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B-2016-3076CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-3076 10033 SAICH WAY CUPERTINO, CA 95014-2124 (326 32 041) DOUGLAS WEIL CONSTRUCTION LLC FRESNO, CA 93711 OWNER'S NAME: JANG ELAINE C TRUSTEE & ET AL e DATE ISSUED: 02/08/2017 OWNER'S PHONE: 559-432-0399 PHONE NO: (559) 438-9392 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class 5 Lic. #445067 Contractor DOUGLAS WEIL CONSTRUCTION LLC Date 02/28/2018 X BLDG —ELECT X PLUMB X MECH RESIDENTIAL X 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: 1 st FLOOR; ADD GAS LINE (20 SF)- REPLACE HOOD & OVEN; ADD I hereby affirm under penalty of perjury one of the following two declarations: 2 FRYERS - BLAST 825 1. I have and will maintain a certificate of consent to self-insure for Worker's compensation, REV #1 - CHANGE HOOD SIZE AND PANEL (ISSUED 3/14/2017) p as provided for by Section 3700 of the Labor Code, for the l� - performance of the work for which this permit is issued. i 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: Valuation: $18000.00 permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances APN Number: Occupancy Type: and state laws relating to building construction, and hereby authorize 326 32 041 A (Tenant Improvements) 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 3/14/2017 Issued by: Abby egg OWNER-BUILDER DECLARATION Date: 02/08/2017 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 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 (Scc.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: 3/14/2017 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 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: __ e APPLICANT CERTIFICATION `. Date: 3/14/2017 CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance correct. I agree to comply with all city and county ordinances and state laws 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 3/14/2017 Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 � � INO I (408) 777-3228 • FAX (408) 777-3333 • buildingAcupertino.org ® NEW CONSTRUCTION FI ADDITION I I ALTF_RATTON / TT ' F, -r RFVTc . IRUT~r) OPT( H.rel 1)PPAATT R PROJECT ADDRESS s �y�y � G � � APN # P OWNERNAME 46 E-MAIL STREET ADDRESS R, ;3 ®r � � CITY, ATE, ZIP ��- ���-terse .. C' FAX CONTACT V ONE - L STREET IP5RgSZIP C CTI�Y CITY ATE, J-tca ®• T J '9 ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT C CTOR�Nt4-r A � [[E ( LICENSEDB (� C�E bro r? LICEN E BUS. LIC# COMPANY NAME E-MAILMMAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHIT t NG11yEERN ®��� LICENSE NUMBER �� BUS. LIC # -r- - COMP NAME E-MAIL STREET ADDRESS CI k -KATE, ZIP HONE DESCRIPTION OF WORK 2� EXISTING USE PROPOSED USE CONSTR. TYPE #STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG NEWFLOOR 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: DETACH CI ATTACH #DWELLING UNITS: ISASECONDUNIT ❑YES SECONDSTORY []YES BEING ADDED? ❑NO ADDITION? ❑NO PRE'APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES REC IVED BY; TOTAL VALUATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO fil By Iny signature below, I certify to each of the following: I am the property owner or authorized agent to ct on t1le 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 relatin building construction. I authoriz resentatives of Cupertino to enter the above -i entified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL lNF0R?vMT10KREQUlRED PLAN CHECK TYPE ROUTING SLIP ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW 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. ❑ EXPRESS ❑ PLANNING PLAN REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FHtE,DEPT Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. El ENVIRONMENTALHEALTH BldgApp_2011.doc revised 06121111 CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRESS: CONTRACTOR: PERMIT NO: B-2016-3076 10033 5AICH WAY CUPERTINO, CA 95014-2124 (326 32 041) DOUGLAS WEIL CONSTRUCTION LLC FRESNO, CA 93711 OWNER'S NAME: JANG ELAINE C TRUSTEE & ET AL I JDATE ISSUED: 02/08/2017 OWNER'S PHONE: 559-432-0399 1 ( PHONE NO: (559) 438-9392 1 License Class 51 Lic. #4450ti7_ Contractor DOUGLAS, WEIL CONSTRUCTION LLC Date 02/2812018 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: i, 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. z, 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 ['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 218/247 a'Z OWI�'FR-$ Tif D R DP` , I hereby affirm that I am exempt from the Contractor's License Law for one of the two reasons: 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) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (See.7044, Business & Professions Code). BUILDING PERMIT INFO: X BLDG —ELECT X PLUMB X MECH _ RESIDENTIAL X COMMERCIAL JOB DESCRIPTION: 1 st FLOOR; ADD GAS LINE (20 SF)- REPLACE HOOD & OVEN; ADD 2 FRYERS - BLAST 825 hereby affirm under penalty of perjury one of the following three declarations, s. 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. 1 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. 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 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 2/8/207 Sq. Ft Floor Area: I Valuation: $18000.00 APN Number: Occupancy Type: 326 32 041 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Abby Aygnde Date: 02/0812017 RF R(FS: 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: 2181207 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSUR 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(x) 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 Code, Sections 25505, 25533, and 25534. Owner or authorized agent: i Date: 2)8/207 I 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 GENERAL PERMIT APPLE' ALTION . MEP COMMUNITY DEVELOPMENT DEPA'-, i MIENT -BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 A04L Lm UPERTINO (408) 77.7-3228 - FAX (408) 777-3333 - buildinq@cupertino.org Cm ISU c[:RPLUMBM IMMECHANICAL EJELFCMICAL [IMISCELLANEOUS PROJECT ADDRESS dfcm tt 3.APIT N � 3 0 PRON E �Eqq FIMAIL DDR STE 2 3.0 7- 0 ,PT 'Z'p agLcaw ST F �2 FAX CT NAM 74� tH�i rq te STR6ETADDR6S C1 ATE, ZIP FAX 0 OWNER 11 OWNER -BUILDER 1�4wlmm AGENT 171 CONTRACTOR Q CONTRACTOR AGENT ❑ ARCHITECT 13 LNGINEER 171 DEVELOPER 13 TENANT CONTRACTOR NAME LICENSENUMBER 4-1 Al rVC, 9 HIM LIC41 COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARRTECTIENOMNAME LLC SR NUMBER. -Bus" LTC a COMPANY NAME' E-MAIL FAX I STREET ADDRESS ZIP PHONE 44 .0 El- DUILDING: ❑COMM11RCIAL URBAN WTERFACE AREA NO FLOOD ZONE El No EICALERHOMW El NO DESCRIPTION OF WORK ey Cei j e.- jij/ -7 k��AC4.1 64,f 4t, -9 j 7— N4TOTAL VALUATION, !!�5; By my signature below, ) cedify to each of the following: I ain 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 tobuilding construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature ofApplicant/Ag.14Date.1 SUP LE TAI., ION REQUIRED F U P A"01 14 kEPA4'!scApp_,201J,doc revised 06121111