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B-2017-0250CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0250 19966 PORTAL PLZ CUPERTINO, CA 95014-3365 (369 45 032) RECON360 LLC SAN JOSE, CA 95118 OWNER'S NAME: HUANG DAVID AND YANG WEN-HUA DATE ISSUED: 02/13/2017 OWNER'S PHONE: 18882775580 X110 PHONE NO: (408) 981-3695 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class 5 Lie. #950805 Contractor REQQN360 LLC Date 12/31/2018 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. 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. z. 1 have and will maintain Worker's Compensation Insurance, as provided for by vSection 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 qupertino Municipal Code, Section 9.18. Date 2/13/2017 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(Sec.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 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 2/13/2017 BLDG —ELECT —PLUMB MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: REPLACE (E) 'TRELLIS Sq. Ft Floor Area: I Valuation: $3000.00 APN Number: Occupancy Type: 369 45 032 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Abby Ayende 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: 2/13/2017 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 Code, Sections 25505, 25533, and 25534. Owner or authorized agent: - Date: 2/13/2017 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 '3-�o[-+ - 02SO CONSTRUCTION PERMIT APPLECAT[ON COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildinaQcupert! no.org ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION /DEFERRED ORIGINAL PERT,4TT PROJECTADDRESS f % s' c /� 3f zctI APN �y ( _� � 03- - — PHONEYIS� � OW11ER111 (/ ,rUl{ M CV,(Ain Kl STREETADDRESS j CITY. STATE; ZIP ` �✓LFAX iSht 'it'l �U1�C. (j—�G4Y� Ll6t/Cl CO C1905-0 CONTACT N.-UIE pfl V: t (V, � PHONE i f - 777- 04, 6 J _ 1 E �y'H" a �� STREET ADDRESS 6 (a �l r �� i ko h LCA n „ CITY, ST.ATE�Zj�IP G� FAX ❑ OwI.ER ❑ OWNER -BUILDER ❑ OHTKERAGE?:T ❑ COON RACTOP NTRSCTORAGENT 0 ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ 1-\,A \T CONTRACTORNAME 90 I LICENSENLNBERg5-(,� 1 I LICENSE TYPE p I _ t `,d BUS. LIC i�3� ?e ` f 23 CO'\�ANY NAMIE • E-1V4AiL FAX STREET ADDRESS / �� y g CITY, STATE, ZIP " PHO\TE y � Toic- C l 7 ARCHITECT/ENGLNEER N.A:ME LICENSE NUMBER _ BUS, LIC - COMPARTY NAME I E-I.ZAIL FAX STRELT.ADDRESS CITY, STATE, ZIP I PHONE D£$CRIPTIONOFA=O.j`\o NISh� 6-i�C} T�,�i\�rS t EXISTLNG USE PROPOSED USE CONSTR TYPE _ STORIES USE TYPE OCC. SQ.FT. � V'ALUA"1"ION (S) E.XISTG NEPl FLOOR DaIO TOTAL — AREA AREA AREA NIDT AREA i BATHROOM KITCHEN OTHER REMODEL AREA REMODELAREA RBIODEL'AREA PORCH.SREA DECK AREA TOTAL DECKPORCH AREA GARAGE AREA: []DETACH ❑ ATTACH DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ TES BEINGADDED? El NO ADDITION? 7 N If PRE-APPLICATIOk ❑YES IFYES: PROVIDE COPY OF IS THEBLDG.A:N ❑Y'ES „PEC ^ \ALUATION: PLAN1\a,GAFPL-- ❑NO PLa'.'\ZNGAPPROVALLETTER I i EICHLERHOME? El .,,B Y �fi er,v following: I s the property owner or autho ,zed as nt to act on the property owner's behalf. I have read this By my signature below, I certify to each of the followa application and the information I have provided is correct. I have read the Description of IXork and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to build' s co ction. I authorize representatives ofCapertino to enter the above -identified property for inspection proposes. SignatureofApplicant/Agent: •e Datg 1i �� - SUPPLE?\ZENTAL INFORMATIO �t REQLIRED ::..-a.:.:::,p•`=;i>:;r:_:;;;--€;1=::;;::;::•i:;:.:.is:i.`.:=,;:::::x:_c.-:cc;::r.:_.;r:cC:`:;:c:.-::...:__:: PL S CFIECIi TrPE .: ,.:,-. iLOITl'ING SLIP "" o� ER=TPiE-coL .TI R Bt IiDLnc Pi\ RE\TEn, New SFD or 1l7ultifamily dwellings: Apply for demolition permit for existing building(s).. Demolition permit is required prior to issuance of building 3 permit 'for new building. ............::. PL'_k2i\IN, GPL�NRE1'IE�1z;:,`-i= Commercial Bldgs: Provide a completed Hazardous Materials Disclosure �l -ST'DA -. I� PI�z.Ic ti� oRl.s _ form ifanv Hazardous 1\iaterials are beim used as part of this project. LARGE { FIRE DEPT Cop} of Planning Approval Letter or hleetmwith Planning prior toW.Nr '��lhl�:i©R:;•:;_;�? i>'iis_i �I xx. z �i5�?iIZARYSE�i'ERDISTRLCT:r;:;:':4 submittal ofBuilding Permit application. t - .. ' '❑F E;\" h RO. IRtNTkLHEALTFI Bldglpp_2011.doc reWsed 06/21/11 4).