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B-2016-2956 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2956 20735 STEVENS CREEK BLVD CUPERTINO,CA 95014(326 32 054) QUALITY TELECOM CONSULTANTS INC LOOMIS,CA 95650 OWNER'S NAME: LAU ALLAN CHOOKYEEAND LINDAYIM SEUNG ET DATE ISSUED:10/20/2016 OWNER'S PHONE:415-309-8979 PHONE NO:(916)315-0500 LICENSED CONTRACTOR'S DECLARATION BUILDING PERNIIT INFO: License Class A.B.C-51:C-60.0-10 Lic.# 18 4859 Contractor QUALITY TELECOM CONSULTANTS INC Date 11/30/2018 X BLDG _ELECT _PLUMB MECH RESIDENTIAL X COMMERCIAL 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. JOB DESCRIPTION: REPLACE(E)ANTENNA-VERIZON WIRELESS I hereby affirm under penalty of perjury one of the following two declarations: 1. I have and will maintain a certificate of consent to self-insure for Worker's vmpensation,as provided for by Section 3700 of the Labor Code,for the `' erformance of the work for which this permit is issued. .2;. 7 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:$10000.00 APPLICANT CERTIFICATION 1 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 32 054 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 •omplywith all non-point source regulatio per the CupertindMunicip Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. f� /Signature Date 19/20/2016 Issnedb Ab Ay ,, y: byende Date: 10/20/2016 O •R-B H,DER DECLARATION 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 1. 1,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:10/20/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 1. 1 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(x)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 Manageme t District 1 Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cu ertino Municipal Code,Cha er 9.12 and exemption,I become subject to the Worker's Compensation provisions ofthe the Health&Safety Co ec` 's 255 5,25 33,an Labor Code,I must forthwith comply with such provisions or this permit shall , be deemed revoked. /Owner or authorized agent: APPLICANT CERTIFICATION Date:10/20/2016 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. SiSignature Date 10/20/2016 Licensed g Professional I - CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408),777-3228•FAX(408)777-3333•buildinq(a�cupertino.om CUP ERTINO [:]NEW CONSTRUCTION ❑ ADDITION 19 ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# MM7 5VCYtS CC1E- S1vd•� PROJECT ADDRESS APN# 2 V y "(N o CA g5'o�4 � y OWNER NAME I PHO _... E-MAII.. �fii 5 s�� STREET ADDRESS � �/ ^ CITY,STATE,ZIP: �v 4 /`t CA �fo FAX CONTACT NAME PHONE E_`oMAIL/`/ STREET ADDRESS CITY,STATE,ZIP FAX ❑OWNER ❑ OWNER-BUTLDER 11 OWNER AGENT _� CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT 11 ENGINEER 11 DEVELOPER '0 TENANT CONTRACTOR NAME 't/Ua' �e ftfl !• • LICENSE NUMBER 0' 0�� L CENSE TYPE r BUS.LIC# 3*45 COMPANY NAME WA�ej\ w�uu� , ��• EMAIL/frLLA 1-1 Iekd*�ij•� FAX 9%,-&6 D,50 . STREET ADDRESS '� 0 7Ct�G; � AVC...- CITY,STATE,ZIP R®(6V1i�`�/► t /�A 4151L7�.,,' PHONE*-S;- ARCHITECT/ENGINEERNAMECjVtI 11a7LICENSE NUMBER BUS.LIC# COMPANY NAME WW% \ m Te"ON E-MAIL FAX STREET ADDRESS CITY,STATE;ZIP PHONE DESCRIPTION OF WORK ,-,^ ` _�w p �� f i1 �tA1 �M/�{�• /�y/'� /j EXISTING USE - PROPOSED USE CONSTR.TYPE #STORTES S1i�.r D r► r.�� J� /, USE TYPE OCC. SQ.FT. VALUATION($) ARE r R AFLOOR /� DREAD !•/JTOTAL IV W NET AREA%xsy'" VW BATHROOM KITCHEN OTHER REMODEL AREA N'A REMODEL AREA NIA REMODEL AREA N 1K PORCH AREA. DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH Nt?� N 1A -T N(J N E]ATTACH #DWELLING UNITS: IS A SECOND UNIT E]YES SECOND STORY ❑YES N/A BEING ADDED? ENO ADDITION? �IWiNO PRE-APPLTCATION U&YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑q YES 'RE 1FED _ TOTAL OT L VALUATION: PLANNING APPL# O PLANNING APPROVAL LETTER - EICHLER HOME? IPS NO F' i e By my signature below,I certify to each of the following: I am the property owner or authorized agent to hct on the property owner's behalf. I have read this application and the information I have provided is correct. I ave rethe Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to MpTttonr—e resentatives of Cupertino to enter the aboove-i entified property for inspection purposes. Signature of Applicant/Agent: Date: l iy1-0��/ i f/,� SUPPLEMENTAL 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. P> ss © ,prtIN PIS AN ii> r>w -' _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure Q'79T-A" D L tIBL tC WORIra 4 form if any Hazardous Materials are being used as part of this project. C Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. AJpR ` A Y s� x rw, C1 .>NVIRON ENTAX EA>Tx BldgApp_2011.doc revised 06121111