel the kitchen, add a new window to dining, enlarge the kitchen window, remove the laundry wall 2nd floor: convert open space to a new bedroom, enlarge and remodel bath 2, master bath, and walk-in closet EXISTING USB R3 PROPOSED USE R3 VB CONSTRYP . TE 8 11IRS USE TYPE OCC. SQ.FT. VALUATION($) EXISTG ' AREA 2445 NEW FLOORn AREA u. DEMO AREA 0 TOTAL NETAREA BATHROOM REMODELAREA 138 KITCHEN REMODLLAREA 158. I- OTHER+ g REMODELAREA PORCH AREA I DECK AREA I TOTAL DFCK/PORCH AREA GARAGE AREA; DETACH 151 1542 ® 1693 ATTACH I It DWELLING UNITS: ISASECUNDUNIT DYES SECONDSTORV DYES 1 BEING,ADDED? ANO ADDITION? DNO PRF -APPLICATION ❑YES IF YRS, PROVIDE COPY OF 1STHRBLDGAN 11 YES `,$ EIV.ED BY .., 'QTA�]LVV�ALUATION: PLANNINGAPPL# jDNO PLANNINOAPPROVAL LETTER EICEILER ITOME? ONO By my signature below, I certify to each of the following: I am the property owner or authorized agent to act an the 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 to building construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicanl/Agent: • Date: 08/1412016 SUPPLEMENTAL INFORMATION RE UIRED Q PLANCHECKTYPffi.' - ROUTINGSLTP', ovER TcieoliNsEn iBUILDING HLAN REYMEW41CYt: Now SRD or Multifamily dwellings: Apply for demolition permit for eXlsting'building(s): Demolition permit is required prior to issuance Of building .. -,�,� - penult for new building. O : ExaREss t\d' PLAN14rNG PLAN REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 0.-S'TANVAIio form if any Hazardous Materials are being used as part of this project. ..0 . L212GE' FIRE ]DEPT, _ Copy of Planning Approval Letter or Meeting with Planning prior to Q MAIDR: ' I]' $ANITARYSEWERDTSTRICT suUmittalofBuildingPermitapplication, ENWROi4MENTALHEALTU:' B1dgrApp_2Q11,doe revised 06121111 --