B-2016-2994 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR PERMIT NO:B-2016-2994
10337 COLD HARBORAVE CUPERTINO,CA 95014-3329(369 10 007) FUTURE VISION
REMODELING INC
VAN NUYS,CA 91406
OWNER'S NAME: LIN GENG AND LU YING DATE ISSUED:10/26/2016
OWNER'S PHONE:917-822-6091 PHONE NO:(800)485-4919
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#991840
Contractor FUTURE VISION REMODELING INC Date 04/30/2018 X BLDG _ELECT —PLUMB
MECH X RESIDENTIAL 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:
I hereby affirm under penalty of perjury one of the following two declarations: 2ND FLOOR BATHROOM REMODEL-(47.5 SF)
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.
/J z. 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. Sq.Ft Floor Area; Valuation:$15000.00
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 36910 007
representatives of this city to enter upon the above mentioned property for
inspection purposes. (We)agree to save indemnify and keep armless 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 grantingf this permit.
Additionally,the applicant understands and will comply with alil non-point WITHIN 180 DAYS OF PERMIT ISSUANCE OR
source regulations per the Cupertino Municipal Code,Section:9.18. 180 DAYS FROM LAST CALLED INSPECTION.
C-Si ature Date 1 d-26-2016 Issued by:Kim Dunbar
i Date:10/26/2016
Iherebytwrmrea at I am exempt from the Contractor's License RE-ROOFS:
p Law for one of the
following All roofs shall be inspected prior to any roofing material being installed.If a roof is
i. I,as owner of the property,or my employees with wagesas 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:10-26-2016
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A OR BETTER
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. HAZARDOUS MATERIALS DISCLOSURE
2. 1 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 25505,255'33,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(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
air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If,atter making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption;I become subject to the Worker's Compensation provisions of the 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.
C Owner or authorized agent:
APPLICANT CERTIFICATION Date:10-26-2016
1 certify that I have read this application and state that the above information is CONSR TI
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 ARCH[TECT'S DECLARATION
Code,Section 9.18. I understand my.plans shall be used as public records.
Signature Date 10-26-2016 Licensed
Si
9 Professional
CONSTRUCTION PERMIT APPLICATION
,. COMWUNITY DEVELOPMIENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE• CUPERTINO,CA 95014-3255
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DESCR TION OF WORK
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By my signature below,I ce;ti;}=to each of the following: I am the property owner or autboriz4agent o act on the prope ty 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 t,•ith all applicable local
ordinances and state laws relating to building constn tion. au horize representatives of CLpe,Lino to enter the Above-identifi d p*op=I;y for inspection puiposes.
Sianature of ADOicant/Azent: Date:
SUPPLEMENT ' ATIO\T REQUIRED
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_Ne-,v StD or AfultI amily d«=ell nas: Apply for demolition p unit for £�
O\I R Tf E COL�TERr BLiLDI\G PL4 RE\�ER
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Pei-Mit for new building.
Comine cial Bldgs: Provide a co gleed Hazardous Materials D?SClosure ❑ �T-`�'�� RD '' ! I DLBr.IC S�ORKS
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FIRE DEPT
Copy of Planning:Approval:Letter or Meeting with Planning prior to
AZITOR
submittal olr ` 54'�FFARl SE�3'ERDi�TRICT
Buildina Pernnt application.
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BldJ4pp_201120C revised 06/21!11