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B-2017-1084CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0184 10636 WUNDERLICH DR CUPERTINO, CA 95014-3652 (375 27 018) CNE CONSTRUCTION INCORPORATION SAN JOSE, CA 95130 OWNER'S NAME: LI HAOJIANG TRUSTEE & ET AL I I DATE ISSUED: 01/30/2017 R'S PHONE: 408-726-2956 1 1PHONE NO: (408) 726-2956 r O 81 i. .. License Class 5 Lic. #1 10 1892 Contractor QNE CONSTRUCTION INCORPORATION Date 03/31/2018 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. I hereby affirm under penalty of perjury one of the following two declarations: t. 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. :�I have and will maintain Worker's Compensation Insurance, as provided for by Vi Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 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 and state laws relating to building construction, and hereby authorize 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 may accrue against said City in consequence of the granting of this permit. Additionally, the app" understands and will comply with all non -point source regulati per Pfe Cupertino jpnicipal Code, Section 9.18. Date 1/30/2017 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1. I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) 2. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (See.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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 performance 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 permit is issued. 3. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after ranking this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. 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 and state laws relating to building construction, and hereby authorize 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 may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date 1/30/2017 BUILDING PERMIT INFO: X BLDG X ELECT _ PLUMB _ MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: (I) TEMP POWER POLE (100 AMP) Sq. Ft Floor Area: Valuation: $1000.00 "N Number: Occupancy Type: 375 27 018 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Abby Aygndg RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: 1/30/2017 ALL ROOF COVERINGS TO BE CLASS "A" HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by theBay Area Air ality Management District I will maintain compliance with the Cuper ' u cipal Code, Chapter 9.12 and the Health & Safety C , ections 3905, 25533, and 25534. Owner r or authorized agent. Date: 1/30/2017 hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255CUPERTINO IFPLTJNIBINCi I IMFCNaTJT( dr i—Iai��Tninhi f—I„ (408} 777-3228 •FAX (408) 777-3333 • buildina(�cupertino.or ------- �J r.i....�aau�.rai. PROJECT ADDRESS � � � fir, bi � di d" L � LJ 1V11JlLLLli1VLV UJ APN # 91_ j `� 0 I n OWNER NAME yy / ss -7 yn'rl S G�S) �°�- is PHONE - �) � (- 6 E-MAIL 8� , s _ ` ! J Cdl UTC.-� S STREET ADDRESS CITY, STATE, ZIP FAX CONTACT NAME �p s'6'Ivii V4J �l°��,1i1V� PHONE EMAIL STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWI,TER. ❑ OWNER -BUILDER ❑ OWNERAGEN'T . ❑ COA'TRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME r % f LICENSE NUMBER C LICENSE TYPE � V BUS. LIC r (A\ (_ ]� t v lf✓✓ V COMPANY NAME /� 5 �� (hCE MAM CA erVIl FAX STREET ADDRESS CITY, STATE, ZIP 1 i �� CSA PHONE ARCHITECT/aIGINTEER NAME y LICENSE NUMBER BUS. LIC 9 COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF VSFD orDUPLEX ❑ MULTI -FAMILY PROJECT INWH.DLAND ❑ YES PROJECT IN ❑ YES BUILDING: F-1 COMMERCIAL URBAN INTERFACE AREA ❑ INTO FLOOD ZONE ❑ NO IS THE BLDG AN ❑ YES EICHLER HOME? El NO DESCRIPTION OF WORK r pq( r� V D U1Nl TOTAL VALUATION: RECEIVED BY t .JA. By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property ow is be al£ I have read this application and the information I have 122 Ic e is Correct. I have read the Description of «7ork and verify itis accurate. I agree to comply with all applicable local ordinances and state lawsselati o-liurldin onstruction. I auth � e repr� fatives of Cupertino to enter the above-identifiedproperty for inspection purposes. Signature ofApplicant/Agent: Date: ` j l /SUPPLEMENTAL INFORMATION REQUIRED ' oFrcE LsE flrr } AC R '© ExTRESS ST A11i3ARD � - ❑ L-4RGE J. ©- RIATOR AIFPA1fiscAPp_2011.doc revised. 06121/11