B-2016-3212 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-3212
10482 SCENIC CIR CUPERTINO,CA 95014-2755(357 07 007) GAYWILL WONG
CONSTRUCTION
SARATOGA,CA 95070
OWNER'S NAME: TANIGUCHI ALAN AND MARGE TRUSTEE DATE ISSUED:12/05/2016
OWNER'S PHONE:408-483-2314 PHONE NO:(408)314-2892
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class Lic.#854662
Contractor GAYWILL WONG CONSTRUCTION Date 02/28/2017 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:
REMODEL 2 BATHROOMS(UP STAIRS);BATHROOM 1 FULL
I hereby affirm under penalty of perjury one of the following two declarations: REMODEL W/WINDOW CHANGE,BATHROOM 2&HALLWAY,
1. I have and will maintain a certificate of consent to self-insure for Worker's LIGHTING ONLY,80 S.F.;REMODEL/RECONFIGURE KITCHEN 300
Compensation,as provided for by Section 3700 of the Labor Code,for the S.F.
performance of the work for which this permit is issued.
2.-„,--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
,"4 permit is issued.
Sq.Ft Floor Area: Valuation:$30000.00
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 APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 357 07 007
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 comply with all non-point 8
source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAS 1 SPECTION.
Signature/ --tea Date 12/05/2016 Issued by:MELISSA NAMES
Date:12/05/2016
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 myemployees 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:12/05/2016
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
a I certify that in the performance of the work for which this permit is issued,I Health 8z 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,Sections 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owner or authorized agent:,
APPLICANT CERTIFICATION Date:12/05/2016
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. I understand my plans shall be used as public records.
Licensed
Signature Date 12/05/2016 Professional
CONSTRUCTION PERMIT APPLICATION
p,,,, COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISIOB
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.�F ' 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•buildincAcupertino.orq
CUPERTINO
❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
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DESCRIPTION OF WORK Ay�/ n-- j y
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EXISTING USE PROPOSED USE C7 CONSTR.TYPE #STORIES
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EXISTG NEW FLOOR DEMO. TOTAL
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PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: 0 DETACH
❑ATTACH
#DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES
BEING ADDED? ❑NO ADDITION? ❑NO
PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS.T$E BLDG AN YES.: r '<-` ` '°°'"- • Ta TAL VALUATION',.
PLANNING AP-PL# ❑NO. PLANNING APPROVAL LETTER EICHLER HO ? I • ,. s a
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By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behal. I have read this
application and the information I have provided iscorrect. 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 building co.' -. . I a representatives of Cupertino Co enter the above de tified property for inspection purposes.
Signature of Applicant/Agent: � Date: /2 14
SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE,... -' ROUTING SLIP
New SEE!or Multifamily dwellings: Apply for demolition permit for ❑ ovER TflE-COUN1ER ❑ BII LDIN .,, „vizEYIRW
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. ❑ ExpREss ss, ❑ r AlvxlNG l J N E S IEW
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑( STAr'''' a ; ❑ PUBLIC WORKS „,"
form if any Hazardous Materials are being used as part of this project. �'
`"❑;LARGE � � � ❑ FIRE DEPT,
Copy of Planning Approval Letter or Meeting with Planning prior to
❑%MAIOR ❑ SAIITTARXSE+wEHDISTI2ICT -,
submittal of Building Permit application.
0 'ENVIRONMENTAL HEALTH-
BldgApp_2011.doc revised 06/21/11 "•