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B-2016-3322 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-3322 10440 CASTINE AVE CUPERTINO,CA 95014-1309(326 41 029) MILLENNIUM ENTERPRISES INC SAN JOSE,CA 95124 OWNER'S NAME: CHUA FAM PARTNERSHIP NO.1 DATE ISSUED:02/02/2017 OWNER'S PHONE:650-326-0887 PHONE NO:(408)833-6432 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class a Lic.#899021 Contractor MILLENNIUM ENTERPRISES INC Date 06/30/2017 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: BATHROOM REMODELS(107 S.F.);KITCHEN REMODEL(108 S.F.); I hereby affirm under penalty of perjury one of the following two declarations: REROOF;TEAR-OFF;INSTALL COMP(20 SQ);REPLACE WINDOW 1. I have and will maintain a certificate of consent to self-insure for Worker's (13);REPLACE SLIDING DOORS(2);REMOVE AND REPLACE ALL Compensation,as provided for by Section 3700 of the Labor Code,for the SWITCHES AND LIGHTS;REPLACE SHEETROCK IN GARAGE 'performance of the work for which this permit is issued. ONLY. (((III. I have and will maintain Worker's Compensation Insurance,as provided for by t Section 3700 of the Labor Code,for the performance of the work for which this REV#1-CHANGE LOCATION OF TOILET AND SINK IN permit is issued. DOWNSTAIRS BATHROOM;SPECIFY SCHLUTER KERDI SYSTEM APPLICANT CERTIFICATION FOR WATERPROOFING;CHANGE LOCATION OF STOVE AND I certify that I have read this application and state that the above OVER-ISSUED 3/27/2017 information is correct.I agree to comply with all city and county ordinances Sq.Ft Floor Area: Valuation:$200000.00 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 APN Number: • Occupancy Type: City of Cupertino against liabilities,judgments,costs,and expenses which p y may accrue against said City in consequence of the granting of this permit. 326 41 029 . Additionally,the applicant understand ,and will comply with all non-point source rege' Ter er the Cuperti Municipal Code,Section 9.18. (�/��1 PERMIT EXPIRES IF WORK IS NOT STARTED r-, Signature I . Date 3/27/2017 WITHIN 180 DAYS OF PERMIT ISSUANCE OR •U 180 DAYS FROM LAST CALLED INSPECTION. OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the Issued by:ABBY AYENDE following two reasons: Date:_02102/E0'Y7 h iv I- 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 RE-ROOFS: sale(Sec.7044,Business&Professions Code) All roofs shall be inspected prior to any roofing material being installed.If a roof is 2. I,as owner of the property,am exclusively contracting with licensed installed without first obtaining an inspection,I agree to remove all new materials for contractors to construct the project(Sec.7044,Business&Professions Code). inspection. 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 Signature of Applicant: Compensation,as provided for by Section 3700 of the Labor Code,for the Date:3/27/2017 performance of the work for which this permit is issued. 2. I have and will maintain Worker's Compensation Insurance,as provided for by ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE a. I certify that in the performance of the work for which this permit is issued,I I have read the hazardous materials requirements under Chapter 6.95 of the shall not employ any person in any manner so as to become subject to the California Health&Safety Code,Sections 25505,25533,and 25534. I will Worker's Compensation laws of California. If,after making this certificate of maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the exemption,I become subject to the Worker's Compensation provisions of the Health&Safety Code,Section 25532(a)should I store or handle hazardous Labor Code,I must forthwith comply with such provisions or this permit shall material. Additionally,should I use equipment or devices which emit hazardous be deemed revoked, air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cup• ':o Municipal Code,Chapter 9.12 and APPLICANT CERTIFICATION the Health&Safety Code, (c i:.s 2550 25533,and 5534. 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 ii relating to building construction,and hereby authorize representatives of this city %Owner or authorized agent: to enter upon the above mentioned property for inspection purposes. (We)agree Date:3/27/2017 to save indemnify and keep harmless the City of Cupertino against liabilities, CONSTRUCTION LENDING AGENCY judgments,costs,and expenses which may accrue against said City in I hereby affirm that there is a construction lending agency for the performance consequence of the granting of this permit. Additionally,the applicant understands of work's for which this permit is issued(Sec.3097,Civ C.) and will comply with all non-point source regulations per the Cupertino Municipal Lender's Name Code,Section 9.18. Lender's Address Signature Date 3/27/2017 ARCHITECT'S DECLARATION I understand my plans shall be used as public records. CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 �•I��s (408) 777-3228• FAX (408)777-3333• buildinq( cupertino.orq CUPERTINO ElNEW CONSTRUCTION ElADDITION ElALTERATION/TI u \REVISIO /DEFERRED ORIGINAL PERMIT# ✓J(�/ 16 ` Z2 PROJ�I/-tD ltlSS ca v 1[s 6.r> a✓7_ Ito. AlB r FA O RP AMC 1e1.191 f I' 16 Zll �V K®,.(PHONE t 5Q ;717. o VC/ v►°Y �9-i n vC`IJ�I/� ,J I�& a fB e Kj �/ STs1DI $'V G s ,, ,, YA CITY,KA PL o r�t *, OA CI L FAX e CON rte.. PHONE E-MAIL STREE -AliU V DRESS� ® CITY,STATE,ZIP FAX 'WOWNER 0 OWNER-BUILDER 0 OWNER AGENT 0 CONTRACTOR 0 CONTRACTOR AGENT 0 ARCHITECT 0 ENGINEER 0 DEVELOPER 0 TENANT CON�R.y ESTA K\E!I 9^,4 as 1 eICENS hf$B4,1 LICE( TYPE BUS.LIC# I1v/I�/•l !►J/E f/Y�I/I� e c/ frt (1�1 IAS! COM' NA E I em,, E-MAI` ZIL 61512-4 FAX / ry STREET I *• e 4'°rr 1 Ave 10 CI G V�'C , �j t ®N 1�g -5J4 2 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE.ZIP PHONE DESRK —aka AnIA fel." t CI esitti erkt 6.' 47)1 Lek &VA :1`.14c., co OLoavl -thl,1.'r-S igAll Jrb IMA7eA'chAati JU rfeu-Fu c 1t -ev KtrdA s1'.ewI d14 WOO o'FAAS L 611 61 t & Ia l . EXISTING USE a PROPOSEIJIS COFYSTR TYPE #STORIES U USE TYPE OCC. SQ.FT. VALUATION($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA • PORCH AREA DECK AREA TOTAL DECK/PORCH AREA- GARAGE AREA: 0 DETACH 0 ATTACH #DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES BEING ADDED? 0 N ADDITION? ONO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN 0 YES EI DI3Y. TOTAL VALUATION: PLANNING APPL# 0 NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO (J`& 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 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^o tinkling ccoonstration. I . e oriz e resentatives of Cupertino to enter the abeov-e-id nftif/ieed property for inspection purposes. Signature of Applicant/Agent: (.."6/14,44/ Date: 1 t( tr- (/00-- SUPPLEMENTAL INFORMATION RE io UIRED PLAN CHECK TYPE ROUTING SLIP New SFD or Multifamily dwellings: Apply for demolition permit for C( OVER-THE-COUNTER 0 BUILDING PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building ' permit for new building. El EXPRESS 0 PLANNING PLAN REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 0STANDARD 0'PUBLIC WORKS ` form if any Hazardous Materials are being used as part of this project. 0 LARGE- El FIRE DEPT Copy of Planning Approval Letter or Meeting with Planning prior to 0 MAJOR © SANITARY SEWER DISTRICT submittal of Building Permit application. 0 ENVIRONMENTAL HEALTH BldgApp 2011.doc revised 06/21/11 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-3322 10440 CASTINE AVE CUPERTINO, CA 95014-1309 (326 41029) MILLENNIUM ENTERPRISES INC SAN JOSE, CA 95124 OWNER'S NAME: CHUA FAM PARTNERSHIP NO.1 OWNER'S PHONE: 650-326-0887 LICENSED ONTRA TOR' DECLARATION License Class B Lic. #899021 Contractor MILLENNIUM ENTERPRISES INC Date 06/30/2017 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: 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. rz. 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. 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 ill comply with all non -point source regulatiga perth_Q Cupertino icipal Code, Section 9.18. Signature Date 02/02/2017 OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: r. 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 (Sec.7044, Business & Professions Code). hereby affirm under penalty of perjury one of the following three declarations: r. 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. s. 1 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 making 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 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 02/02/2017 DATE ISSUED: 02/02/2017 PHONE NO: (408) 833-6432 BUILDING PERMIT INFO: X BLDG _ ELECT —PLUMB _ MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: BATHROOM REMODELS (107 S.E); KITCHEN REMODEL (108 S.F.); REROOF; TEAR -OFF; INSTALL COMP (20 SQ); REPLACE WINDOW (13); REPLACE SLIDING DOORS (2); REMOVE AND REPLACE ALL SWITCHES AND LIGHTS; REPLACE SHEETROCK IN GARAGE ONLY. Sq. Ft Floor Area: I Valuation: $200000.00 APN Number: Occupancy Type: 326 41029 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Kim Dunbar Date: 02/02/2017 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: 02/02/2017 COVERINGS TO BE CLASS "A" OR 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 the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &Safety Cod y(Sections 25505, 25 , and 25534. .Owner or authorized agent - Date: 02/02/2017 CONSTRUCTION LENDING AGENCY 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 CUPERTINO NEW CONSTRUCTION CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 • build! ng a.cuoertho.orq I I ADDITION r-1 AT.TRRA'n0N/TT 17 RF.VTCTCIAIiT3FFRRRI'n rITaMIMAT DVDWArr4 Bldg,4pp 1Q11.doc ierised O6l2lllI q5w�l APN "C' 4 STATyt P p� ✓Irl �jS4ECYA FAX y1/��6jG%- r ' i `Zbr boo , - N D S• — }'I /STAT,ZIPJL &/ D�I PAX ❑ OWNER OWNER-BLUDER El OWM-AAGENT CONTRACTOR❑CONTRACTOR AGENT ARRCMTECT ❑ ENOINEER ❑ DEVELOPER ❑ TENANT C4NT�.�w LNN L 71C."'Sr& BUS. LIC 9 COMPANY NAME v v 'n l Cn �vl EMAIL ed CrL VSe, YK r/kplj7i`LAIL,C� FAX �to Od_ LS1 STREETADDRESSHONE le -1.93?- C om. f �� CITY ATE,ZP s G! - 9,S-/ i yv Fr zl Z/� BUS. LIC # COMPANY NAME -2 — FAI ST ➢DESS 'f—.—s sk. 4Y STIATE}ZTP�y qq f l� HONE 6,50 r D� ) •[7 -���fT`t_—�,i,(J —{Q Aw 1v I +1[j}}//'',,/F Ct`��mQj U L es W&YL -1z 'f n dud e rM e � � I EXXISTING USE PROPOSED USE CONSTR. TYPE #STORIES USE TYPE OCC. SQ.FT, VALUATION (S) EXISTG AREA NEW FLOOR AREA DMV0 AREA TOTAL NET AREA BATHROOM KITCHEN REMODELAREA jd' REMODEL AREA 4DECK OTHER REMODELAREA PORCH AREA AREA TOTAL DECKIPORCH AREA GARAGE AREA: bLTACH ❑ ATTACFI #DWELLINGUNITS: IS A SECOND UNIT DYES BEINGADDED? [-]NO SECOND STORY DYES AMMON? ❑NO u PRE -APPLICATION 0 YES IF YES, PROVIDE COPY OF PLANNING ADPL# ❑NO PLANND3G APPROVAL LETTER ISTHEBLDGAN D YES E1C➢LLR.HOA1E7 l]NO - __ _ - -"_ .:EDBY:'•: .�-^�-_:�J,:=~�-_v__ TOTALVALUATIOA. r�.'� By my signature below, I certify to each of the following: I am the property owner or authorized agent tt act on Ae property owner's behalf. I have re d this application and the information�11avprovided is correct. I haveread the Description of`�ioik and verify it is accurate. I agree to comply with all applicable local ' ordinances anti state laws relato Idi onstr t, . I a ti or' e epresentatives of Cupertino to Clpter the above -idea Ied property forinspection S. Date: r Signature ofApplicant/Agent: f� SUPPLEMENTAL INFOR4ATION REQUIRED R-- OUT3NG_S_ � H'.&- C- Q:U<;-NT:-E-=K�. --i- New SFD or Multifamily dwellings: d A1pl for P crnt for existing building(s), Demolitionpermitis required prior to issuance ofbuildm --.;jr =r -_:< .�:.._. permit for new building. - ! ,rL�ni<txc Commercial Bldgs. Provide a completed Hazardous Materials Disclosure STt1ADARD PUBLIC tVORICS -- To—= if an , Hazardous Materials are being. used as part of this project. 3 1 p { - ;. _• ,i,FiIiE.DEPT:.:=ri: �-:!t::r= .=�<:::i --�'._ � i Copy ofPlarming Approval Letter or Meeting with Planninog prior to - - - - ❑'' — _ -- -- - -- - submittal of Building Perlit application _ _ -_ _ - - _ - -- -- --I _ _ _ - _t -A - - ITiO-Pv'li_•I_ E ;"- I'-AL E- Bldg,4pp 1Q11.doc ierised O6l2lllI