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B-2016-2741CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 4ANLONG NTRACTOR: PERMIT NO: B-2016-2741 10495 S DE ANZA BLVD CUPERTINO, CA 95014-3011 (359 17 023) CONSTRUCTION INC ROSEMEAD, CA 91770 OWNER'S NAME: BDC ATWATER SHOPS LP ISSUED: 04/06/2017 OWNER'S PHONE: 510-479-5832 I I PHONE NO: (626) 213-4599 LICENSED CONTRACTOR'S DECLARATION License Class a Lic. #1012793 Contractor YUANLONG CONSTRUCTION INC Date 04/30/2018 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: 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. -,92. 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 will comply with all non -point source regulations per the Cupertino %Municipal Code, Section 9.18. Signature i���� Vl/ Date 4/6/2017 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) z. 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. 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 4/6/2017 BUILDING PERMIT INFO: X BLDG —ELECT —PLUMB _ MECH _ RESIDENTIAL X COMMERCIAL JOB DESCRIPTION: TI -POWER POT SUITE C; 1 ST FLOOR (2386 SF); - INSTALL; KITCHEN; DINING AREA; SERVICE AREA; Sq. Ft Floor Area: I Valuation: $180000.00 APN Number: Occupancy Type: 359 17 023 1 A (Tenant Improvements) PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Kim Dunbar Date: 04/06/2017 RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: 4/6/2017 TO BE CLASS "A" HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25`505, 2255553.33, and 25534. Owner or authorized agent:! Date: 4/6/2017 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCIHTFCT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildingC GUDerltno.org CUPERTINO d"'TT ❑ NEty CONSTRUCTION. I]-A.DDITiON - EIALTERATION A _[I -REVISION /DEFERRED ORIGINAL PERMIT #. _.. _.. PROJECT ADDRESS {� f- .F� APN7 . n „-CSL l OWNERNAME JI/Ln 17th. XII✓♦ PHOA'E I��� JG( "'�j flt 3 L "'A" !�� STREET ADDRESS 104%7 7 , �e CdA QTY, STATE, ZIP t" b ew, , CA j�, � 01 +1 FAX CONTACT NAME 6 ni a PHONE (jj Q4 } �L1C$ t / 1 E-T9AIL[�+� rlA�lei �]!l 88, � STREET ADDRESS (..y i �j rt" CZ ti � v y C x q4V CITY, STATE, ZIP Swn v _ (1 •} R 4-0 r eq� I I ❑ OWNER 1DIAN�ER-BMDEER ❑ OW ERAGENT ❑ CONTRACTOR 0 CONTRACTORAGENT N ARCHITECCT11EN�G'INaR. ❑ DEVL•LOPER © TENANT CONTRACTORNA - k f , /"d �Jd17 i LICENSEAUNIBER a iICENSETYPE13 BUS.IdC# 403 1 (24 f ��� """ �" - COMPANY NAME 6 t V �j �o L E RIA1L !/� ah � ? , Z 3 i�1 Fi ,CVA FAX STREET ADDRESS' IS(? k6 Dr, . ���H 9 CITY, STATE, ZIP / ' (��y� F" - v C� PHONE ARCHITECT/ENGINEER NAME ©] �lll LICENSE NLM4BER YJ r 3 7 BUS. LIC'I COMPAArYNAME cc�� ti 1 PA e- E-MAIL f�rj j 6i 7 ,{ u ` iiY1 �J j�t.y1),LA l f? O FAX fjj�j+12-4f- � 2- iy -d7 f i �``1 Bbl `i d7fl _ _— LA4JCITY,STATE,ZIP 1�P/+it t`aG� 1 %� �7NI1Y+�uJ 1rBv�ilr r CA 14o 8 PRUNE } q 8 ! �I l 0 2 X417 DESCRIPTION OF WORT: J__ 1�+ I�nttyr�►.►^e� 1 r arv�e. , `�`` - oL re-s1fnrv4a. e j�Pr EXISTn.G USE PR�OnPO.S,E(D �l3SEC1NSI'R. TYPE 7� `+ L'TOTAL :STORIES USE TYPE OCC. SQ.FT. VALUATION (S) ExaSTG AREA ]j Q v NEW ]FLOOR AREA ® DEMO ARL• A © NET AREA } 4 1/ r_ B ty 2-39-b 16010" BATHROOM REMODELAREAil10 ! KA'CHEN OTHER mwODELAREA4 g1 REMODELAREA PORCHAREA DECK AREA TOTALDECKIPORCHAREA I GARAGEAREA: DETACH ❑ ATTACH % n MMLING ITNITS:IS A sECOAD I1IiIr [J YES BEING ADDED? gj NO SECOND STORY ❑YES ADDITION? ['NO PRE -APPLICATION []YES IF YES, PROVIDECOPY OF PLAI.NINOAPPLO ❑NO .PLANNWGAPPROVALLETTER. IS THE BLDG AN ❑ YES EICHLER ROAM [NO _ D _ _ _ -- =- =_ _ - - _- • "� _'' """`- --=_ - ---- cYn d.• • �_' _ _ _ _ or TOTAL VALUATION: By Illy signature below, I Certify to each of the following: I am the property owner or.authorized aizent to act OD 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 to building cos} on. thon,ze representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: ='`;' Date: 12,916 SUPPLEIvIEN'1'AI_ IPOItMATIO-NyREQUIRED %�;�>::PLA_nCH$CK;T'iPli::�-->=��`=�x's`.->w�r.R0I1'1'I�G`SI,IP"==; - - - �l BLiLBIIi_G.Plitl�T2El7E\1'�`�i ?:�;_- New SFD or Multifamily dwellings: Apply for demol Ito p existing buildnlag(s), Demolition permit is required prior to issuance of b o '" `- ' -�,_ `"`""- _ _ "" '= ms's--: '� :-• -"- - - ermit for new building. osure Commercial BIdg• ]rG�ride a completed Hazardous JA Dlscl o-x-xs-.-...._... ._.-.- ---:-.- _0_ 1 if an Hazardous Materials are being used as partoftlisProl - - Planning Letter or Meeting with Planning riot to Co of Pia Copy � iP - Approval Le o g p _ - _ - - - - d>:5_Aiti'iARX:SE\�yERSiISTR�CT;?�:�i., Q subrnittai of Buiidin� Permit application. kSd_:Sx_i.''."_.jS -x--_jai_:::^�-r.5::=e�F::.�;1%_•'.,:2 _ _-- -_ _ _ _ _ _ _•_�- = _ __'`�'_t=z=`-iM +s `_ _ - -- -_ _ __ -- __..�:--�.. �,�-_,_---_=r=. BldgApp 2011. doe revised 06121111 C-ONSTRUCTION PERMIT APPLICATION =mix COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 •FAX (408) 777-3333 - building@cuperting. CUPERTI-NO or," "fN ITF.Nv rn-K 'T'iirirTfh N. f, M ATIn nXT rF A T �'­­- B1dgApp__:2011.d0c revised 06121111 PROJECT ADDRESS N API OWNERNAME J14nJ"X (SI 0)47 3-2-F-M_A )Le_ �kA � 1 STREET ADDRESS ; Pe-/4W2e',:B) CITY, STATE, rH no pc. CA ISOJ FAX CONTACT'NAAffi &M YAA PHONE (40S) !!/ �,,91111 E-l"LAIL 'gro'c'.0-6) eivhq STREETADDRFSS CITY, STATE, ZIP FAX(40t) Wr J El OWNER ❑ 01AWER-BUJI-DER OWNEP AGEN'r ❑ CONTRACTOR 11 CONTRACTOR AGENT ARCHTFECT El ENGLNEER 13 DEVELOPER ❑ TENANT CONI ACTOR NAhO� LICENSE: NUMBER LICENSE TYPE BUS. LIC 0 COMPANY NAW E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NART JoW %33\MER 2 LICENSE N BUS. LIC 4 COMPANY NAME IPA , Ira- E-MAIL 6 IDA 89, aw% FAx (4,3) 24-r- 0? /'1 STREET ADDRESS Law "Ka &Xpwl' CITY, STATE, ZIP W4n2JeAJL W409r[ PHONE (408) 892 -441 DESCRIPTION OFIVORK i�; ket pot Z� prvje_c� i�g u pnoqe e4 f t dAk 1&r114CC &VecleA TtLk- � and- ri i/14 al'L-A' , ReL�47vrf- "1\,5f`nM &B, LPSE J PROPOSED USE CONsTR_TYPE #STORIES V _EXISTIG I USE TYPE OCC. SQ.FT. VALUATION (S) EXISTO AREA NEWFLOOR AREA DEMO AREA TOTAL NET AREA V -B rY 2-3 9b 9010 BATHROOM REMODELAREA14()AREA KITCHEN L406BL 41 1 OTHER REMODELAREA :. PORCH AREA DECK AREA TOTAL DECKRORCH AREA GARAGE XRR�EA_DE�TACH J:IATTACH t* D"ATUING UNITS: IS A SECOND UNITSEC BEINGAM)PI)? FIT" ND STORY FIYES ADDITION? ONO PRE -APPLICATION' El NTS IF -ITS, PROVIDE COPY OF ISTHE BLDG AN El YES TOTAL VALUATION: PLANNINGAPPL-, E]NO, . PLANNI1,16. LER HONIE? [] NO 2 By my signature below, I certify to i . each of the following: I am the property owner onauthorized agent to act on the property owner's behalf. 1have read this application and the inforination. 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 to building co'o3,,Laythorize representatives of Cupertino to enter the above -identified property for inspection purposes. SgZgjit.,W_nf4&jl@qt/Agerrt . 'A SUPPLEMENTAL;STFOR14ATION REQUIRED r7.91Y V N't. P REV M' New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of uildirig �i Wil pernift for new building. ..... . . . . . E M ON Commercial Bldgs: Provide a completed Hazardous Materials Disclosure im Tor—in if any Hazardous Materials are being used as part of this project E� LARGEH 'AFIRE DEPT Copy of Planning Approval Letter or Meeting with Planning prior to. 5 ks; x'fl rtRDISTRiCTn, submittal. of Building Permit application. B1dgApp__:2011.d0c revised 06121111 Arnold Hom 03/16/17 Arnold Hom 03/16/17 Arnold Hom 03/16/17 Arnold Hom 03/16/17 Arnold Hom 03/16/17 Arnold Hom 03/16/17 Arnold Hom 03/16/17 Arnold Hom 03/16/17 Arnold Hom 03/16/17