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B-2016-2907CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-2907 10591 GLENVIEW AVE CUPERTINO, CA 95014-4567 (369 26022) CALDERON AND SON'S CONSTRUCTION COMPANY HAYWARD, CA 94544 OWNER'S NAME: KUO CHIH F AND HSU H TRUSTEE I DATE ISSUED: 10/13/2016 I OWNER'S PHONE: 408-857-5442 I I PHONE NO: (650) 248-6470 License Class B Lic. #778430 Contractor CALDERON AND SON'S CONSTRUCTION COMPANY Date 05131/2018 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. hereby 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 Cupertino Municipal Code, Section 9.18. Date 10/13/2016 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. 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). 1 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. 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. ` s. 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 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. BUILDING PERMIT INFO: X BLDG —ELECT —PLUMB MECH X RESIDENTIAL — COMMERCIAL JOB DESCRIPTION: MASTER BEDROOM REMODEL (148 S.F.); MASTER BATHROOM REMODEL AND RELOCATE WINDOW (59 S.F.) Sq. Ft Floor Area: I Valuation: $19000.00 "N Number: Occupancy Type: 369 26 022 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. by: Abby Ayende 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 of Applicant: Date: 10/13/2016 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: Date: 10/13/2016 CONSTRUCTION LENDING AGENCY 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 1 understand my plans shall be used as public records. CONSTRUCTION PERMIT APPLICATION .. COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 y CUPERTINO (408) 777-3228 -'FAX (408)777-3333 building(�cupertino,org �' 1:(p_7 Q 0 1,T -W CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION /DEFERRED ORIGINAL PERMIT F" PROTECTADDRESS ® G? (eo V ircis / �, Aptitr /'„ �p (ir - 021 Vf/ ! j PHONE E-1`ZAIL O\VNERNANIE q ,1rS 6 �1 1�-u Ll y �( 06- STREET:ADDRESS CITY, STATE, ZIP FAX l t� t ! i 1 �n to mo ff e� -r J- n CONTACT NA4E f B �Q E-NLAIL �t �L �rtiPHONEl"c �s-0 l STREET ADDRESS Oe 1 rte r B 7 CITY, STATE, ZIP �9 (h FA3 El ONNER ❑BOM \ER-BLZTDER El012,NTTERAGENT ❑. CONTRACTOR ❑ COI`'IRACTORAGENT ❑l ARCHITECT ❑j B1 GLNMER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAhIM E Z CA( & I LICENSE NTUMBER LICENSE TYPE BUS. LIC r NV_oU COMP:AYNAME E-h4AIL COPV5 FAX STREET-. D SS < CITY, STATE, ZIP ®d a Q 9 d W (� I PHONE .&RCHITECT/ENGLNEER NAIuE LICE ISE KUi BER BUS. LIC COMPANY NAME E-MAIL I FAX — STREET ADDRESS CITY, STATE, 71P I PHONE DESCRIPTION OF WORK f4 a {qc�o ew K i y -46o 5Aw 101 6r, IV5CIt EXISTING USE PROPOSED USE - CON'STR.TYPE = STORIES ' USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEO - TOTAL _F - - - - AREA AREA AREA I NEI' AREA BATHROOM KITCHEN OTHER REMODELAREA REMODEL AREA REA40DEL AREA -- PORCH :AREA DECK AREA TOTAL DECKPORCH AREq G.A AGE AREA: ❑ DETACH ❑ ATTACH D1;•EL1JNG UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑1'ES BEINGADDED? NO ADDITION? ❑NO I PRE-.APPLIC.ATION ❑ YES IF ITS. PROVIDE COPY OF IS THE BLDG AN ❑ YES PL.AN.TT .NG APPI. Fl NO PL.A NTIN-G APPROVAL LETTER. EICHLER HOME? El NO CENED B �s. � cs - �TAL VALL ATIO\: r By my signature below, I certify to each of the following: I am the property owner or authorized agent to act & the property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Mork and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to b ild* a construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Date: Signature of ApplicanttAgent: SUPPLEMENTAL INFORMATION REQUIRED = � New SFD or Multifamily dwellings: Apply for demolition permit for O\ ER THE O OLTNTER I] BLTiLDI1G PLA RE\TET\ existing building(s). Demolition pen -nit is required prior to issuance of building permit for new building. Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ sT�`DARn -' �� � PCBLIC \\ORi�S _ form if any Hazardous Materials are being used as part of tlriS pr OjeCt' Copy of Planning Approval Letter or Meeting with Planning prior t0 LARGE f fl FIRE DEPT � ERDI�TRICT $ — submittal of Building Permit application. IL�JDR a SANILARI SEk� x: '-.t EA'-IROTtT4EI�TAL"HEAL'i'A B1dg1pp_2011.doc revised 06121111 s CUPERTINO uisding Department t �o-,C (s}c 1 A 1059 1 'JenvIi (-W Ave i7 Ei 1 �9 O Ota LIANCE _ , Z Z'i i _ l ` _l _ a �yS - res y 4 P (`` �. y r 1l Vv ,� i,e cR 94?