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B-2016-3179CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRESS: CONTRACTOR: PERMIT NO: B-2016-3179 19938 PORTAL PLZ CUPERTINO, CA 95014-3366 (369 45 011) RECON360 LLC SAN JOSE, CA 95118 OWNER'S NAME: LU 2SHONGAND ZHENG ZHAOHUI DATE ISSUED:: 11/29/2016 OWNER'S PHONE: 888-277-5580 PHONE NO: (408);981-3695 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class PAINTING AND DECORATING Lic, #950805 Contractor RECON360 LLC Date 12/31/2018 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: REPLACE FENCE (9 L.F.) 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 Compensation, as provided for by Section 3700 of the Labor Code, for the V 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. Sq. Ft Floor Area: Valuation: $4939'.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 369 45 011 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 t Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. 6.Signature11NAIA Date 11/29/2016 Issued by: Abby A, ey nde Date: 11/2962016 OWNER -BUILDER 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. 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 ofApplieant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 11/29/2016 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. 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(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, after 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 ns 2550525533,, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. Own" er or authorized agent: fS%�—` APPLICANT CERTIFICATION _ Date: 11/29/2016 1 certify that 1 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 CONSTRUCTION LENDING AGENCY 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 tLendees Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in Lenders 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 I understand my plans shall be used as public records. Code, Section 9.18. Licensed Signature Date 11/29/2016 Professional CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 - building(a)-cupertino.org H NEW CONSTRUCTION ❑ry,-ADDITION ❑ ALTERATION / TI ❑' REVISION / DEFERRED ORIGINAL PERMIT # PRO CT ADDRESS O �� ' LN r�_ . APN# 4 OWNERNAME /' L ,LJ►rC ►iiAl�M1 PHONEll -X7 77,5 ©/, ��U -6,5'90 EMAIL i. STREET ADDRESSCITY, n VC 5�I .STATE, ZIP Sa ah - acoso F X - CON*�IfAfCT N�j P /ij f / " Q l E-/jjT/ 9q j G T �j /•J�(/!V1 kt�iVi1^ 60, STREET ADDRESS o CITY, STATE, ZIP <' FAX 11 OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT 11 ARCHITECT '❑ ENGINEER ❑ DEVELOPER El TENANT CONTRACTOR NAME' 1110�y LICENSE NUMBER �� 7 LICENSE TYPE BUS. LIC # ; i o c� 0 (� L COMPANY NAMEpp e,conE-MAIL I``050►►f"8�Q •- . 6M. FAX STREET ADDRESS Vd Sul Goo CITY, STATE, ZIP a«h PHONE g81- 36as' ARCHIT ECT/ENGNEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK c1 i aS alfl 1 � Jb O ✓113 i�1 i� n►t� �1 \ Y1 L�4e�s 'ccs+ and I ry T f ihLvhcr�4it hWl n f*.o-m • Vg+A , 1,.►+ L. -ands a j F y 3 c -ft+ iiurc.o Syskrr a r-emse— Fi Uegr- EXISTING USE TROPOSED USE - CONSTR. TYPE - - # STORIES USE - TYPE OCC. SQ.FT. VALUATION ($) EXISTG AREA NEW FLOOR AREA DEMO AREA. TOTAL NET AREA - - BATHROOM REMODELAREA KITCHEN - REMODEL AREA OTHER REMODEL AREA - - PORCH AREA DECK AREA TOTAL DECKTORCH AREA I GARAGE AREA; DETACH - ATTACH #DWELLINGUNITS: IS A SECOND UNIT ElYES SECONDSTORY EYES - BEING ADDED? E] NO ADDITION? []NO PRE -APPLICATION ❑YES IF YES, PROVIDE. COPY OF IS THE BLDG AN YES RECEIVED BY: TOTAL VALUATION: PLANNING APPL # E] NO PLANNING APPROVAL LETTER EICHLER HOME? �. NO ' _ �fi; a By my signature below, I certify to each of the following: I am the property owner or authorized agent to Acton thA 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 ' c 'on. I a thorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: // ° Ag - /6 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. 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. &ZdgA p_2 011. doc revised 0 6121111 \---)ov-vc,vt �-Y-OAv UJOL'At (14) - (D fij (e- Ju CV) 3 S Srs +'c, P[.. 3T PLANS CHECKED By DATE PLANNING DEPT CUPERTINO f a(el/ V, -T V CUPERTINO Building Department Lr1LL--R.EVff-WfR E-0R-CQD;E-00-MPL1ANC-F---- Rev o y Ayende w- 31 vi 11/3 /16 4W*' hfi&7A �f I R c� 3 g �Pbr-FAI Copt: Repac2 Wall (64-411) 2013 C? -C t at the job changes or ut approval The st ping of this plan and specifications SHALL NOT be IdJrjRo i e an roval of the violation of any inance or State Law. B Abby Ayende DATE 11/30/16 PERMIT -3179 E�oketto CUPERTINO BLJ!ding Department 1 I � i P,7-.V17,V,'-ED FOR CODE COMPLIANCE Reviewed By. —