B-2016-2174r
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-2174 "
21925 LOMITAAVE CUPERTINO, CA 95014-2864 (357 16 069)
ZHENGLONG WEI
SAN JOSE, CA 95132
OWNER'S NAME:
DATE ISSUED: 12/09/2016
OWNER'S PHONE:
PHONE NO: (408) 386-7550
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class 5 Lic. #841215
Contractor ZHENGLONG WEI Date 06/30/2018
X BLDG _ELECT _PLUMB
X 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:
ADD BEDROOM, MASTER BEDROOM, BATHROOM, DEN (1491
I hereby affirm under penalty of perjury one of the following two declarations:
S.F.); ADD NEW WINDOWS AND DOORS; REMODEL BATHROOM
1. I have and will maintain a: certificate of consent to self -insure for Worker's
AND 2 BEDROOMS (235 S.F.); ADD (N) FURNACE AND A/C; (N)
ompensation, as provided for by Section 3700 of the Labor Code, for the
DECK (549 S.F)
performance of the work for which this permit is issued.
DEF#1 - ROOF TRUSS CALCS - ISSUED 8/22/2017
I have and will maintain Worker's, Compensation Insurance, as provided for by
UY0z.
Section 3700 of the Labor Code, for the performance of the work for which this
Sq. Ft Floor Area: 1491
Valuation:'$300000.00
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and, state that the above
information is correct., I agree to complylwith all city and county ordinances
APN Number:
Occupancy Type:
and state laws relating to building jcohstruction, and hereby authorize
357 16 164
Deferred Submittal (R -3),R-3 (Custom)
representatives of this city to enter upon the above mentioned property for
inspection purposes. (Vile) 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
sour a regulations per the C 5 ' nicipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 8/22/2017•
Issued by; AbbyAvende
Date: 12/09/2016
OWNF-BUILDER D C O
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
a. I, as owner of the propeily 'or my employees with wages as their sole
installed without fust obtaining an inspection, I agree to remove all new materials for
compensation, will -do 6 work, and the structure is not intended or offered for
inspection.
sale (Sec.7044, Business & Professions Code)
z. I, as owner of the properl' am exclusively contracting with licensed
Signature of Applicant:
contractors to constructthe-project (Sec.7044, Business & Professions Code).
y.
Date: 8/22/2017
I hereby affirm under penalty'of pe'rj'ury one "of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
t. I have and will mainiain'a`Ceriificate 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
z. 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
Sectio i
700 of the Labor Code, for the performance of the work for which this
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
p is
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 & 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
Worker's Compensatonilaws of California. If, after making this certificate of
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
p
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. 40
op
f6wrier or authorized agent:
APPLICANT CERTIFICATION
Date: 8/22/2017
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.
Licensed
Signature Date 8/22/2017
Professional
CITY OF CUPERTINO BUILDING PERMIT
BUMDINGADDRESS:
CONTRACTOR:
PERMIT NO: B-2016-2174
21925 LOMITAAVE CUPERTINO, CA 95014-2864 (357 16 069)
ZHENGLONG WEI
SAN JOSE, CA 95132
OWNER'S NAME:
PHONE NO: (408) 386-7550
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class B Lic. #841,215
Contractor ZHENGLONG WEI Date 06/30/2018
$BLDG _ELECT _PLUMB
X 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:
ADD BEDROOM, MASTER BEDROOM, BATHROOM, DEN (1491
I hereby affirm under penalty of perjury one of the following two declarations:
S.F.); ADD NEW WINDOWS AND DOORS; REMODEL BATHROOM
1. I have and will maintain a certificate of consent to self -insure for Worker's
AND 2 BEDROOMS (235 S.F.); ADD (I) FURNACE AND A/C; (N)
Compensation, as provided for by Section 3700 of the Labor Code, for the
DECK (549 S.F)
ir erformance of the work for which this permit is issued.
2�, (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
Sq. Ft Floor Area; 1491
Valuation: $300000.00
permit is issued.
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
35716 069
Deferred Submittal (R -3),P-3 (Custom)
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
source regulations per the Cupertino Municipal Code, Section 9.18,.
180 DAYS FROM LAST CALLED INSPECTION.
Signature .�� Date 12/9/2016
Issued by: AbbyAvende
Date: 12/09/2016
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
following two reasons:
1. 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)
z. 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: 12/9/2016
I hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" ORBETTER
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. 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, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
permit is issued.
s. 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
material. Additionally, should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the
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:
12/9/2016
I certify that I have read this application and state that the above information is
CONSTRUCTION LENDING AGENCY
s construction lending agency for the performance
I hereby affirm that there is
correct. I agree to comply with all city and county ordinances and state laws
i
of work's for which this permit is issued (Sec. 3097, Civ C.)
relating to building construction, and hereby authorize representatives of this city
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,
Lender's Address
judgments, costs, and expenses which may accrue against said City in
consequence of the granting of this permit. Additionally, the applicant understands
ARCHITECT'S DECLARATION
and will comply with all non -point source regulations per the Cupertino Municipal
I understand my plans shall be used as public records.
Code, Section 9.18.
Licensed
Signature Date 12/9/2016
Professional