B-2016-1717CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-1717
20790 HANFORD DR CUPERTINO, CA 95014-1$24 (326 30 065)
B L BUILDERS INC
REDWOOD CITY, C
94061
OWNER'S NAME: VAN BUREN JUSTIN LU AND ZHANG YU
DATE ISSUED: 09/30/2016
OWNER'S PHONE: 415-830-7144
PHONE NO: (650) 363-2300
LICENSED CONTRACTOR'S DECLARATION ARATION
BUILDING PERMIT
INFO:
License Class a Lie. #659504
Contractor B L BUILDERS INC Date 05/31/2017
X BLDG _ ELECT
_PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
MECH X RES
ENTIAL COMMERCIAL
with Section 7000) of Division 3 of the Business & Professions Code and that my
license is in full force and effect.
JOB DESCRH'TI
N:
CONSTRUCT 2 ST
DRY SFD, (3195 S.F.), FRONT PORCH (52 S.F.),
I hereby affirm under penalty of perjury one of the following two declarations:
REAR PORCH (67
.F.), ENCLOSED PORCH (132 S.F.) WITH
1. I have and will maintain a certificate of consent to self -insure for Worker's
ATTACHED GARA
GE (479 S.F.)
-ompensatiop, as provided for by Section 3700 of the Labor Code, for the
nance of the work for which this permit is issued.
REV#1 -ISSUED 12/22/2016
z. have and will maintain Worker's Compensation Insurance, as provided for by
1. REMOVE STONE
VENEER FROM FRONT ELEVATION AND
Section 3700 of the Labor Code, for the performance of the work for which this
CHANGE FIBER GLASS
COLUMNS TO SQUARED STUCCO
permit is issued.
COLUMNS
APPLICANT NT RTIFI ATION
2. REMOVE GRID
FROM ALL WINDOWS
I certify that I have read this application and state that the above
3. REPLACE ANEXTERIOR
DOOR NEAR THE DINING TABLE
information is correct. I agree to comply with all city and county ordinances
WITH A WINDOW
W20
and state laws relating to building construction, and hereby authorize
4. REMOVE JETTED
TUB FROM MASTER BEDROOM AND SHRINK
representatives of this city to enter upon the above mentioned property for
WINDOWS ABO
TUB
inspection purposes. (We) agree to save indemnify and keep harmless the
5. SHIFT TOILET
O APPROVED JETTED TUB
City of Cupertino against liabilities, judgments, costs, and expenses which
may accrue against said City in consequence of the granting of this permit.)
6. REMOVE TWO
WINDOWS IN THE BUILT IN SEAT (BEDROOM #4
Additionally, the applicant understands d will comp) with all non -point
7. MODIFY ELECTRICAL
PLAN TO ADD LIGHTS IN PORCH
Sq. Ft Floor Area: 33 8
Valuation: $600000.00
Source regulations Cupertino nicipal Co , Section 9.18.
Slgnatur Date 12/22/2016
APN Number:
Occupancy Type:
326 30 065
Deferred Submittal (R -3),R-3 (Custom),R-3 (Custom),U
OWNER -BUILDER DECLARATION
(Private Gar / Ag Bldg),U (Private Gar / Ag Bldg)
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
i. I, as owner of the property, or my employees with wages as their sole
PERMIT E
IRES IF WORK IS NOT STARTED
compensation, will do the work, and the structure is not intended or offered for
WITHIN 18
DAYS OF PERMIT ISSUANCE OR
sale (Sec.7044, Business & Professions Code)
180 DAYS FROM
LAST CALLED INSPECTION.
2. I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec.7044, Business & Professions Code).
Issued by: A -AN
ande
I hereby affirm under penalty of perjury one of the following three declarations:
Date: 09/30/2016
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.
RE -ROOFS:
2. I have and will maintain Worker's Compensation Insurance, as provided for byAll
roofs shall be inspected prior to any roofing material being installed. If a roof is
Section 3700 of the Labor Code, for the performance of the work for which this
installed without first obtaining an inspection, I agree to remove all new materials for
permit is issued.
inspection.
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
Signature of Applicant
Worker's Compensation laws of California. If, after making this certificate of
Date: 12/22/2016
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
ALL ROOI
COVERINGS TO BE CLASS "A" OR BETTER
be deemed revoked.
APPLICANT CERTIFICATION
HAZARDOUS
MATERIALS DISCLOSURE
I certify that I have read this application and state that the above information is
I have read the ha ardous materials requirements under Chapter 6.95 ofthe
correct. I agree to comply with all city and county ordinances and state laws
California Health
& Safety Code, Sections 25505, 25533, and 25534. I will
relating to building construction, and hereby authorize representatives of this city
maintain compliane with the Cupertino Municipal Code, Chapter 9.12 and the
to enter upon the above mentioned property for inspection purposes. (We) agree
Health & Safety
de, Section 25532(a) should I store or handle hazardous
to save indemnify and keep harmless the City of Cupertino against liabilities,
material. Additiony,
should I use equipment or devices which emit hazardous
judgments, costs, and expenses which may accrue against said City in
air contaminants as
efined by the Bay Area Air Quality Management District I
consequence of the granting of this permit. Additionally, the applicant understands
will maintain compliance with the Cupe MumcrIC e, Chapter 9 2 and
and will comply with all non -point source regulations per the Cupertino Municipal
the Health
& Safety Cod ectio s 25505/553 and 25534.
Code, Section 9.18.
Owner or authorized
age'
Signature Date 12/22/2016
Date: 12/22/2016
CONSTRUC
ION LENDING AGENCY
I hereby affirm that t ere is a construction lending agency for the performance
CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-1717
20790 HANFORD DR CUPERTINO, CA 95014-1824 (326 30 065)
B L BUILDERS INC
REDWOOD CITY, CA
94061
OWNER'S NAME: VAN BUREN JUSTIN LU AND ZHANG YU
DATE ISSUED: 09/30/2016
OWNER'S PHONE: 408-830-7141
PHONE NO: (650) 363-2300
LICENSED CONTRACTOR'S DEC RATION
BUILDING PERMIT INFO:
License Class B Lie. #659504
Contractor B L BUILDERS INC Date 05/31/2017
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:
CONSTRUCT 2 STORY SFD, (3195 S.R), FRONT PORCH (52 S.F.),
I hereby affirm under penalty of perjury one of the following two declarations:
REAR PORCH (67 S.F.), ENCLOSED PORCH (132 S.F.) WITH
t. 1 have and will maintain a certificate of consent to self -insure for Worker's
ATTACHED GARAGE (479 S.F.)
Compensation, as provided for by Section 3700 of the Labor Code, for the
�'"perfom�ance of the work for which this permit is issued.
I ve and will maintain Worker's Compensation Insurance, as provided for by
eclion 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
Sq. Ft Floor Area: 3348
Valuation: $600000.00
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
APN Number:
Occupancy Type:
and state laws relating to building construction, and hereby authorize
326 30 065
Deferred Submittal (R -3),R-3 (Custom),R-3 (Custom),U
representatives of this city to enter upon the above mentioned property for
(Private Gar / Ag Bldg),U (Private Gar / Ag Bldg)
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.
PERMIT EXPIRES IF WORK IS NOT STARTED
Additionally, the applicant understa ds and will comply with all non -point
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
source regulatio er the uperf o Munici ode, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
.Signature Date 9/3012016
ende
Issued by: Abby Ay.
OWNER -B JILD .RD . RATION
Date: 09/30/2016
I hereby affirm that I am exemptfrom the Contractor's License Law for one of the
following two reasons:
RE- ROOFS:
1. I, as owner of the property, or my employees with wages as their sole
All roofs shall be inspected prior to any roofing material being installed. If a roof is
compensation, will do the work, and the structure is not intended or offered for
installed without first obtaining an inspection, I agree to remove all new materials for
sale (Sec.7044, Business & Professions Code)
inspection.
2. I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec.7044, Business & Professions Code).
Signature of Applicant:
Date: 9/30/2016
I hereby affirm under penalty of perjury one ofthe following three declarations:
s. 1 have and will maintain a Certificate of Consent to self -insure for Worker's
ALL ROOF COVERINGS TO BE CLASS "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.
2. I have and will maintain Worker's Compensation Insurance, as provided for by
HAZARDOUS MATERIALS DISCLOSURE
Section 3700 of the Labor Code, for the performance of the work for which this
I have read the hazardous materials requirements under Chapter 6.95 of the
permit is issued.
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
s. I certify that in the performance of the work for which this permit is issued, I
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
shall not employ any person in any manner so as to become subject to the
should I store or handle hazardous
Sectionuse
Health &Safety Code, should
material. Additionally, should I use equipment or devices which emit hazardous
equip25532(a)ment
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 Cupor " Municipal Cod!, Chapter
Labor Code, I must forthwith comply with such provisions or this permit shall
the Health & Safety Code; Sec ' s 2550 2553 �rdn 3 .
be deemed revoked.
Ow er or authorized agent: j
APPLICANT CERTIFICATION
certify that I have read this application and state that the above information is (-Date:
9/30/2016 a`
correct. 1 agree to comply with all city and county ordinances and state laws
relating to building construction, and hereby authorize representatives of this city
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
to enter upon the above mentioned property for inspection purposes. (We) agree
of work's for which this permit is issued (Sec. 3097, Civ C.)
to save indemnify and keep harmless the City of Cupertino against liabilities,
Lender's Name
judgments, costs, and expenses which may accrue against said City in
consequence of the granting of this permit. Additionally, the applicant understands
Lender's Address
and will comply with all non -point source regulations per the Cupertino Municipal
ARCHITECT'S DECLARATION
Code, Section 9.18.
I understand my plans shall be used as public records.
Signature Date 9/30/2016
Licensed
Professional